Colon cancer surgery in patients operated on an emergency basis

Abstract

Objective: to study the epidemiological profile of patients with colorectal cancer operated on an emergency basis at the Bonsucesso Federal Hospital. Methods: this is a retrospective study of patients operated between January 1999 and December 2012. We analyzed the following variables: age, gender, clinical data, TMN staging, tumor location, survival and types of surgery. Results: we evaluated 130 patients in the study period. The most frequent clinical picture was intestinal obstruction, in 78% of cases. Intestinal perforation was the surgical indication in 15%. The majority (39%) of the patients had advanced TNM staging, compared with 27% in the initial stage. There were 39 deaths (30%) documented in the period. The most common tumor site was the sigmoid colon (51%), followed by the ascending colon (16%). The curative intent was performed in most cases, with adjuvant treatment being performed in 40% of the patients. Distant metastases were found in 42% of the patients and 10% had documented disease recurrence. Disease-free survival at two and five years was 69% and 41%, respectively. Conclusion: there was a high mortality rate and a low survival rate in colorectal cancer patients operated on urgently.

Adult and Elderly Risk Factors of Mortality in 23,614 Emergently Admitted Patients with Rectal or Rectosigmoid Junction Malignancy

“…Antony et al have concluded after risk adjustment that urgent surgery in colon cancer has no impact on survival [ 52 ]. On the other hand, Ramos et al claimed that there was a high mortality rate and a low survival rate in colorectal cancer patients operated on urgently [ 53 ]. Smothers et al claimed that emergency surgery has a strong negative influence on immediate surgical morbidity and mortality; however, other coexistent factors, such as advanced disease, the age of the patient, and medical comorbid conditions, may also influence these outcomes [ 54 ].…”

Comparison of Oncologic Outcomes Between Incomplete Obstructive Colon Cancer and Non-Obstructive Colon Cancer by Tumor Location

“…Instant management is needed for acute complete OCC (COCC). Recommended treatments are different according to tumor location ( 1 , 2 , 4 – 6 , 18 , 19 ). According to 2017 WSES guidelines on colon cancer obstruction, for right COCC, right colectomy with primary anastomosis is a preferred treatment option ( 18 ).…”

“…However, the strength of this study was that it only included non-emergent obstructive colon cancer cases. Thus, morbidities in an emergent situation would not affect survival ( 4 – 6 ).…”

“…Patients with acute complete obstructive colon cancer (OCC) need emergent colectomy with or without anastomosis, colonic stent insertion, or primary stoma formation. Surgery under this emergent condition is associated with increased morbidity and mortality, affecting survival outcomes ( 4 – 6 ). Moreover, complete obstruction by colorectal cancer is associated with worse survival ( 3 , 7 – 9 ).…”

Nomogram for Prediction of Postoperative Morbidity in Patients with Colon Cancer Requiring Emergency Therapy

“…The Hartmann procedure was initially indicated for complicated tumors of the descending colon [ 12 ] but then was questioned because of its association with an increased risk of postoperative morbidity [ 13 ]. However, for other authors, the Hartman procedure remains an applicable option for the majority of patients with emergency surgery for left colon cancer [ 14 ].…”