Changes in the Surgical Approach to Colonic Emergencies during a 15-Year Period

Abstract

Purpose: The present study aims to determine the morbidity and mortality of emergency colonic surgery and the factors associated with adverse outcome, and to evaluate any change in incidence of the different types of pathological conditions and in the surgical approach over the last 15 years. Materials and Methods: A total of 319 patients who underwent emergency colonic surgery between January 1997 and December 2011 were retrospectively analyzed. Patients were divided into two groups according to the date of surgery, namely group 1, between 1997 and 2006, and group 2, between 2006 and 2011. The differences in terms of postoperative outcomes between the groups were analyzed. Results: Overall postoperative morbidity and mortality rates were 25.3 and 17.2%, respectively; no differences were found between the groups. Group 2 showed a significantly increased rate of primary resection and anastomosis (p < 0.001), as well as an increase in laparoscopic approach compared with group 1 (p < 0.001). Conclusions: Emergency colon surgery is today primarily performed for benign diseases, of these the most common is diverticular disease followed by ischemic colitis. Age, comorbidities, and ischemic colon disease are predictors of adverse outcomes, while the surgical procedure per se is not.

Total Colectomy with Subtotal Proctocolectomy of High Risk Colorectal Cancer Patients

“…Another study shows a higher incidence of new colonic cancer development after segmental colectomy to be as high as 72% at 40 years. Another study shows that patients having Amsterdam criteria have the chance of developing adenomas as high as 32% after segmental colonic resection [32] while in total abdominal colectomy with ilio-rectal anastomosis, whole or most the risky mucosa will be removed which by prevent the development of precancerous polyps but the remaining rectum should be screened annually as a clinic arrangement and rectal evacuation by an enema which decrease the incidence of metachronous rectal cancer during ongoing life as the risks shown in some studies to be between 3-12% at 10 -12 years follow-up [4,29,34]. Quality of Life and Functional Outcomes are matters of consideration in patients with total abdominal colectomy with illeorectal anastomosis (TAC-IRA) as an alternative of a segmental colonic resection for cancer of colon in patients with Lynch syndrome.…”

“…On the other hand, the frequency of paralytic ileus postoperatively was greater in patients operated with more total resections [29]. Philosophy of the surgical approach, total abdominal colectomy with illeorectal anastomosis (TAC-IRA) must be considered in medically well patients with Lynch syndrome who is high risk to develop colorectal cancer [34]. This suggestion is depending on retrospective data and statistical analysis demonstrating the raised threat of metachronous colorectal cancer in these patients.…”

“…This divergence is mostly due to the deficit of a preoperative identification of Lynch syndrome or hereditary non-polyposis colorectal cancer (HNPCC). Regardless of the relative predominance of proximal colonic lesions in Lynch syndrome, cancer of the rectum is frequent; around 20 to 30 % of patients with Lynch syndrome will develop rectal cancer, including 15 to 24 % with rectal cancer as their index cancer [34,36,37,38]. Rectal cancer associated with a higher risk with family history of rectal cancer of a first-degree relative [34].…”

“…Regardless of the relative predominance of proximal colonic lesions in Lynch syndrome, cancer of the rectum is frequent; around 20 to 30 % of patients with Lynch syndrome will develop rectal cancer, including 15 to 24 % with rectal cancer as their index cancer [34,36,37,38]. Rectal cancer associated with a higher risk with family history of rectal cancer of a first-degree relative [34]. The management of rectal cancer in Lynch syndrome is controversial; surgical procedures may be in the form of anterior resection of the rectum or low anterior resection or abdominoperineal proctosigmoidectomy, the choice of the procedure depends on whether the anal sphincter involved by the cancer or not or a more radical surgical resection, removing all of the colonic mucosa at risk in the form of a total proctocolectomy with terminal ileostomy or restorative ileal pouch-anal anastomosis.…”

Frailty and emergency surgery in the elderly: Protocol of a prospective, multicenter study in Italy for evaluating perioperative outcome (The FRAILESEL Study)

“…The study is also registered at ClinicalTrials.gov (ClinicalTrials.gov Identifier: NCT02825082). With this aging population, the number of elderly patients requiring emergency surgical intervention has risen dramatically [3][4][5][6][7][8] . Moreover, there is usually less time to make decisions during emergency interventions, and less information about the patient's condition is available.…”