Emergency Presenting Colon Cancer Is an Independent Predictor of Adverse Disease-Free Survival

Abstract

Twenty percent of colon cancers present as an emergency. However, the association between emergency presentation and disease-free survival (DFS) remains uncertain. Consecutive patients who underwent elective (CC) and emergent (eCC) resection for colon cancer were included in the analysis. Survival outcomes were compared between the 2 groups in univariate/multivariate analyses. A total of 439 patients underwent colonic resection for colon cancer during the interval 2000-2010; 97 (22.1%) presented as an emergency. eCC tumors were more often located at the splenic flexure (P = 0.017) and descending colon (P = 0.004). The eCC group displayed features of more advanced disease with a higher proportion of T4 (P = 0.009), N2 tumors (P < 0.01) and lymphovascular invasion (P< 0.01). eCC was associated with adverse locoregional recurrence (P = 0.02) and adverse DFS (P < 0.01 ) on univariate analysis. eCC remained an independent predictor of adverse locoregional recurrence (HR 1.86, 95% CI 1.50-3.30, P = 0.03) and DFS (HR 1.30, 95% CI 0.88-1.92, P = 0.05) on multivariate analysis. eCC was not associated with adverse overall survival and systemic recurrence. eCC is an independent predictor of adverse locoregional recurrence and DFS.

Surgical Risk and Pathological Results of Emergency Resection in the Treatment of Acutely Obstructing Colorectal Cancers: A Retrospective Cohort Study

“…Unfortunately, this study lacks long-term follow-up, so there are no data regarding survival. However, the number of harvested lymph nodes and status of the surgical margins are considered good surrogate indicators of oncologic outcome, and on the basis of our series, we can therefore confirm the findings of the literature [6,8,21] that immediate resection itself should not affect long-term survival.…”

Causes and outcomes of emergency presentation of rectal cancer

“…It is not possible to estimate directly from our data, how many emergency admissions would be “preventable” but as under 6% of private patients in the most affluent areas had emergency admission compared to 20% of public patients in the most deprived areas, a significant number of emergency admissions seems avoidable. The factors contributing to emergency admission in this study are similar to those associated with diagnostic and treatment delay . Almost all emergency admissions are likely to have been preceded by symptoms, although in a minority of cases the disease may have been occult prior to presentation .…”

“…We succeeded in estimating and testing a number of indirect effects and showed that emergency admission mediates a significant part of the influence of deprivation, private health insurance and marital status on survival. Emergency presentations pose complex clinical challenges, and are associated with advanced stage and co‐morbidity and a high rate of post‐operative complications . Some of the adverse impact of emergency admission may be mitigated by admission to a specialist centre which can deal with these complexities, and there may be a case for transfer to a specialist centre for definitive surgery.…”

“…The factors contributing to emergency admission in this study are similar to those associated with diagnostic and treatment delay. 1,15,[18][19][20] Almost all emergency admissions are likely to have been preceded by symptoms, although in a minority of cases the disease may have been occult prior to presentation. 21 Any delay, whether due to patient or health system factors, [22][23][24][25][26] will make progression and emergency admission more likely.…”

The results of emergent curative surgery for the colorectal cancer; a single center experience of 52 patients

“…Emergency CRC surgery is a clinical challenges (18,19) that associated with advanced stage and high morbidity and mortality (20,21,22) and a high postoperative complications rate (10,23). Our study revealed that emergency CRC surgery is more worse outcomes than elective CRC surgery group in all stages.…”