Emergency resection is an independent risk factor for decreased long-term overall survival in colorectal cancer: a matched-pair analysis

Abstract

Background Colorectal cancer is one of the most common malignant neoplasms worldwide. Up to 30% of the patients present in an emergency setting despite an established screening program. Emergency colorectal resection is associated with increased mortality and morbidity as well as worse oncological outcome. This study aims to analyze the impact on tumor recurrence and survival in patients with an emergency colorectal resection, independent of sex, age, and tumor stage. Methods Patients, who underwent an oncological resection for colorectal cancer at the Medical University of Innsbruck, Department of Visceral, Transplant and Thoracic Surgery, between January 2003 and December 2018 were analyzed retrospectively and screened for emergency resections. Matched pairs were formed to analyze the impact of emergency operations on long-term outcomes, considering tumor stage, sex, and age, comparing it with elective patients. Results In total, 4.5% out of 1297 patients underwent surgery in an emergency setting. These patients had higher UICC (Union internationale contre le cancer) stages than elective patients. After matching the patients for age, sex, and tumor stage, emergency patients still had higher mortality. The incidence of recurrence was higher (47.5% vs. 25.4%, p = 0.003) and the 5-year overall survival decreased (35.6% vs. 64.4%, p < 0.001) compared to the matched patients with elective resection. Correcting for 90-day mortality still a reduction in the 5-year overall survival was demonstrated (44% vs. 70%, p = 0,001). The left-sided colon tumors were more common in the emergency group (45.8% vs. 25.4%, p = 0.006) and the rectal tumors in the elective one (21.2% vs. 3.4%, p = 0.002). Conclusion Patients undergoing emergency resection for colorectal cancer have a decreased tumor-specific and overall survival compared to patients after elective resection, independent of age, sex, and tumor stage, even after correcting for 90-day mortality. These findings confirm the importance of colorectal cancer awareness and screening to reduce emergency resections.

LapEmerge trial: study protocol for a laparoscopic approach for emergency colon resection—a multicenter, open label, randomized controlled trial

“…The LapEmerge trial has a unique setting of evaluating the oncological outcome of these patients, also taking into account the quality of the surgical specimen. Since emergency colon resections for oncologic patients are inevitable and the oncologic outcome is clearly inferior to elective surgery [ 44 ], this aspect of the trial is of the utmost importance. Overall, both of these trials, which are complementary, will provide novel information on both the short- and long-term effects and safety of laparoscopy in emergency colorectal surgery.…”

Management of obstructed colorectal carcinoma in an emergency setting: An update

“…A recent study conducted in Austria including 59 patients (4.5%) who underwent emergency colectomy for colorectal carcinoma among 1297 patients treated with elective colectomy for colorectal carcinoma found that emergency resection reduced 5-year overall survival (35.6% vs 64.4%) and disease-free survival (54.2% vs 75.4%) and increased 1-year recurrence (47.5% vs 25.4%) rates. The 5-year overall survival rate for elective cases was higher in laparoscopic than open colectomy (71.4% vs 62.2%)[ 4 ]. Right-sided obstruction, despite more primary resections and anastomoses, is related to a worse prognosis than left-sided obstruction[ 45 ].…”

“…It is the third most common carcinoma, after lung, and breast or prostate carcinoma and the second leading cause of cancer-related deaths, after lung carcinoma, in the United States and Western Europe, causing more than 50000 deaths annually in the United States[ 1 - 3 ]. Early detection and proper management improves survival and avoids complications (mainly obstruction, perforation, bleeding, and fistula)[ 4 - 8 ].…”