Emergency treatment of complicated colorectal cancer

Abstract

AimTo find evidence to suggest the best approach in patients admitted as an emergency for complicated colorectal cancer.MethodsThe medical records of 131 patients admitted as an emergency with an obstructing, perforated, or bleeding colorectal cancer to Noble’s Hospital, Isle of Man, and the Umberto I University Hospital, Rome, were retrospectively evaluated. Patients were divided in 3 groups on the basis of the emergency treatment they received, namely 1) immediate resection, 2) damage control procedure and elective or semielective resection, and 3) no radical treatment. Demographic variables, clinical data, and treatment data were considered, and formed the basis for the comparison of groups. Primary endpoints were 90-day mortality and morbidity. Secondary endpoints were length of stay, number of lymph nodes analyzed, rate of radical R0 resections, and the number of patients who had chemoradiotherapy.ResultsForty-two patients did not have any radical treatment because the cancer was too advanced or they were too ill to tolerate an operation, 78 patients had immediate resection and 11 had damage control followed by elective resection. There was no statistically significant difference between immediate resections and 2-stage treatment in 90-day mortality and morbidity (mortality: 15.4% vs 0%; morbidity: 26.9% vs 27.3%), number of nodes retrieved (16.6±9.4 vs 14.9±5.7), and rate of R0 resections (84.6% vs 90.9%), but mortality was slightly higher in patients who underwent immediate resection. The patients who underwent staged treatment had a higher possibility of receiving a laparoscopic resection (11.5% vs 36.4%).ConclusionThe present study failed to demonstrate a clear superiority of one treatment with respect to the other, even if there is an interesting trend favoring staged resection.

Analysis of Prognostic Factors in Complicated Colorectal Cancer Operated in Emergency

“…Similar to our data, the practice of serial interventions has been shown to be a protective factor in other studies (15,(45)(46)(47). In contrast, other authors concluded that resections with anastomosis ensure better survival, including for occlusive tumors (48).…”

Postoperative Complications Predict Long-term Outcome After Curative Resection for Perforated Colorectal Cancer

“…Perforated CRC patients face the life-threatening conditions of both malignant disease and sepsis (1). These patients often require emergent surgery (1), with perioperative mortality ranging between 11%-21% (13)(14)(15)(16)(17)(18). Furthermore, even after perforated CRC patients recover from peritonitis and the perioperative phase, colorectal perforation is reported to be a risk factor for poor prognosis (2-5) and high recurrence (3,6).…”

Is Low Inferior Mesenteric Artery Ligation Worthwhile to Prevent Urinary and Sexual Dysfunction After Total Mesorectal Excision for Rectal Cancer?

“…In our study, we aimed to investigate the role of high and low IMA ligation and no other confounding factors (i.e. radiation therapy, neoadjuvant chemotherapy and open surgery, benign lesions, emergency setting) (9,(31)(32)(33)(34)(35) in the impairment of the defecatory, sexual and urinary function after TME. The ligation of the IMA at its origin may accidentally damage the superior hypogastric plexus, which is interconnected with the inferior hypogastric plexus.…”