J K Jiang1, Y T Lan, T C Lin, W S Chen, S H Yang, H S Wang, S C Chang, J K Lin. 1. Division of Colon and Rectal Surgery, Department of Surgery, Taipei Veterans General Hospital, and National Yang-Ming University, School of Medicine, No. 201, Sec. 2, Shih-Pai Rd., Taipei, Taiwan, 11217. jkjiang@vghtpe.gov.tw
Abstract
PURPOSE: By comparing surgical outcomes between primary and delayed resection, we addressed whether and how surgical strategies impacted prognosis of patients with left-sided colorectal cancer underwent emergency curative resection. METHODS: Between January 1980 and December 2002, a total of 143 patients were identified who presented with obstructive left-sided colorectal cancer and received emergency curative resection in Taipei Veterans General Hospital. Patients were stratified according to the timing of tumor resection into two groups: primary resection and delayed resection. Demographic data of the patients, characteristics of the tumors, and short-term and long-term outcomes were analyzed and compared between the two groups. RESULTS: The demographic data and tumor characteristics did not differ between the two groups except for more rectal cancers in the delayed resection group (P=0.021). Primary resection group had a higher anastomotic leakage rate (P=0.017) and a trend toward a higher mortality rate, which did not reach statistical significance (P=0.063). The median follow-up intervals were similar (60.4 vs. 58.3 months; P=0.79). The median survival tended to be longer in delayed resection group (66 vs. 105 months; P=0.088). Overall five-year and ten-year survival for primary resection were 43.7 and 31.9 percent, respectively, compared with 67.2 and 53.2 percent, respectively, for delayed resection. CONCLUSIONS: Delayed resection seems to be a safer procedure and provided a better oncologic outcome compared with primary resection in obstructive left-sided colorectal cancer under emergency situations.
PURPOSE: By comparing surgical outcomes between primary and delayed resection, we addressed whether and how surgical strategies impacted prognosis of patients with left-sided colorectal cancer underwent emergency curative resection. METHODS: Between January 1980 and December 2002, a total of 143 patients were identified who presented with obstructive left-sided colorectal cancer and received emergency curative resection in Taipei Veterans General Hospital. Patients were stratified according to the timing of tumor resection into two groups: primary resection and delayed resection. Demographic data of the patients, characteristics of the tumors, and short-term and long-term outcomes were analyzed and compared between the two groups. RESULTS: The demographic data and tumor characteristics did not differ between the two groups except for more rectal cancers in the delayed resection group (P=0.021). Primary resection group had a higher anastomotic leakage rate (P=0.017) and a trend toward a higher mortality rate, which did not reach statistical significance (P=0.063). The median follow-up intervals were similar (60.4 vs. 58.3 months; P=0.79). The median survival tended to be longer in delayed resection group (66 vs. 105 months; P=0.088). Overall five-year and ten-year survival for primary resection were 43.7 and 31.9 percent, respectively, compared with 67.2 and 53.2 percent, respectively, for delayed resection. CONCLUSIONS: Delayed resection seems to be a safer procedure and provided a better oncologic outcome compared with primary resection in obstructive left-sided colorectal cancer under emergency situations.
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