Gianluca Costa1, Laura Lorenzon2, Giulia Massa1, Barbara Frezza1, Mario Ferri1, Pietro Fransvea1, Paolo Mercantini1, Maria Cristina Giustiniani3,4, Genoveffa Balducci1. 1. Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy. 2. Surgical and Medical Department of Translational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy. laura.lorenzon@uniroma1.it. 3. Department of Clinical and Molecular Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy. 4. Department of Pathology, Università Cattolica del Sacro Cuore-Fondazione Agostino Gemelli, Rome, Italy.
Abstract
PURPOSE: About 30% of colorectal cancers (CRCs) present with acute symptoms. The adequacy of oncologic resections is a matter of concern since few authors reported that emergency surgery in these patients results in a lower lymph node harvest (LNH). In addition, emergency resections have been reported with a longer hospital stay and higher morbidity rate. We thus conducted a propensity score-matched analysis with the aim of investigating LNH in emergency specimens comparing with elective ones. Secondary aim was the comparison of morbidity and hospital stay. METHODS: Eighty-seven consecutive R0 emergency surgical procedures were matched with elective CRCs using the propensity score method and the following covariates: age, sex, stage, and localization. Groups were compared using univariate and multivariate analyses. Outcome measures were LNH, nodal ratio, Clavien's morbidity grades, and hospital stay. RESULTS: Emergency patients presented more metastatic nodes compared with elective ones (p 0.017); however, both presented a comparable mean LNH. Multivariate analysis documented that a T stage ≥3 was the only variable correlated with a nodal positivity (OR 6.3). On univariate analysis, emergency CRCs had a longer mean hospital stay compared with elective resections (p 0.006) and a higher rate of Clavien ≥4 events (p 0.0173). Finally, emergency resection and an age >66 years were variables independently correlated with a mean hospital stay >10 days (OR, respectively, 3.7 and 3.5). CONCLUSIONS: Emergency CRC resections were equivalent to the elective procedures with respect to LNH. However, emergency surgery correlated with a longer mean hospital stay. Graphical abstract Emergency and Elective resections for CRC provide similar LNH.
PURPOSE: About 30% of colorectal cancers (CRCs) present with acute symptoms. The adequacy of oncologic resections is a matter of concern since few authors reported that emergency surgery in these patients results in a lower lymph node harvest (LNH). In addition, emergency resections have been reported with a longer hospital stay and higher morbidity rate. We thus conducted a propensity score-matched analysis with the aim of investigating LNH in emergency specimens comparing with elective ones. Secondary aim was the comparison of morbidity and hospital stay. METHODS: Eighty-seven consecutive R0 emergency surgical procedures were matched with elective CRCs using the propensity score method and the following covariates: age, sex, stage, and localization. Groups were compared using univariate and multivariate analyses. Outcome measures were LNH, nodal ratio, Clavien's morbidity grades, and hospital stay. RESULTS: Emergency patients presented more metastatic nodes compared with elective ones (p 0.017); however, both presented a comparable mean LNH. Multivariate analysis documented that a T stage ≥3 was the only variable correlated with a nodal positivity (OR 6.3). On univariate analysis, emergency CRCs had a longer mean hospital stay compared with elective resections (p 0.006) and a higher rate of Clavien ≥4 events (p 0.0173). Finally, emergency resection and an age >66 years were variables independently correlated with a mean hospital stay >10 days (OR, respectively, 3.7 and 3.5). CONCLUSIONS: Emergency CRC resections were equivalent to the elective procedures with respect to LNH. However, emergency surgery correlated with a longer mean hospital stay. Graphical abstract Emergency and Elective resections for CRC provide similar LNH.
Authors: Zhaomin Xu; Adan Z Becerra; Christopher T Aquina; Bradley J Hensley; Carla F Justiniano; Courtney Boodry; Alex A Swanger; Reza Arsalanizadeh; Katia Noyes; John R Monson; Fergal J Fleming Journal: J Gastrointest Surg Date: 2017-01-12 Impact factor: 3.452
Authors: Mario Ferri; Laura Lorenzon; Mariadele Rapazzotti Onelli; Marco La Torre; Paolo Mercantini; Edoardo Virgilio; Genoveffa Balducci; Luigi Ruco; Vincenzo Ziparo; Emanuela Pilozzi Journal: Int J Surg Date: 2013-06-06 Impact factor: 6.071
Authors: Gianluca Costa; Francesco Stella; Luigi Venturini; Simone Maria Tierno; Federico Tomassini; Pietro Fransvea; Barbara Frezza; Tommaso Bocchetti; Salvatore Di Somma; Genoveffa Balducci Journal: Ann Ital Chir Date: 2013 Jan-Feb Impact factor: 0.766
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Authors: Gianluca Costa; Barbara Frezza; Pietro Fransvea; Giulia Massa; Mario Ferri; Paolo Mercantini; Genoveffa Balducci; Antonio Buondonno; Aldo Rocca; Graziano Ceccarelli Journal: Open Med (Wars) Date: 2019-10-02