Joël L Lavanchy1, Lukas Vaisnora1, Tobias Haltmeier1, Inti Zlobec2, Lukas E Brügger1, Daniel Candinas1, Beat Schnüriger3. 1. Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. 2. Institute of Pathology, University of Bern, Bern, Switzerland. 3. Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland. beat.schnueriger@insel.ch.
Abstract
PURPOSE: Long-term outcomes in patients undergoing emergency versus elective resection for colorectal cancer (CRC) are discussed controversially. This study aims to assess long-term outcomes of emergency versus elective CRC surgery. METHODS: Single-center retrospective cohort study. Patients undergoing emergency or elective CRC surgery from July 2002 to January 2013 were included. Primary outcome was 5-year survival, secondary outcomes were in-hospital mortality and local tumor recurrence. RESULTS: Overall, 475 patients were included. Median age was 69.0 (IQR 59.0-77.0) years. A total of 141 patients (30%) were operated for rectal cancer and 334 patients (70%) for colon cancer. Median follow-up was 445 (IQR 67-1409) days. Emergency resection was performed in 105 patients (22%) due to obstruction, perforation, or bleeding. Stage IV tumors and ASA scores≥ 3 were significantly more frequent in the emergency than in the elective resection group (39.0% vs. 33.5%, p < 0.001; 75.5% vs. 61.3%, p = 0.003). The rate of patients with positive lymph nodes was similar in the two groups (46.2% vs. 46.3%, p = 1.000). In-hospital mortality was significantly higher in the emergency CRC versus the elective CRC group (8.4% vs. 3.0%, p = 0.023). Five-year survival (aHR 1.38; 95%CI 0.81-2.37, p = 0.237) or local tumor recurrence (aHR 1.48; 95%CI 0.47-4.66, p = 0.500) were not significantly different in patients undergoing emergency versus elective surgery for CRC. CONCLUSION: In-hospital mortality was increased in emergency versus elective CRC resections. However, 5-year survival and local recurrence after surgery for CRC were determined by the tumor stage, and not by the emergency versus elective setting of surgical resection.
PURPOSE: Long-term outcomes in patients undergoing emergency versus elective resection for colorectal cancer (CRC) are discussed controversially. This study aims to assess long-term outcomes of emergency versus elective CRC surgery. METHODS: Single-center retrospective cohort study. Patients undergoing emergency or elective CRC surgery from July 2002 to January 2013 were included. Primary outcome was 5-year survival, secondary outcomes were in-hospital mortality and local tumor recurrence. RESULTS: Overall, 475 patients were included. Median age was 69.0 (IQR 59.0-77.0) years. A total of 141 patients (30%) were operated for rectal cancer and 334 patients (70%) for colon cancer. Median follow-up was 445 (IQR 67-1409) days. Emergency resection was performed in 105 patients (22%) due to obstruction, perforation, or bleeding. Stage IV tumors and ASA scores≥ 3 were significantly more frequent in the emergency than in the elective resection group (39.0% vs. 33.5%, p < 0.001; 75.5% vs. 61.3%, p = 0.003). The rate of patients with positive lymph nodes was similar in the two groups (46.2% vs. 46.3%, p = 1.000). In-hospital mortality was significantly higher in the emergency CRC versus the elective CRC group (8.4% vs. 3.0%, p = 0.023). Five-year survival (aHR 1.38; 95%CI 0.81-2.37, p = 0.237) or local tumor recurrence (aHR 1.48; 95%CI 0.47-4.66, p = 0.500) were not significantly different in patients undergoing emergency versus elective surgery for CRC. CONCLUSION: In-hospital mortality was increased in emergency versus elective CRC resections. However, 5-year survival and local recurrence after surgery for CRC were determined by the tumor stage, and not by the emergency versus elective setting of surgical resection.
Entities:
Keywords:
Colorectal cancer; Elective colorectal cancer resection; Emergency colorectal cancer resection; Five-year survival; Recurrence-free survival
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: Erik von Elm; Douglas G Altman; Matthias Egger; Stuart J Pocock; Peter C Gøtzsche; Jan P Vandenbroucke Journal: Lancet Date: 2007-10-20 Impact factor: 79.321
Authors: Anton Bilchik; Aviram Nissan; Zev Wainberg; Perry Shen; Martin McCarter; Mladjan Protic; Robin Howard; David Elashoff; Josh Tyler; George E Peoples; Alexander Stojadinovic Journal: Ann Surg Date: 2010-09 Impact factor: 12.969
Authors: Simona Ascanelli; Giuseppe Navarra; Giulia Tonini; Carlo Feo; Antonio Zerbinati; Enzo Pozza; Paolo Carcoforo Journal: Tumori Date: 2003 Jan-Feb
Authors: Benjamin Weixler; Rene Warschkow; Michaela Ramser; Raoul Droeser; Urs von Holzen; Daniel Oertli; Christoph Kettelhack Journal: BMC Cancer Date: 2016-03-11 Impact factor: 4.430
Authors: Adrian Diaz; Elizabeth Barmash; Rosevine Azap; Anghela Z Paredes; J Madison Hyer; Timothy M Pawlik Journal: J Gastrointest Surg Date: 2020-08-10 Impact factor: 3.452
Authors: Michael Shinkwin; Louise Silva; Irene Vogel; Nicola Reeves; Julie Cornish; James Horwood; Michael M Davies; Jared Torkington; James Ansell Journal: Colorectal Dis Date: 2021-04-24 Impact factor: 3.917
Authors: Jian Lv; Yuan Yuan Liu; Yi Tao Jia; Jing Li He; Guang Yao Dai; Peng Guo; Zhao Long Zhao; Yan Ni Zhang; Zhong Xin Li Journal: World J Surg Oncol Date: 2021-12-02 Impact factor: 2.754
Authors: Sami Akbulut; Abdirahman Sakulen Hargura; Ibrahim Umar Garzali; Ali Aloun; Cemil Colak Journal: World J Clin Cases Date: 2022-09-16 Impact factor: 1.534