The results of emergent curative surgery for the colorectal cancer; a single center experience of 52 patients

Aim: Even though, protective methods and early diagnostic modalities are used in current practice, almost 6 to 30% of colorectal cancer patients admit to hospital for emergency operation with late complications.The aim of this study is to interpreting data of the early postoperative oncologic outcomes of the emergent curative CRC surgeries.Material and Methods: Between January 2012 and January 2017, 173 patients were operated curatively for colorectal cancer atMehmet Akif İnan Training and Research Hospital of Health Sciences University. Of these, 52 patients were treated with emergent curative colorectal surgery. Demographics, laboratory, and clinical data, diagnostic studies, surgical procedures, operative findings,histopathologic results, postoperative complications, and patient follow-up were retrospectively analyzed.Results: The mean age (59.6 ± 10.9 vs. 57.7 ± 11.5, P = 0.98) and gender (71.15 vs. 76.03% male, P = 0.18) were close in emergent and elective colorectal cancer surgery groups. Early postoperative mortality was seen in 6 (11.5%) of those patients. The mean postoperative hospital stay in emergent surgery group was significantly longer than in elective surgery group. The 2-years overall survival rate of emergent and elective group were estimated 33 versus 77%, respectively.Conclusion: Our findings reveal that emergency CRC surgery predicts more advanced disease and longer operation time. Also in the emergent group have a higher complication rates, longer hospital stay, increased early postoperative morbidity, and lower long term survival in even all same stages.

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Baer C, Menon R, Bastawrous S, Bastawrous A. Emergency presentations of colorectal cancer Surg Clin North Am 2017;97(3):529-45.
Biondo S, Martí-Ragué J, Kreisler E, Parés D, Martín A, Navarro M, et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg 2005;189(4):377-83.
Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis 2003;5(3):262-9.
Skala K, Gervaz P, Buchs N, Inan I, Secic M, MugnierKonrad B, et al. Risk factors for mortality-morbidity after emergency-urgent colorectal surgery. Int J Colorectal Dis 2009;24(3):311-6.
Amri R, Bordeianou LG, Sylla P, Berger DL. Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes. Am J Surg 2015;209(2):246-53.
Oliphant R, Mansouri D, Nicholson GA, McMillan DC, Horgan PG, Morrison DS. Emergency presentation of node-negative colorectal cancer treated with curative surgery is associated with poorer short and longer-term survival. Int J Colorectal Dis 2014;29(5):591-8.
Amelung FJ, Mulder CL, Verheijen PM, Draaisma WA, Siersema PD, Consten EC. Acute resection versus bridge to surgery with diverting colostomy for patients with acute malignant left sided colonic obstruction: systematic review and meta-analysis. Surg Oncol 2015;24(4):313-21.
Teloken PE, Spilsbury K, Levitt M, Makin G, Salama P, Tan P, et al. Outcomes in patients undergoing urgent colorectal surgery ANZ J Surg 2014;84(12):960-4.
Hogan J, Samaha G, Burke J, Chang KH, Condon E, Waldron D, et al. Emergency presenting colon cancer is an independent predictor of adverse disease-free survival. Int Surg 2015;100(1):77-86.
McPhail S, Elliss-Brookes L, Shelton J, Ives A, Greenslade M, Vernon S, et al. Emergency presentation of cancer and short-term mortality. Br J Cancer 2013;109(8):2027-34.
Thompson MR, Asiimwe A, Flashman K, Tsavellas G. Is earlier referral and investigation of bowel cancer patients presenting with rectal bleeding associated with better survival? Colorectal Dis 2011;13(11):1242-8.
Mitchell AD, Inglis KM, Murdoch JM, Porter GA. Emergency room presentation of colorectal cancer: a consecutive cohort study. Ann Surg Oncol 2007;14(3):1099-104.
Lewis MA, Hendrickson AW, Moynihan TJ. Oncologic emergencies: Pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin 2011;61(5):287-314.
Askari A, Malietzis G, Nachiappan S, Antoniou A, Jenkins J, Kennedy R, et al. Defining characteristics of patients with colorectal cancer requiring emergency surgery. Int J Colorectal Dis 2015;30(10):1329-36.
Mandava N, Kumar S, PIzzi WF, Aprille IJ Perforated colorectal carcinomas. Am J Surg 1996;172(3):236-8.
Carraro P, Segala M, Orlotti C, Tiberio G. Outcome of largebowel perforation in patients with colorectal cancer. Dis Colon Rectum 1998;41(11):1421-6.
Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T. Emergency surgery for colon carcinoma. Dis Colon Rectum 2003;46(1):24-30.
Amri R, Bordeianou LG, Sylla P, Berger DL. Impact of screening colonoscopy on outcomes in colon cancer surgery. JAMA Surg 2013;148(8):747-54.
Ramos M1, Esteva M, Cabeza E, Campillo C, Llobera J, Aguiló A. Relationship of diagnostic and therapeutic delay with survival in colorectal cancer: a review. Eur J Cancer 2007;43(17):2467-78.
Wong SK, Jalaludin BB, Morgan MJ, Berthelsen AS, Morgan A, Gatenby AH,, et al. Tumor pathology and longterm survival in emergency colorectal cancer. Dis Colon Rectum 2008;51(2):223-30.
Coco C, Verbo A, Manno A, Mattana C, Covino M, Pedretti G, et al. Impact of emergency surgery in the outcome of rectal and left colon carcinoma. World J Surg 2005;29(11):1458-64.
Biswas M, Ades AE, Hamilton W. Symptom lead times in lung and colorectal cancers: what are the benefits of symptombased approaches to early diagnosis? Br J Cancer 2015;112(2):271-7.
Lyratzopoulos G, Saunders CL, Abel GA. Are emergency diagnoses of cancer avoidable? A proposed taxonomy to motivate study design and support service improvement. Future Oncol 2014;10(8):1329-33.
Metcalfe MS, Norwood MG, Miller AS, Hemingway D. Unreasonable expectations in emergency colorectal cancer surgery. Colorectal Dis 2005;7(3):275-8.
McGillicuddy EA, Schuster KM, Davis KA, Longo WE. Factors predicting morbidity and mortality in emergency colorectal procedures in elderly patients. Arch Surg 2009;144(12):1157- 62.
Scott NA, Jeacock J, Kingston RD. Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg 1995;82(3):321-3.
Rabeneck L, Paszat LF, Li C. Risk factors for obstruction, perforation, or emergency admission at presentation in patients with colorectal cancer: a population-based study. Am J Gastroenterol 2006,101(5):1098-103.
Teixeira F, Akaishi EH, Ushinohama AZ, Dutra TC, Netto SD, Utiyama EM, et al. Can we respect the principles of oncologic resection in an emergency surgery to treat colon cancer? World J Emerg Surg 2015;14:10-5
World Cancer Research Fund and American Institute for Cancer Research Food, nutrition, physical activity, and the prevention of cancer: a global perspective. American Institute for Cancer Research, Washington (2007).
Bass G, Fleming C, Conneely J, Martin Z, Mealy K. Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients. Dis Colon Rectum 2009;52(4):678-84.