Skip to main content

Advertisement

SpringerLink
Log in

Oncologic long-term outcomes of emergency versus elective resection for colorectal cancer

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Douaiher J, Ravipati A, Grams B, Chowdhury S, Alatise O, Are C (2017) Colorectal cancer-global burden, trends, and geographical variations. J Surg Oncol 115(5):619–630. https://doi.org/10.1002/jso.24578

    Article  PubMed  Google Scholar 

  2. Global Burden of Disease Cancer C, Fitzmaurice C, Allen C, Barber RM, Barregard L, Bhutta ZA, Brenner H, Dicker DJ, Chimed-Orchir O, Dandona R, Dandona L, Fleming T, Forouzanfar MH, Hancock J, Hay RJ, Hunter-Merrill R, Huynh C, Hosgood HD, Johnson CO, Jonas JB, Khubchandani J, Kumar GA, Kutz M, Lan Q, Larson HJ, Liang X, Lim SS, Lopez AD, MF MI, Marczak L, Marquez N, Mokdad AH, Pinho C, Pourmalek F, Salomon JA, Sanabria JR, Sandar L, Sartorius B, Schwartz SM, Shackelford KA, Shibuya K, Stanaway J, Steiner C, Sun J, Takahashi K, Vollset SE, Vos T, Wagner JA, Wang H, Westerman R, Zeeb H, Zoeckler L, Abd-Allah F, Ahmed MB, Alabed S, Alam NK, Aldhahri SF, Alem G, Alemayohu MA, Ali R, Al-Raddadi R, Amare A, Amoako Y, Artaman A, Asayesh H, Atnafu N, Awasthi A, Saleem HB, Barac A, Bedi N, Bensenor I, Berhane A, Bernabe E, Betsu B, Binagwaho A, Boneya D, Campos-Nonato I, Castaneda-Orjuela C, Catala-Lopez F, Chiang P, Chibueze C, Chitheer A, Choi JY, Cowie B, Damtew S, das Neves J, Dey S, Dharmaratne S, Dhillon P, Ding E, Driscoll T, Ekwueme D, Endries AY, Farvid M, Farzadfar F, Fernandes J, Fischer F, GH TT, Gebru A, Gopalani S, Hailu A, Horino M, Horita N, Husseini A, Huybrechts I, Inoue M, Islami F, Jakovljevic M, James S, Javanbakht M, Jee SH, Kasaeian A, Kedir MS, Khader YS, Khang YH, Kim D, Leigh J, Linn S, Lunevicius R, HMA ER, Malekzadeh R, Malta DC, Marcenes W, Markos D, Melaku YA, Meles KG, Mendoza W, Mengiste DT, Meretoja TJ, Miller TR, Mohammad KA, Mohammadi A, Mohammed S, Moradi-Lakeh M, Nagel G, Nand D, Le Nguyen Q, Nolte S, Ogbo FA, Oladimeji KE, Oren E, Pa M, Park EK, Pereira DM, Plass D, Qorbani M, Radfar A, Rafay A, Rahman M, Rana SM, Soreide K, Satpathy M, Sawhney M, Sepanlou SG, Shaikh MA, She J, Shiue I, Shore HR, Shrime MG, So S, Soneji S, Stathopoulou V, Stroumpoulis K, Sufiyan MB, Sykes BL, Tabares-Seisdedos R, Tadese F, Tedla BA, Tessema GA, Thakur JS, Tran BX, Ukwaja KN, BSC U, Vlassov VV, Weiderpass E, Wubshet Terefe M, Yebyo HG, Yimam HH, Yonemoto N, Younis MZ, Yu C, Zaidi Z, Zaki MES, Zenebe ZM, Murray CJL, Naghavi M (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 3(4):524–548. https://doi.org/10.1001/jamaoncol.2016.5688

    Article  Google Scholar 

  3. McArdle CS, Hole DJ (2004) Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 91(5):605–609. https://doi.org/10.1002/bjs.4456

    Article  CAS  PubMed  Google Scholar 

  4. Xu Z, Becerra AZ, Aquina CT, Hensley BJ, Justiniano CF, Boodry C, Swanger AA, Arsalanizadeh R, Noyes K, Monson JR, Fleming FJ (2017) Emergent colectomy is independently associated with decreased long-term overall survival in colon cancer patients. J Gastrointest Surg 21(3):543–553. https://doi.org/10.1007/s11605-017-3355-8

    Article  PubMed  Google Scholar 

  5. Sjo OH, Larsen S, Lunde OC, Nesbakken A (2009) Short term outcome after emergency and elective surgery for colon cancer. Color Dis 11(7):733–739. https://doi.org/10.1111/j.1463-1318.2008.01613.x

    Article  CAS  Google Scholar 

  6. Lee CHA, Kong JCH, Heriot AG, Warrier S, Zalcberg J, Sitzler P (2018) Short-term outcome of emergency colorectal cancer surgery: results from bi-national colorectal cancer audit. Int J Color Dis 34:63–69. https://doi.org/10.1007/s00384-018-3169-5

    Article  Google Scholar 

  7. Ascanelli S, Navarra G, Tonini G, Feo C, Zerbinati A, Pozza E, Carcoforo P (2003) Early and late outcome after surgery for colorectal cancer: elective versus emergency surgery. Tumori 89(1):36–41

    Article  PubMed  Google Scholar 

  8. Bass G, Fleming C, Conneely J, Martin Z, Mealy K (2009) Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients. Dis Colon Rectum 52(4):678–684. https://doi.org/10.1007/DCR.0b013e3181a1d8c9

    Article  PubMed  Google Scholar 

  9. Anderson JH, Hole D, McArdle CS (1992) Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 79(7):706–709. https://doi.org/10.1002/bjs.1800790739

    Article  CAS  PubMed  Google Scholar 

  10. Scott NA, Jeacock J, Kingston RD (1995) Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg 82(3):321–323. https://doi.org/10.1002/bjs.1800820311

    Article  CAS  PubMed  Google Scholar 

  11. Coco C, Verbo A, Manno A, Mattana C, Covino M, Pedretti G, Petito L, Rizzo G, Picciocchi A (2005) Impact of emergency surgery in the outcome of rectal and left colon carcinoma. World J Surg 29(11):1458–1464. https://doi.org/10.1007/s00268-005-7826-9

    Article  PubMed  Google Scholar 

  12. Chiarugi M, Galatioto C, Panicucci S, Scassa F, Zocco G, Seccia M (2007) Oncologic colon cancer resection in emergency: are we doing enough? Surg Oncol 16(Suppl 1):S73–S77. https://doi.org/10.1016/j.suronc.2007.10.019

    Article  PubMed  Google Scholar 

  13. Weixler B, Warschkow R, Ramser M, Droeser R, von Holzen U, Oertli D, Kettelhack C (2016) Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease-free survival: a propensity score analysis. BMC Cancer 16:208. https://doi.org/10.1186/s12885-016-2239-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  14. Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology 2(3):281–284

    Article  Google Scholar 

  15. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383

    Article  CAS  PubMed  Google Scholar 

  16. Glynne-Jones R, Wyrwicz L, Tiret E, Brown G, Rodel C, Cervantes A, Arnold D, Committee EG (2017) Rectal cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol 28 (suppl_4):iv22-iv40. doi:https://doi.org/10.1093/annonc/mdx224

    Article  CAS  PubMed  Google Scholar 

  17. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery--the clue to pelvic recurrence? Br J Surg 69(10):613–616. https://doi.org/10.1002/bjs.1800691019

    Article  CAS  PubMed  Google Scholar 

  18. von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, Initiative S (2007) The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet 370(9596):1453–1457. https://doi.org/10.1016/S0140-6736(07)61602-X

    Article  Google Scholar 

  19. van Gijn W, Marijnen CA, Nagtegaal ID, Kranenbarg EM, Putter H, Wiggers T, Rutten HJ, Pahlman L, Glimelius B, van de Velde CJ, Dutch Colorectal Cancer G (2011) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial. Lancet Oncol 12(6):575–582. https://doi.org/10.1016/S1470-2045(11)70097-3

    Article  PubMed  Google Scholar 

  20. Sauer R, Liersch T, Merkel S, Fietkau R, Hohenberger W, Hess C, Becker H, Raab HR, Villanueva MT, Witzigmann H, Wittekind C, Beissbarth T, Rodel C (2012) Preoperative versus postoperative chemoradiotherapy for locally advanced rectal cancer: results of the German CAO/ARO/AIO-94 randomized phase III trial after a median follow-up of 11 years. J Clin Oncol 30(16):1926–1933. https://doi.org/10.1200/JCO.2011.40.1836

    Article  CAS  PubMed  Google Scholar 

  21. Minnella EM, Carli F (2018) Prehabilitation and functional recovery for colorectal cancer patients. Eur J Surg Oncol 44(7):919–926. https://doi.org/10.1016/j.ejso.2018.04.016

    Article  PubMed  Google Scholar 

  22. Norwood MG, Sutton AJ, West K, Sharpe DP, Hemingway D, Kelly MJ (2010) Lymph node retrieval in colorectal cancer resection specimens: national standards are achievable, and low numbers are associated with reduced survival. Color Dis 12(4):304–309. https://doi.org/10.1111/j.1463-1318.2009.01788.x

    Article  CAS  Google Scholar 

  23. Bilchik A, Nissan A, Wainberg Z, Shen P, McCarter M, Protic M, Howard R, Elashoff D, Tyler J, Peoples GE, Stojadinovic A (2010) Surgical quality and nodal ultrastaging is associated with long-term disease-free survival in early colorectal cancer: an analysis of 2 international multicenter prospective trials. Ann Surg 252(3):467–474; discussion 474-466. https://doi.org/10.1097/SLA.0b013e3181f19767

    Article  PubMed  Google Scholar 

  24. Wanis KN, Ott M, Van Koughnett JAM, Colquhoun P, Brackstone M (2018) Long-term oncological outcomes following emergency resection of colon cancer. Int J Color Dis 33(11):1525–1532. https://doi.org/10.1007/s00384-018-3109-4

    Article  Google Scholar 

  25. Hall GM, Shanmugan S, Bleier JI, Jeganathan AN, Epstein AJ, Paulson EC (2016) Colorectal specialization and survival in colorectal cancer. Color Dis 18(2):O51–O60. https://doi.org/10.1111/codi.13246

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland

    Joël L. Lavanchy, Lukas Vaisnora, Tobias Haltmeier, Lukas E. Brügger, Daniel Candinas & Beat Schnüriger

  2. Institute of Pathology, University of Bern, Bern, Switzerland

    Inti Zlobec

Authors
  1. Joël L. Lavanchy
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lukas Vaisnora
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tobias Haltmeier
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Inti Zlobec
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Lukas E. Brügger
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Daniel Candinas
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Beat Schnüriger
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

Joël Lavanchy, Tobias Haltmeier, and Beat Schnüriger contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Joël Lavanchy, Lukas Vaisnora, Tobias Haltmeier, and Beat Schnüriger. The first draft of the manuscript was written by Joël Lavanchy and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Beat Schnüriger.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the cantonal research committee (Cantonal Ethics Committee of Bern, Switzerland, 2017–00792) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lavanchy, J.L., Vaisnora, L., Haltmeier, T. et al. Oncologic long-term outcomes of emergency versus elective resection for colorectal cancer. Int J Colorectal Dis 34, 2091–2099 (2019). https://doi.org/10.1007/s00384-019-03426-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-019-03426-8

Keywords

Search

Navigation