Skip to main content

Advertisement

SpringerLink
Log in

Defining characteristics of patients with colorectal cancer requiring emergency surgery

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

Abstract

Introduction

Emergency surgery for colorectal cancer has been associated with high mortality. The aim of this study is to determine factors predictive of undergoing emergency surgery, of 30-day mortality, and explore the role of screening in patients undergoing emergency surgery.

Methods

All patients at our unit, undergoing surgery for colorectal cancer between 2004 and 2014 were included. Data on patient demographics, tumour staging, admission type, comorbidity score, mortality data, and screening data were analysed. Multivariable analyses were carried out to determine predictors of undergoing emergency surgery as well as mortality postoperatively.

Results

A total of 1911 consecutive patients underwent elective and emergency surgery for colorectal cancer. Of the 263 patients who underwent emergency surgery for CRC, 37.3 % (n = 98) had right-sided colonic cancers. Multivariable analyses determined right-sided cancers (OR 2.92, 95 % CI 2.03–4.20, p < 0.001) and stage IV tumours to be independently associated with undergoing emergency surgery (OR 6.64, 95 % CI 2.86–15.42, p < 0.001). Undergoing emergency surgery was an independent predictor of 30-day mortality (OR 9.62, 95 % CI 5.96–15.54, p < 0.001). Of the 50 patients that died within 30 days in the emergency surgery group, 32 % were in patients with right-sided colon cancers. Cancer detection through guaiac faecal occult blood testing (gFOBT) amongst this group is low with six out of nine patients having a false negative gFOBT test.

Conclusion

Emergency CRC surgery is associated with high mortality. Alternative screening strategies that improve detection of proximal colon cancers may reduce the number of patients undergoing emergency surgery for right-sided cancers.

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

Similar content being viewed by others

References

  1. Finan P., & Greenaway K. (2012). National Bowel Cancer Audit 2012

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

    Article  CAS  Google Scholar 

  3. Scott N. A., Jeacock J., & Kingston R. D. (1995) Risk factors in patients presenting as an emergency with colorectal cancer. British J Surg, 82(3), 321–3. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/7795995

  4. Anderson J. H., Hole D., & McArdle C. S. (1992) Elective versus emergency surgery for patients with colorectal cancer. British J Surg 79(7), 706–709. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/1379508

  5. Von Wagner C, Baio G, Raine R, Snowball J, Morris S, Atkin W, Wardle J (2011) Inequalities in participation in an organized national colorectal cancer screening programme: results from the first 2.6 million invitations in England. Int J Epidemiol 40(3):712–718. doi:10.1093/ije/dyr008

    Article  Google Scholar 

  6. Whitaker KL, Good A, Miles A, Robb K, Wardle J, von Wagner C (2011) Socioeconomic inequalities in colorectal cancer screening uptake: does time perspective play a role? Health Psychol : Off J Division Health Psychol, Am Psychol Assoc 30(6):702–709. doi:10.1037/a0023941

    Article  Google Scholar 

  7. Brouse CH, Basch CE, Wolf RL, Shmukler C (2004) Barriers to colorectal cancer screening: an educational diagnosis. J Cancer Educ : Off J Am Assoc Cancer Educ 19(3):170–173. doi:10.1207/s15430154jce1903_12

    Article  Google Scholar 

  8. Dindo D., Demartines N., & Clavien P.-A. (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Anna Surg 240(2), 205–13. Retrieved from http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1360123&tool=pmcentrez&rendertype=abstract

  9. ACPGBI. (n.d.). National Bowel Cancer Audit 2012. Retrieved from http://www.hqip.org.uk/assets/NCAPOP-Library/NCAPOP-2012-13/Bowel-Cancer-Audit-National-Report-pub-2012.pdf

  10. Clark AJ, Stockton D, Elder A, Wilson RG, Dunlop MG (2004) Assessment of outcomes after colorectal cancer resection in the elderly as a rationale for screening and early detection. British J Surg 91(10):1345–1351. doi:10.1002/bjs.4601

    Article  CAS  Google Scholar 

  11. Jestin P, Nilsson J, Heurgren M, Påhlman L, Glimelius B, Gunnarsson U (2005) Emergency surgery for colonic cancer in a defined population. British J Surg 92(1):94–100. doi:10.1002/bjs.4780

    Article  CAS  Google Scholar 

  12. Repici A, Adler DG, Gibbs CM, Malesci A, Preatoni P, Baron TH (2007) Stenting of the proximal colon in patients with malignant large bowel obstruction: techniques and outcomes. Gastrointest Endosc 66(5):940–944. doi:10.1016/j.gie.2007.04.032

    Article  PubMed  Google Scholar 

  13. Dronamraju SS, Ramamurthy S, Kelly SB, Hayat M (2009) Role of self-expanding metallic stents in the management of malignant obstruction of the proximal colon. Dis Colon Rectum 52(9):1657–1661. doi:10.1007/DCR.0b013e3181a8f4af

    Article  PubMed  Google Scholar 

  14. Williams D, Law R, Pullyblank AM (2011) Colorectal stenting in malignant large bowel obstruction: the learning curve. Int J Surg Oncol 2011:917848. doi:10.1155/2011/917848

    PubMed Central  CAS  PubMed  Google Scholar 

  15. Dauphine C. E., Tan P., Beart R. W., Vukasin P., Cohen H., & Corman M. L. (2002) Placement of self-expanding metal stents for acute malignant large-bowel obstruction: a collective review. Ann Surg Oncol 9(6), 574–9. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12095974

  16. Keränen I, Lepistö A, Udd M, Halttunen J, Kylänpää L (2012) Stenting for malignant colorectal obstruction: a single-center experience with 101 patients. Surg Endosc 26(2):423–430. doi:10.1007/s00464-011-1890-z

    Article  PubMed  Google Scholar 

  17. Fernández-Esparrach G, Bordas JM, Giráldez MD, Ginès A, Pellisé M, Sendino O, Llach J (2010) Severe complications limit long-term clinical success of self-expanding metal stents in patients with obstructive colorectal cancer. Am J Gastroenterol 105(5):1087–1093. doi:10.1038/ajg.2009.660

    Article  PubMed  Google Scholar 

  18. Tan CJ, Dasari BVM, Gardiner K (2012) Systematic review and meta-analysis of randomized clinical trials of self-expanding metallic stents as a bridge to surgery versus emergency surgery for malignant left-sided large bowel obstruction. British J Surg 99(4):469–476. doi:10.1002/bjs.8689

    Article  CAS  Google Scholar 

  19. Sebastian S, Johnston S, Geoghegan T, Torreggiani W, Buckley M (2004) Pooled analysis of the efficacy and safety of self-expanding metal stenting in malignant colorectal obstruction. Am J Gastroenterol 99(10):2051–2057. doi:10.1111/j.1572-0241.2004.40017.x

    Article  PubMed  Google Scholar 

  20. Scholefield J. H., Robinson M. H., Mangham C. M., & Hardcastle J. D. (1998) Screening for colorectal cancer reduces emergency admissions. Europ J Surg Oncol : J Europ Soc Surg Oncol British Assoc Surg Oncol 24(1), 47–50. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9542516

  21. Elliss-Brookes L, McPhail S, Ives A, Greenslade M, Shelton J, Hiom S, Richards M (2012) Routes to diagnosis for cancer - determining the patient journey using multiple routine data sets. Br J Cancer 107(8):1220–1226. doi:10.1038/bjc.2012.408

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  22. Haug U, Knudsen AB, Brenner H, Kuntz KM (2011) Is fecal occult blood testing more sensitive for left- versus right-sided colorectal neoplasia? a systematic literature review. Expert Rev Mol Diagn 11(6):605–616. doi:10.1586/erm.11.41

    Article  PubMed  Google Scholar 

  23. Haug U, Kuntz KM, Knudsen AB, Hundt S, Brenner H (2011) Sensitivity of immunochemical faecal occult blood testing for detecting left- vs right-sided colorectal neoplasia. Br J Cancer 104(11):1779–1785. doi:10.1038/bjc.2011.160

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  24. Bressler B., Paszat L. F., Vinden C., Li C., He J., & Rabeneck L. (2004) Colonoscopic miss rates for right-sided colon cancer: a population-based analysis. Gastroenterology 127(2), 452–6. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15300577

  25. Chao S, Ying J, Liew G, Marshall W, Liew C-C, Burakoff R (2013) Blood RNA biomarker panel detects both left- and right-sided colorectal neoplasms: a case–control study. J Experiment Clin Cancer Res : CR 32:44. doi:10.1186/1756-9966-32-44

    Article  PubMed Central  Google Scholar 

  26. Logan RFA, Patnick J, Nickerson C, Coleman L, Rutter MD, von Wagner C (2012) Outcomes of the Bowel Cancer Screening Programme (BCSP) in England after the first 1 million tests. Gut 61(10):1439–1446. doi:10.1136/gutjnl-2011-300843

    Article  PubMed Central  PubMed  Google Scholar 

  27. Lasser KE, Murillo J, Lisboa S, Casimir AN, Valley-Shah L, Emmons KM, Ayanian JZ (2011) Colorectal cancer screening among ethnically diverse, low-income patients: a randomized controlled trial. Arch Intern Med 171(10):906–912. doi:10.1001/archinternmed.2011.201

    Article  PubMed  Google Scholar 

  28. Morris S, Baio G, Kendall E, von Wagner C, Wardle J, Atkin W, Raine R (2012) Socioeconomic variation in uptake of colonoscopy following a positive faecal occult blood test result: a retrospective analysis of the NHS Bowel Cancer Screening Programme. Br J Cancer 107(5):765–771. doi:10.1038/bjc.2012.303

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Whynes DK, Frew EJ, Manghan CM, Scholefield JH, Hardcastle JD (2003) Colorectal cancer, screening and survival: the influence of socio-economic deprivation. Public Health 117(6):389–395. doi:10.1016/S0033-3506(03)00146-X

    Article  CAS  PubMed  Google Scholar 

  30. Cram P, Fendrick AM, Inadomi J, Cowen ME, Carpenter D, Vijan S (2003) The impact of a celebrity promotional campaign on the use of colon cancer screening: the Katie Couric effect. Arch Intern Med 163(13):1601–1605. doi:10.1001/archinte.163.13.1601

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Our thanks to all the staff at the St. Mark’s Hospital Bowel Screening Centre for their invaluable help in identifying screened patients, in particular Ms Sarah Marshall (Clinical Programme Manager) and Ms Jennifer Bartley. We would also like to thank the staff at Medical Records & Coding, in particular Mr Stephen Hiles for his help in obtaining the relevant patient data as well Mr Mannish Sankaran for his help in data procurement.

Conflict of interest

The authors have no competing interests to declare.

Author information

Authors and Affiliations

  1. Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark’s Hospital & Academic Institute, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK

    Alan Askari, George Malietzis, Subramanian Nachiappan, Anthony Antoniou, John Jenkins, Robin Kennedy & Omar Faiz

  2. Department of Surgery & Cancer, Imperial College, St Mary’s Hospital, Praed Street, London, W21NY, UK

    Anthony Antoniou, John Jenkins, Robin Kennedy & Omar Faiz

Authors
  1. Alan Askari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. George Malietzis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Subramanian Nachiappan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Anthony Antoniou
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. John Jenkins
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Robin Kennedy
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Omar Faiz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Omar Faiz.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Askari, A., Malietzis, G., Nachiappan, S. et al. Defining characteristics of patients with colorectal cancer requiring emergency surgery. Int J Colorectal Dis 30, 1329–1336 (2015). https://doi.org/10.1007/s00384-015-2313-8

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-015-2313-8

Keywords

Search

Navigation