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

  • Joël L. Lavanchy
  • Lukas Vaisnora
  • Tobias Haltmeier
  • Inti Zlobec
  • Lukas E. Brügger
  • Daniel Candinas
  • Beat SchnürigerEmail author
Original Article
  • 31 Downloads

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.

Keywords

Emergency colorectal cancer resection Elective colorectal cancer resection Colorectal cancer Five-year survival Recurrence-free survival 

Notes

Author 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.

Compliance with ethical standards

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Visceral Surgery and Medicine, InselspitalBern University Hospital, University of BernBernSwitzerland
  2. 2.Institute of Pathology, University of BernBernSwitzerland

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