Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery.
OBJECTIVE
To review the results of the analysis and quantification of the influence of medical factors on the morbidity and mortality associated with emergency surgery for colorectal cancer.


METHODS
We analyze retrospectively the data for 51 patients who underwent emergency surgery: 34 (67%) to treat acute obstruction and 17 (33%) for perforation. The median follow-up period was 18.5 months (3 to 62 months).


RESULTS
The main tumor was located in the right colon in 13 patients (25%), in the left colon in 35 (69%) and in, the rectum in 3 (6%). Primary resection was performed in 94% of the patients: without anastomosis in 35% (18 of 51) and with primary anastomosis in 59% (30 of 51); 6% of the tumors were not resectable. The postoperative morbidity was 41%: 29% (10 of 34) occurring in obstructions and 65% (11 of 17) in perforations. The mortality rate was 14% (9% and 23%, respectively). There were statistically significant associations between mortality and the American Society of Anesthesia grading (p < 0.01) and between both the mortality and morbidity and the score for the acute physiology component of APACHE II (p = 0.01, respectively) and the total APACHE II score (p < 0.01 in both cases). The rate of actuarial disease-free survival was 26% at 36 months. Overall survival was 15% at 62 months. A recurrence rate of 48% (14 of 29) has been recorded.


CONCLUSIONS
Emergency surgery for colorectal cancer is associated with a high postoperative morbidity and mortality rate, which correlate with the medical status and, particularly, with the acute physiology score of the APACHE II risk stratification system.
Tobaruela
E
E
Servicio de Cirugía General y Digestiva, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Madrid.
Camuñas
J
J
Enríquez-Navascúes
J M
JM
Díez
M
M
Ratia
T
T
Martín
A
A
Hernández
P
P
Lasa
I
I
Martín
A
A
Cambronero
J A
JA
Granell
J
J
D018806:APACHE; D000230:Adenocarcinoma / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000150:complications / Q000453:epidemiology* / Q000601:surgery; D018572:Disease-Free Survival; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D009026:Mortality; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology