Therapeutic strategy of emergency surgery for colon cancer in 71 patients over 70 years of age in Japan.
OBJECTIVE
The prognosis for colon cancer is poorest in cases of emergency situation in the elderly not only in Japan, but worldwide. The aim was to design a therapeutic approach used for colon cancer in the elderly.


METHODS
Seventy-one patients, who were all older than 70 years, with colon carcinoma in an emergency situation were examined. Lethality, surgical procedure, risk of comorbidity, multiple organ system failure and the effect of endotoxin absorption were examined.


RESULTS
Any increase in comorbidity was associated with a higher clinical lethality in the lungs, heart, kidney, and diabetes. The highest postoperative mortality rate was recorded in patients who underwent primary resection after perforation, while the lowest postoperative mortality rate was recorded in patients who underwent primary resection after obstruction. Postoperative failure of the lungs and heart and renal failure were associated with a significantly higher mortality rate. Twenty-five septic patients received an endotoxin adsorption due to blood filtration and 8 patients survived. Of the eight survivors, the endotoxin concentration was significantly decreased by an endotoxin absorption.


CONCLUSIONS
In cases of ileus, the resection may be performed positively. In cases of perforation, we may safely say now that stoma and resection is to be recommended. Endotoxin absorption due to blood filtration may be an effective additional therapy for post-operative septic shock.
Tsugawa
Kouji
K
Department of Surgery II, Faculty of Medicine, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
Koyanagi
Nobuhiro
N
Hashizume
Makoto
M
Akahoshi
Kazuya
K
Wada
Hiroya
H
Ayukawa
Katsuhiko
K
Tomikawa
Morimasa
M
Sugimachi
Keizo
K
D000230:Adenocarcinoma / Q000453:epidemiology / Q000601:surgery*; D000368:Aged; D003110:Colonic Neoplasms / Q000150:complications / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D004632:Emergency Medical Services; D004731:Endotoxins / Q000097:blood; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D007564:Japan / Q000453:epidemiology; D009102:Multiple Organ Failure; D010538:Peritonitis / Q000209:etiology; D011183:Postoperative Complications; D011379:Prognosis; D016019:Survival Analysis
D004731:Endotoxins