title: Emergency surgery for colon carcinoma.
abstract: OBJECTIVE
  Emergency surgery for colon cancer is widely thought to be associated with increased likelihood of surgical morbidity and mortality; however, other coexistent factors such as advanced disease, the age of the patient, and medical comorbid conditions may also influence these outcomes. The primary purpose of this study was to identify the relative risk for surgical morbidity and/or mortality conferred by emergency surgery compared with elective surgery for patients with colon cancer.
  
  
  METHODS
  An Institutional Review Board-approved, case-control study was performed. During the period from January 1, 1995, to June 30, 2001, a total of 184 primary surgeries for colon cancer were performed. Emergency indications for surgery were defined as peritonitis, intra-abdominal abscess, or complete bowel obstruction at presentation (defined as emesis, distention on examination, and confirmatory plain radiograph films). By this definition, 29 patients (15.7 percent) met the criteria for inclusion. These patients were age and stage matched with 29 patients derived from the remaining 155 patients. Information was collected on surgical morbidity and mortality, length of stay, and survival.
  
  
  RESULTS
  Age, medical comorbidities, and stage of disease were well matched between groups. The indications for the 29 emergency surgeries were as follows: 6 for peritonitis, 2 for abscesses, and 21 for complete obstructions. Nine patients did not have their primary tumor removed. Sixteen patients underwent resection and anastomosis; the remaining four patients underwent a Hartmann's procedure. Overall surgical morbidity (64 vs. 24 percent; odds ratio, 5.1; 95 percent confidence interval, 1.7-16) and mortality (34 vs. 7 percent; odds ratio, 7.1; 95 percent confidence interval, 1.4-36.2) were significantly higher for patients undergoing emergency surgery. Among patients surviving surgery, there was no difference in overall survival between patients undergoing emergency compared with elective operation.
  
  
  CONCLUSIONS
  Emergency surgery has a strong negative influence (beyond that which is expected based on stage of disease) on immediate surgical morbidity and mortality. The similarity between the two groups in overall survival for patients surviving the perioperative period suggests that the negative impact of emergency surgery is confined to the immediate postoperative period.
authors.affiliation: Department of Surgery, University of Texas, Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Lane
authors.initials: L
authors.lastname: Smothers
authors.forename: Linda
authors.initials: L
authors.lastname: Hynan
authors.forename: Jason
authors.initials: J
authors.lastname: Fleming
authors.forename: Richard
authors.initials: R
authors.lastname: Turnage
authors.forename: Clifford
authors.initials: C
authors.lastname: Simmang
authors.forename: Thomas
authors.initials: T
authors.lastname: Anthony
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D003110:Colonic Neoplasms / Q000601:surgery*; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome