Effect of emergent presentation on outcome from rectal cancer management.
BACKGROUND
We have previously reported outcomes for all rectal cancers in BC in 1996. We found that our local recurrence rates and survival were suboptimal relative to current standards in recent literature.


METHODS
In this retrospective, population-based study, we report the influence of emergent presentation (obstruction, perforation, massive hemorrhage) on outcomes, types of surgical procedures and use of staging investigations, and use of adjuvant radiation and chemotherapy.


RESULTS
There were 452 invasive adenocarcinomas of the rectum of which 45 were emergent and 407 nonemergent. Disease-specific survival at 4 years for emergent and nonemergent stage II cancers were 66% versus 80%, respectively, and for stage III cancers, 60% versus 73%, respectively (P <0.04). Local recurrence rates at 4 years for emergent and nonemergent stage II cancers were 20% versus 15%, respectively, and for stage III cancers, 70% and 20%, respectively (P <0.05). Surgical resection more frequently involved a stoma for emergent (60%) than for nonemergent (35%) cases (P <0.01). Percent of patients having complete staging investigations were similar between emergent (42%) and nonemergent patients (39%). Adjuvant radiation was given in similar proportion to emergent (61%) and nonemergent (55%) patients. Adjuvant chemotherapy was given to a slightly higher proportion of emergent patients (63%) than nonemergent patients (43%).


CONCLUSIONS
We conclude that outcome from rectal cancer management is worse for emergent than nonemergent presentation. Since there is no difference in use of staging investigations or adjuvant therapy, the difference in outcome is likely due to difference in surgical technique between emergent and nonemergent cases.
Phang
P Terry
PT
British Columbia Cancer Agency and Department of Surgery, University of British Columbia, 1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. tphang@providencehealth.bc.ca
MacFarlane
John K
JK
Taylor
Robert H
RH
Cheifetz
Rona
R
Davis
Noelle
N
Hay
John
J
McGregor
Greg
G
Speers
Caroline
C
Coldman
Andy
A
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003107:Colorectal Surgery; D003131:Combined Modality Therapy; D006801:Humans; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D012004:Rectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012189:Retrospective Studies; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome