title: Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma.
abstract: BACKGROUND
  It is known that emergency surgery for colorectal cancer is associated with high morbidity and mortality. The aim of this study was to assess the presentation, treatment, and outcome of patients with complicated colorectal cancer. Risk factors for morbidity and mortality were also evaluated.
  
  
  METHODS
  From 1991 to 2002, the medical records of 107 consecutive patients undergoing emergency surgery for obstructing or perforating colorectal carcinoma were retrospectively reviewed. Information regarding patient and tumor characteristics, treatment, and outcome was recorded. Risk factors were assessed by multivariate analysis.
  
  
  RESULTS
  Eighty-three patients (78%) had complete obstruction and 24 (22%) had perforation. Overall and major complications occurred in 70% and 34%, respectively. The mortality rate was 15%. Independent risk factors for major morbidity were perioperative blood transfusion and high American Society of Anesthesiologists (ASA) class, whereas those for mortality were older age and high Acute Physiology and Chronic Health Evaluation II (APACHE II) score.
  
  
  CONCLUSIONS
  Emergency surgery for complicated colorectal carcinoma carries high rates of morbidity and mortality. To achieve improvements in outcome, intensive treatment after surgery in patients with risk factors is recommended.
authors.affiliation: Department of Surgery, Hospital San Agustín, Avilés, Spain. josealvar@telecable.es
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Alvarez
authors.forename: Ricardo F
authors.initials: RF
authors.lastname: Baldonedo
authors.forename: Isabel G
authors.initials: IG
authors.lastname: Bear
authors.forename: Nuria
authors.initials: N
authors.lastname: Truán
authors.forename: Gerardo
authors.initials: G
authors.lastname: Pire
authors.forename: Paloma
authors.initials: P
authors.lastname: Alvarez
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D018709:Statistics, Nonparametric