[Long-term results of emergency surgery for colon cancer compared with elective surgery].
BACKGROUND
Currently, the mechanisms that worsen the prognosis of complicated colon cancers are still not well known. Moreover, the possible effect of using sound oncological principles in emergency surgery on long-term prognosis has not been studied in detail.


OBJECTIVE
The aim of the present study was to analyze the 5-year efficacy of curative oncological surgery for complicated colon cancer performed in an emergency setting in terms of tumor recurrence and survival compared with elective surgery of uncomplicated tumors.


METHODS
We performed a prospective observational cohort study in patients who underwent emergency surgery for complicated colon cancer (group 1) and patients who underwent elective surgery (group 2). Exclusion criteria were tumors of less than 15 cm from the anal verge, palliative surgery, and distant metastases.


RESULTS
During the study period, 646 patients underwent surgery: there were 165 (25.5%) emergency surgeries and 481 (74.5%) elective interventions. Surgery was considered curative in 456 (70.6%) patients: 102 (22.4%) emergency and 354 (77.6%) elective surgeries. Significant differences were found in disease stage between the 2 groups (P = 0.003). The postoperative mortality rate was 12.7% in group 1 and 3.4% in group 2 (P = 0.001). When patients were stratified by TNM stage, worse 5-year cancer-related and disease-free survival rates were observed in group 1 patients with stage II tumors. No differences were found in cancer-related survival rates in stage III patients (P = 0.178). There were no significant differences in overall survival, cancer-related survival or tumor recurrence rates when group 1 was compared with a subgroup of patients in group 2 with factors of poor prognosis.


CONCLUSIONS
Complicated colon cancer presents in more advanced stages and had a worse overall long-term prognosis than uncomplicated tumour. These differences decrease when patients are subclassified by tumoral stage. Overall survival and cancer-related survival rates similar to those of elective surgery can be achieved in emergency surgery when curative oncological resection is performed.
Biondo
Sebastiano
S
Unidad de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. sebastianobiondo@yahoo.com
Kreisler
Esther
E
Millan
Monica
M
Martí-Ragué
Joan
J
Fraccalvieri
Domenico
D
Golda
Thomas
T
De Oca
Javier
J
Osorio
Alfonso
A
Fradera
Rosa
R
Salazar
Ramon
R
Rodriguez-Moranta
Francisco
F
Sanjuán
Xavier
X
D003110:Colonic Neoplasms / Q000601:surgery*; D017558:Elective Surgical Procedures; D004638:Emergency Treatment; D006801:Humans; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome