Oncologic colon cancer resection in emergency: are we doing enough?
BACKGROUND
The primary challenge of surgery for colon cancer (CC) presenting as an emergency is the control of the complication but a proper oncologic technique should not be missed when bowel resection is feasible. Currently, recommended oncologic criteria include en-bloc resection of invaded organs and structures, an adequate extent of the bowel resection and of the free margins and an adequate number of lymph nodes yielded.


METHODS
Chart-review of 499 CC patients undergone colectomy. One hundred and twenty-one (group A) presented as emergencies (obstruction n=85, perforation n=30, hemorrhage n=6) and were analyzed for tumor stage, need for enlarged resection, distal free margin, lymph node yield, mortality and morbidity. Results were compared with those observed in the 378 patients operated electively (group B).


RESULTS
Group A patients had a more advanced cancer stage (stage III/IV 62.8% vs. 48.7%, p<.01), but the need for enlarged resection was not significantly different in the two groups. Also the length of free distal margin was similar (means, group A: 97 mm; group B: 84 mm, p=ns). The number of excised nodes was greater in emergency (means, group A: 26.2 nodes; group B: 20.8 nodes, p<.01). Compared with group B, emergency procedures resulted in higher morbidity (22.3% vs. 13.4%, p<.05) and mortality (8.2% vs. .8%, p<.0001).


CONCLUSIONS
Recommended oncologic resection techniques may be applicable to surgery for complicated tumors of the colon and radical resection may be warranted by emergency colectomy. The worse long-term prognosis for patients with colonic cancer presenting acutely may be related to the stage of the disease rather than to the failure of surgery.
Chiarugi
Massimo
M
Department of Surgery, University of Pisa, General and Emergency Surgery Unit, Pisa, Italy. m.chiarugi@dc.med.unipi.it
Galatioto
Christian
C
Panicucci
Sonia
S
Scassa
Francesca
F
Zocco
Giuseppe
G
Seccia
Massimo
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical; D003082:Colectomy; D003110:Colonic Neoplasms / Q000150:complications* / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000601:surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery; D007416:Intestinal Perforation / Q000209:etiology / Q000601:surgery; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D054047:Surgical Stomas