Tumor pathology and long-term survival in emergency colorectal cancer.
OBJECTIVE
Patients who have an emergency operation for colorectal cancer have poorer long-term survival outcomes compared with elective patients. This study was designed to define the role of tumor pathology as a basis for the differences in survival outcomes.


METHODS
There were 1,537 elective and 286 emergency patients who had an operation for bowel cancer from 1997 to 2003. Tumor pathology and survival data collected prospectively for these patients were compared by modes of presentation.


RESULTS
Excluding 30-day mortality, emergency patients as a whole had a five-year all-cause survival rate of 39.2 percent compared with 64.7 percent for elective patients P<0.0001 they also had more advanced Dukes C and D tumors (P<0.0001). The rates of early T1 and T2 cancers were 4.7 percent for the emergency and 25 percent for the elective group. Emergency cases had more lymph node-positive patients and N2 patients (57.1 vs. 41.8 percent and 26.6 vs. 15.9 percent, respectively; P<0.0001). Curatively resected emergency colon patients again had more advanced Dukes staged tumors (P<0.0001) with a five-year survival rate of 51.6 percent compared with 75.6 percent for elective patients P<0.0001. On stage-for-stage analysis, the survival rates for curatively resected Dukes B and C colon cancers remained worse for emergency patients (P=0.003 and P=0.0002, respectively). Both emergency Dukes B and C groups had more T4 cases (21.5 vs. 10.6 percent; P=0.017 and 26.4 vs. 15 percent; P=0.016, respectively).


CONCLUSIONS
Advanced tumor pathology is a basis for poor long-term survival in emergency colorectal cancers.
Wong
Siu Kin C
SK
South Western Sydney Colorectal Tumor Group, Sydney South West Area Health Service, Sydney, Australia. cyril@isopah.com
Jalaludin
Bin B
BB
Morgan
Matthew J
MJ
Berthelsen
Angela S
AS
Morgan
Ann
A
Gatenby
Andrew H
AH
Fulham
Stephen B
SB
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology* / Q000601:surgery; D004630:Emergencies / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009517:New South Wales / Q000453:epidemiology; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D013997:Time Factors