title: Emergency surgery for complicated colorectal cancer. A two-decade trend analysis.
abstract: OBJECTIVE
  Emergency procedures for colorectal cancer have worse outcomes than elective resections. Temporal trends in emergency surgery are analyzed by comparing two decade-related series of colorectal cancer patients.
  
  
  METHODS
  The clinical data of 985 patients undergoing colorectal cancer surgery were collected during two decades (1975-1984 and 1995-2004). Rates of emergency surgery, operative mortality, 5-year cancer-related and overall survival were compared retrospectively.
  
  
  RESULTS
  The rate of emergency surgery decreased from 81 out of 513 cases (16%) during 1975-1984 to 41 out of 471 cases (9%) during 1995-2004 (p = 0.005). Over the same time, the rate of curative resections in emergency increased from 46% (37/81 cases) to 76% (31/41 cases) (p < 0.001), while patient and tumor characteristics remained similar. Operative mortality after emergency procedures decreased from 14% (11 deaths) to 5% (2 deaths) and cancer-related survival increased from 21 to 42% (p = 0.03). However, when excluding palliative procedures, survival after emergency surgery increased from 52 to 58%, while after elective treatment it increased from 56 to 78% (p < 0.001).
  
  
  CONCLUSIONS
  Frequency and operative mortality of emergency colorectal cancer surgery decreased substantially from 1975-1984 to 1995-2004. No significant improvement in long-term survival was observed when curative emergency resections only were considered. Further efforts are needed to reverse the diverging trend of long-term outcomes between emergency and elective curative procedures.
authors.affiliation: Cattedra di Chirurgia Generale, Università degli Studi di Brescia, Brescia, Italy. nascsurg@hotmail.com
authors.forename: Riccardo
authors.initials: R
authors.lastname: Nascimbeni
authors.forename: Hyginus
authors.initials: H
authors.lastname: Ngassa
authors.forename: Francesco
authors.initials: F
authors.lastname: Di Fabio
authors.forename: Eleonora
authors.initials: E
authors.lastname: Valloncini
authors.forename: Ernesto
authors.initials: E
authors.lastname: Di Betta
authors.forename: Bruno
authors.initials: B
authors.lastname: Salerni
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D006801:Humans; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome