title: Short term outcome after emergency and elective surgery for colon cancer.
abstract: OBJECTIVE
  Emergency presentation of colon cancer is common and associated with high mortality and morbidity following surgical treatment. The purpose of this study was to evaluate postoperative mortality and complications in a consecutive and population based series.
  
  
  METHODS
  All patients with adenocarcinoma of the colon diagnosed between 1993 and 2007 were registered prospectively. Postoperative mortality and complication rates in elective and emergency patients were compared. Logistic regression analysis was used to identify independent risk factors for postoperative complications.
  
  
  RESULTS
  In the study period 1129 patients were admitted, of whom 279 (25%) presented as an emergency. A total of 999 (89%) patients underwent surgical treatment; 924 patients (82%) had a major resection. The mortality rate was 3.5% after elective and 10% after emergency operation with resection (P < 0.01), and the complication rate was 24% and 38% (P < 0.01), respectively. In patients with left-sided obstruction, the mortality rate after Hartmann's procedure was 19% compared to 3% after resection with primary anastomosis (P < 0.01). Multivariate analyses demonstrated that emergency operation, increasing age, advanced tumour stage and ASA class IV were independent risk factors for postoperative mortality.
  
  
  CONCLUSIONS
  Emergency operation for colon cancer was associated with high rates of complications and mortality, indicating that immediate surgery should be avoided if possible. Decompression of left sided obstruction with a stent seems promising, whereas no conclusion can be made with regard to optimal procedure if stent placement fails; in this study Hartmann's procedure was associated with high mortality and morbidity.
authors.affiliation: Department of Gastrointestinal Surgery, Aker University Hospital, Oslo, Norway. ole.sjo@akersykehus.no
authors.forename: O H
authors.initials: OH
authors.lastname: Sjo
authors.forename: S
authors.initials: S
authors.lastname: Larsen
authors.forename: O C
authors.initials: OC
authors.lastname: Lunde
authors.forename: A
authors.initials: A
authors.lastname: Nesbakken
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000601:surgery*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003082:Colectomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D003110:Colonic Neoplasms / Q000150:complications / Q000601:surgery*; D003125:Colostomy / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D017558:Elective Surgical Procedures; D004630:Emergencies; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009664:Norway / Q000453:epidemiology; D010538:Peritonitis / Q000209:etiology / Q000401:mortality / Q000601:surgery; D011446:Prospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013529:Surgical Wound Dehiscence; D055815:Young Adult