title: Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients.
abstract: OBJECTIVE
  Colorectal cancer commonly presents first as an emergency and is likely to be complicated by bowel obstruction/perforation requiring more difficult procedures, with poorer outcomes. Analysis of all of the procedures performed on patients diagnosed in Wexford General Hospital, Ireland, during the period 2000 to 2006 was carried out to validate this hypothesis in our western European population.
  
  
  METHODS
  Retrospective analysis of a prospectively maintained database of patient demographics, diagnosis, procedures, and mode of presentation (elective, emergency) was undertaken.
  
  
  RESULTS
  A total of 356 patients with colorectal cancer underwent 498 procedures during the years 2000 to 2006. Eighty-four emergency endoscopies and 100 emergency bowel resections were performed. Obstructive lesions were more likely to require emergency resection (P < 0.001). Median survival time for patients treated electively was 82 months vs. 59 months for patients treated on an emergency basis.
  
  
  CONCLUSIONS
  Of all colonic resections, 34 percent were carried out as emergencies and were significantly more likely to be complicated by obstruction or perforation (P < 0.001). Emergency resections were associated with a significantly poorer perioperative mortality and five-year survival rate (P < 0.001). Forty-one percent of colorectal cancers diagnosed at endoscopy were first seen emergently. These data raise concerns regarding public awareness of colorectal cancer and resource allocation and reemphasize the need for a national colorectal screening program.
authors.affiliation: Department of Surgery, Wexford General Hospital, Wexford, Ireland. garbass@rcsi.ie
authors.forename: Gary
authors.initials: G
authors.lastname: Bass
authors.forename: Cathy
authors.initials: C
authors.lastname: Fleming
authors.forename: John
authors.initials: J
authors.lastname: Conneely
authors.forename: Zenia
authors.initials: Z
authors.lastname: Martin
authors.forename: Kenneth
authors.initials: K
authors.lastname: Mealy
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000517:prevention & control / Q000601:surgery*; D017558:Elective Surgical Procedures; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome