title: Emergency presentation of node-negative colorectal cancer treated with curative surgery is associated with poorer short and longer-term survival.
abstract: OBJECTIVE
  The majority of patients with node-negative colorectal cancer have excellent 5-year survival prospects, but up to a third relapse. Strategies to identify patients at higher risk of adverse outcomes are desirable to enable optimal treatment and follow-up. The aim of this study was to examine postoperative mortality and longer-term survival by mode of presentation for patients with node-negative colorectal cancer undergoing surgery with curative intent.
  
  
  METHODS
  Patients from 16 hospitals in the west of Scotland between 2001 and 2004 were identified from a prospectively maintained regional clinical audit database. Postoperative mortality and 5-year relative survival by mode of presentation were recorded.
  
  
  RESULTS
  Of 1,877 patients with node-negative disease, 251 (13.4%) presented as an emergency. Those presenting as an emergency were more likely to be older (P = 0.023), have colon rather than rectal cancer (P < 0.001), have pT4 stage disease (P < 0.001), have extramural vascular invasion (P = 0.001), and receive surgery under the care of a nonspecialist surgeon (P < 0.001) compared to those presenting electively. The postoperative mortality rate was 3.3% after elective and 12.8% after emergency presentation (P < 0.001). Five-year relative survival was 91.8% after elective and 66.8% after emergency presentation (P < 0.001). The adjusted relative excess risk ratio for 5-year relative survival after emergency relative to elective presentation was 2.59 (95% CI 1.67-4.01; P < 0.001) and 1.90 (95% CI 1.00-3.62; P = 0.049) after exclusion of postoperative deaths.
  
  
  CONCLUSIONS
  Emergency presentation of node-negative colorectal cancer treated with curative intent was independently associated with higher postoperative mortality and poorer 5-year relative survival compared to elective presentation.
authors.affiliation: Academic Unit of Surgery, University of Glasgow, 4th Floor Walton Building, Glasgow Royal Infirmary, Glasgow, G4 0SF, UK, raymondoliphant@nhs.net.
authors.forename: Raymond
authors.initials: R
authors.lastname: Oliphant
authors.forename: David
authors.initials: D
authors.lastname: Mansouri
authors.forename: Gary A
authors.initials: GA
authors.lastname: Nicholson
authors.forename: Donald C
authors.initials: DC
authors.lastname: McMillan
authors.forename: Paul G
authors.initials: PG
authors.lastname: Horgan
authors.forename: David S
authors.initials: DS
authors.lastname: Morrison
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003110:Colonic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D012004:Rectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D012959:Socioeconomic Factors; D016019:Survival Analysis; D055815:Young Adult