title: Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes.
abstract: BACKGROUND
  Emergency presentation with colon cancer is intuitively related to advanced disease. We measured its effect on outcomes of surgically treated colon cancer.
  
  
  METHODS
  A retrospective cohort of 1,071 surgical colon cancer patients (2004 to 2011), with 102 emergency cases requiring surgery within the index admission, was analyzed.
  
  
  RESULTS
  Emergency patients required longer surgeries (median 141 vs 124 minutes; P = .04), longer median admissions (8% vs 5%; P < .001), more readmissions (12.7% vs 7.1%; P = .040), and perioperative mortality (7.8% vs .8%; P < .001). Surgical pathology displayed higher rates of node-positive disease (56.6% vs 38.6%; P < .001), extramural vascular invasion (39.6% vs 29.1%; P = .021), and metastatic disease (19.6% vs 8%; P < .001). Consequently, adjusting for staging, emergency presentations had considerably higher mortality (odds ratio = 2.07; P = .003) and shorter disease-free survival (hazard ratio = 1.39; P = .042).
  
  
  CONCLUSIONS
  Emergency presentation is a stage-independent poor prognostic factor associated with aggressive tumor biology, resulting in longer surgeries and admissions, frequent readmissions, worsening outcomes, and increasing healthcare costs.
authors.affiliation: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Ramzi
authors.initials: R
authors.lastname: Amri
authors.affiliation: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Liliana G
authors.initials: LG
authors.lastname: Bordeianou
authors.affiliation: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Sylla
authors.affiliation: Division of General and Gastrointestinal Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. Electronic address: dberger@mgh.harvard.edu.
authors.forename: David L
authors.initials: DL
authors.lastname: Berger
mesh_terms: D000368:Aged; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D009367:Neoplasm Staging; D061646:Operative Time; D010343:Patient Admission / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Colon cancer; Disease-free survival; Emergency surgery; Pathology; Perioperative outcomes; Survival