title: Emergency presenting colon cancer is an independent predictor of adverse disease-free survival.
abstract: Twenty percent of colon cancers present as an emergency. However, the association between emergency presentation and disease-free survival (DFS) remains uncertain. Consecutive patients who underwent elective (CC) and emergent (eCC) resection for colon cancer were included in the analysis. Survival outcomes were compared between the 2 groups in univariate/multivariate analyses. A total of 439 patients underwent colonic resection for colon cancer during the interval 2000-2010; 97 (22.1%) presented as an emergency. eCC tumors were more often located at the splenic flexure (P = 0.017) and descending colon (P = 0.004). The eCC group displayed features of more advanced disease with a higher proportion of T4 (P = 0.009), N2 tumors (P < 0.01) and lymphovascular invasion (P< 0.01). eCC was associated with adverse locoregional recurrence (P = 0.02) and adverse DFS (P < 0.01 ) on univariate analysis. eCC remained an independent predictor of adverse locoregional recurrence (HR 1.86, 95% CI 1.50-3.30, P = 0.03) and DFS (HR 1.30, 95% CI 0.88-1.92, P = 0.05) on multivariate analysis. eCC was not associated with adverse overall survival and systemic recurrence. eCC is an independent predictor of adverse locoregional recurrence and DFS.
authors.affiliation: 1 Department of Colorectal Surgery, University Hospital Limerick, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Hogan
authors.forename: Georges
authors.initials: G
authors.lastname: Samaha
authors.forename: John
authors.initials: J
authors.lastname: Burke
authors.forename: Kah Hoong
authors.initials: KH
authors.lastname: Chang
authors.forename: Eoghan
authors.initials: E
authors.lastname: Condon
authors.forename: David
authors.initials: D
authors.lastname: Waldron
authors.forename: John Calvin
authors.initials: JC
authors.lastname: Coffey
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000368:Aged; D003082:Colectomy; D003110:Colonic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality / Q000473:pathology; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Colon cancer; Disease free survival; Emergency presentation; Locoregional recurrence