title: Emergency surgery for obstructing colorectal malignancy: prognostic and risk factors.
abstract: OBJECTIVE
  Emergency surgery for colorectal malignant obstruction is thought to correlate with poor outcome. The main aim of our study was to identify possible factors that could predict obstruction, and risk factors of poor postoperative outcome. The second aim was to determine any differences between primary anastomosis and stoma creation in the obstruction population, especially in left-sided tumors.
  
  
  METHODS
  A retrospective review of 212 patients who underwent surgery for colorectal malignancy between January 2008 and January 2013 was performed. Fifty-five patients (26%) underwent emergency surgery for completely obstructing colorectal carcinoma, and 157 (74%) underwent elective surgery.
  
  
  RESULTS
  The groups were comparable for age, gender, ASA score, tumor location, tumor stage, lymph node metastasis and mortality. Advanced tumor stage was recorded as the only prognostic factor of obstruction (p=0.001). Postoperative mortality rate was 9.1% in the obstruction group and 6.4% in the elective group (p=0.498). Analysis didn't reveal any risk factors for poor early outcome in the obstruction group. All patients with right-sided obstructive cancer were treated with resection and primary anastomosis, while the same procedure was performed in almost 61% of operations for left-sided tumors with no anastomotic failure.
  
  
  CONCLUSIONS
  Obstructive colorectal malignancy presents at a more advanced stage compared with non-obstructive cancer, with, interestingly, no statistically significant differences in postoperative mortality. Risk factors of poor early outcome couldn't be identified. Resection and primary restitution of continuity is the surgical approach of choice for right-sided obstructive cancers, but it can be, also, safely performed in left-sided cancers.
authors.affiliation: First Department of Surgery and Transplant Unit, Evangelismos General Hospital, Athens, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Papadimitriou
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Manganas
authors.forename: Christos
authors.initials: C
authors.lastname: Phedias Georgiades
authors.forename: Vasileios
authors.initials: V
authors.lastname: Vougas
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Vardas
authors.forename: Spiros
authors.initials: S
authors.lastname: Drakopoulos
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors