title: Defining characteristics of patients with colorectal cancer requiring emergency surgery.
abstract: BACKGROUND
  Emergency surgery for colorectal cancer has been associated with high mortality. The aim of this study is to determine factors predictive of undergoing emergency surgery, of 30-day mortality, and explore the role of screening in patients undergoing emergency surgery.
  
  
  METHODS
  All patients at our unit, undergoing surgery for colorectal cancer between 2004 and 2014 were included. Data on patient demographics, tumour staging, admission type, comorbidity score, mortality data, and screening data were analysed. Multivariable analyses were carried out to determine predictors of undergoing emergency surgery as well as mortality postoperatively.
  
  
  RESULTS
  A total of 1911 consecutive patients underwent elective and emergency surgery for colorectal cancer. Of the 263 patients who underwent emergency surgery for CRC, 37.3 % (n = 98) had right-sided colonic cancers. Multivariable analyses determined right-sided cancers (OR 2.92, 95 % CI 2.03-4.20, p < 0.001) and stage IV tumours to be independently associated with undergoing emergency surgery (OR 6.64, 95 % CI 2.86-15.42, p < 0.001). Undergoing emergency surgery was an independent predictor of 30-day mortality (OR 9.62, 95 % CI 5.96-15.54, p < 0.001). Of the 50 patients that died within 30 days in the emergency surgery group, 32 % were in patients with right-sided colon cancers. Cancer detection through guaiac faecal occult blood testing (gFOBT) amongst this group is low with six out of nine patients having a false negative gFOBT test.
  
  
  CONCLUSIONS
  Emergency CRC surgery is associated with high mortality. Alternative screening strategies that improve detection of proximal colon cancers may reduce the number of patients undergoing emergency surgery for right-sided cancers.
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Alan
authors.identifier: http://orcid.org/0000-0001-5993-7613
authors.initials: A
authors.lastname: Askari
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: George
authors.initials: G
authors.lastname: Malietzis
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.
authors.forename: Subramanian
authors.initials: S
authors.lastname: Nachiappan
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.|Department of Surgery & Cancer, Imperial College, St Mary's Hospital, Praed Street, London, W21NY, UK.
authors.forename: Anthony
authors.initials: A
authors.lastname: Antoniou
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.|Department of Surgery & Cancer, Imperial College, St Mary's Hospital, Praed Street, London, W21NY, UK.
authors.forename: John
authors.initials: J
authors.lastname: Jenkins
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK.|Department of Surgery & Cancer, Imperial College, St Mary's Hospital, Praed Street, London, W21NY, UK.
authors.forename: Robin
authors.initials: R
authors.lastname: Kennedy
authors.affiliation: Surgical Epidemiology, Trials and Outcome Centre (SETOC), St Mark's Hospital & Academic Institute, Northwick Park, Watford Road, Harrow, Middlesex, HA1 3UJ, UK. omarfaiz@aol.com.|Department of Surgery & Cancer, Imperial College, St Mary's Hospital, Praed Street, London, W21NY, UK. omarfaiz@aol.com.
authors.forename: Omar
authors.initials: O
authors.lastname: Faiz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015897:Comorbidity; D055088:Early Detection of Cancer; D004630:Emergencies; D005260:Female; D006138:Guaiac; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009367:Neoplasm Staging; D009780:Occult Blood; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
chemical_list: D006138:Guaiac
keywords: Colorectal cancer; Guaiac faecal occult blood testing; Mortality