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 23 November 2017

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News

Emergency surgery for colon carcinoma

Emergency surgery has a strong negative influence on immediate surgical morbidity and mortality, find researchers in the January issue of Diseases of the Colon and Rectum.

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Emergency surgery for colon cancer is thought to be associated with increased likelihood of surgical morbidity and mortality. However, other coexistent factors such as advanced disease, patient age, and medical comorbid conditions may influence these outcomes.

In this study, researchers from Dallas, Texas, sought to identify the relative risk for surgical morbidity and/or mortality conferred by emergency surgery, compared with elective surgery for patients with colon cancer.

Between 1995 and 2001, a total of 184 primary surgeries for colon cancer were performed.

The team defined emergency indications for surgery as peritonitis, intra-abdominal abscess, or complete bowel obstruction at presentation.

Of the 184 patients, 29 were included in the study. Their indications for emergency surgery were 6 cases of peritonitis, 2 abscesses, and 21 complete obstructions.

The research team matched the study patients with 29 derived from the remaining 155 patients.

Among patients surviving surgery, there was no difference in overall survival between emergency and elective operations.
Diseases of the Colon and Rectum

They collected data on surgical morbidity and mortality, length of stay, and survival.

Age, medical comorbidities, and stage of disease were well matched between groups.

Of the 29 study patients, 9 did not have their primary tumor removed, 16 underwent resection and anastomosis, and 4 underwent a Hartmann's procedure.

The researchers found that overall surgical morbidity (64% versus 24%) and mortality (34% versus 7%) were significantly higher for patients undergoing emergency surgery.

However, among patients surviving surgery, there was no difference in overall survival between patients undergoing emergency compared with elective operation.

Dr Lane Smothers's team concluded, "Emergency surgery has a strong negative influence…on immediate surgical morbidity and mortality".

"The similarity between the 2 groups in overall survival for patients surviving the perioperative period suggests that the negative impact of emergency surgery is confined to the immediate postoperative period."

Dis Colon Rectum 2003; 46(1): 24-30
23 January 2003

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