DOI: 10.4103/wjcs.wjcs_37_23 ISSN: 1941-8213

Emergency Colorectal Cancer Surgery: Is There a Difference in Outcomes between Specialist and Non-Specialist?

Vita Klimasauskiene, Monica Ortenzi, Joseph W. Nunoo-Mensah
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Background:

An emergency presentation of colorectal cancer is expected to be a poor prognostic factor as this mode of presentation usually indicates an advanced disease. The contribution of surgical expertise on the outcome of patients with CRC in an emergency setting is unknown.

Objectives:

An observational study of retrospective collected data of emergency CRC patients who undergo urgent surgical procedures.

Design:

Retrospective study.

Setting:

This study was conducted in the colorectal unit of a tertiary teaching hospital in London, UK.

Patients (Materials) and Methods:

Between 2013 and 2017, all patients who underwent an emergency surgery for CRC were enrolled. One group was operated on by colorectal surgeons (CRS) and the other by acute general surgeons (AGS).

Main Outcome Measures:

Indications for emergency surgery included intestinal bleeding, peritonitis, intra-abdominal abscess, or complete bowel obstruction at presentation. All cases had a preliminary diagnosis of colon cancer. The differences between patients who underwent emergency surgery by CRS and AGS were assessed on four main levels: patient demographics, surgical pathology, and short- and long-term outcomes.

Sample Size:

One hundred and one patients were analyzed, of which 61.4% were male. The median age was 68.2 years, and 71.3% of the patients were operated on by a CRS.

Results:

Sixteen procedures were done laparoscopically, all by CRS ( P = 0.002). CRS were more likely to perform a tumor resection with primary anastomosis ( P = 0.009) and a segmental resection with stoma formation ( P = 0.02) compared to AGS who were more likely to perform palliative procedures ( P = 0.045). Multivariate analysis showed that overall surgical intervention from a CRS correlated with a lower recurrence rate of -1.60 [odds ratio (OR) = 2.36, 95% confidence interval (CI) = 0.84–6.62] and death rate of 0.169 (OR = 0.73, 95% CI = 0.3–1.8); however, these were not statistically significant. The 5-year overall survival rate for stage I and II tumors was statistically significant and in favor of CRS than AGS ( P = 0.003, P < 0.001, respectively).

Conclusions:

We conclude that colorectal surgical expertise influences the procedures performed in an emergency setting and specialty may have an impact on the long-term survival and recurrence rates in CRC.

Limitations:

As a retrospective study, this study has certain limitations. The data for this study was collected from electronic records and databases of patients after they had completed follow-up.

Conflict of Interest:

The authors have no conflict of interest to declare.

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