SURGERY FOR COLO-RECTAL CANCER: ADEQUACY OF NODAL STAGING IN AN EMERGENCY SETTING.

Background: It is a commonly held belief that in emergency surgery is not rare an inadequate lymphadenectomy resulting in pathologically understaged or indeterminate staging of the patient. Consequently some patients may not receive a necessary adjuvant chemotherapy or be subjected to unnecessary therapy. Methods: From September 2011 to May 2015, 483 patients were admitted in our Unit with the diagnosys of colo-rectal cancer. Four-hundred and fifty-five underwent to radical resection and were enrolled in this study. One-hundred and fifty-seven patients (35%) required an emergency operation (Group 1) and 298 (65%) had elective surgery (Group 2). Patients information were entered into a database: age and sex, tumor site, type of resection, laparoscopic versus open approach, stage, number of nodes and adequacy of lymph-node harvest (adequacy >= 12 lymph-nodes harvested). Statistical analysis was performed with SPSS v13; significance was defined as p< 0,05. Results: In Group 1, tumor sites were: right-sided 46%, left sided 45% and 9 % rectum. In Group 2, tumor sites were right-sided 38%, left sided 31% and 31 % rectum. These differences were statistically significant. The number of nodes harvested was similar in the two groups (Group 1: 18,3±9,2 nodes; Group 2: 18,7±10,1 nodes, p=0,97). The adequacy of lymph node harvest was 95% in Group 1 and 89% in Group 2. Thus the adequacy of lymphadenectomy was better in Group 1, however these differences were not statistically significant (p=0,60). The number of nodes harvested and the adequacy of lymphadenectomy were not influenced by the type of surgical approach (laparoscopic versus open surgery). Group 1 patients had a more advanced cancer stage (stage III/IV 47,1% vs. 36,0%, p=0,0006), but the need for enlarged resection was not significantly different in the two groups. Conclusions: Our data didn’t show significant differences in nodes harvesting in emergency colo-rectal surgery compared to elective surgery. Adequacy of lymphadenectomy is comparable in the two settings.