Emergency surgery for colorectal cancer (CRC)

Aim: In elective surgery, the recommended oncologic criteria include en-bloc resection of invaded organs and structures, free margins and an adequate number of lymph nodes yielded. The aim of this study was to analyse whether the above criteria were met in emergency surgery. Method: From September 2011 to January 2016 494 patients underwent colonic resection for CRC. Data were collected and statistical analysis was performed with SPSS v13.0; significance was defined as P < 0.05. Results: In the Emergency Group patients had a more advanced cancer stage (51.4% vs 36.0%, P = 0, 0002), but the need for enlarged resection was not significantly different. The number of radical resections (R0) was greater for elective patients (93.4% vs 79.7%, P < 0.001), but the numbers of free distal margins and of excised nodes was similar in two groups. Emergency procedures had a higher morbidity (34.2% vs 31.9%, P = 0.67) and mortality (12.4% vs 1.3%, P < 0.001). Multivariate analysis showed that emergency presentation is an independent predictor both for mortality and morbidity (P = 0.0001~OR = 7.6; p = 0.0220~OR = 1.7), and for R0 resection (P = 0.0002~OR = 3.5) but it is not an independent prognostic factor for distal margins involved and lymph nodes harvest (P = n.s.). Conclusion: Adherence to guidelines for CRC surgery is safe and feasible, but the emergency setting is an independent risk factor for postoperative morbidity and mortality; and is associated with a lower R0 resection rate.