196 Long-term mortality after emergency laparotomy for malignancy – a single centre, retrospective study

Abstract

Abstract Emergency laparotomy (EmLap) has a variable 30-day mortality rate (8.7-14%) but less is known about the long-term outcomes. We aim to describe long-term mortality in those undergoing EmLap for malignancy, and also to explore whether those who undergo EmLap have an increased incidence of new malignancy. A retrospective single-centre review of a prospectively maintained database of patients undergoing EmLap in 2018 at a district general hospital was performed. Inclusion criteria was per NELA guidelines. Clinical data was assessed from electronic records until December ’22. n=86 patients were identified (Mean age-65.9years) with 33.7% having malignancy at EmLap (n=17 pre-existing, n=12 new diagnoses). 30 day, 90 day and 1 year mortality rates were 10.5%,15.1% and 23.3% respectively, and by time of follow-up, almost half died (48.8%). There was no significant difference in the 30 or 90 day mortality between malignant and benign pathologies, however, the long-term mortality was higher in the malignancy group (1 year-41.4%v12.5%, p=0.002; By-time-of-follow-up -69.0%v27.8%, p<0.0001). The long-term mortality of those with new malignancy at EmLap was higher than those with pre-exisiting malignancy (83.3%v58.8%, p<0.005), with no differences in short term-mortality. n=3 patients developed a new primary malignancy by time of follow-up, including 2 females in their 70s who developed primary lung cancer, which is higher than normal expected rates for this cohort. EmLap for malignancy has higher long-term mortality rates than for benign disease, but there is no difference in short-term mortality. There may be an association between EmLap and developing new malignancy, potentially due to the induced inflammatory response, but larger scale research with an appropriate control group is required.