Comparison of resected lymph nodes and additional factors in colorectal cancer patients undergoing emergency versus elective surgery

Abstract

Aims: Controversy persists regarding the number of lymph nodes (LNs) that should be removed during surgery for accurate colorectal carcinoma (CRC) staging and its impact on prognosis. The effects of other prognostic factors on survival, such as the metastatic LN to resected LN (LNR) ratio and the type of surgical approach, were retrospectively examined. Methods: A total of 325 patients who underwent emergency or elective surgery for CRC between March 1st, 2019, and December 31st, 2022, were included in the study. Age, sex, tumor location, stage, number of resected LNs, number of metastatic LNs, presence of distant metastases, distance of the tumor from the surgical margins, need for ostomy opening, development of postoperative complications, and level of tumor markers at diagnosis were recorded for patient records. Results: The data of 142 (43.7%) emergency surgery patients and 183 (56.3%) elective surgery patients were compared. It was revealed that there was a positive relationship between the removal of at least 22 LNs during surgery and survival (p = 0.036). Factors such as age, a high LNR, emergency surgery, advanced stage of CRC, and not receiving adjuvant chemotherapy were significant predictors of increased mortality (age: hazard ratio (HR): 1.03, 95% CI: 1.01–1.05, p < 0.001; LNR: HR: 4.74, 95% CI: 1.69–13.3, p = 0.003; emergency surgery: HR: 2.33, 95% CI: 1.51–3.59, p < 0.001; advanced stage: HR: 3.24, 95% CI: 1.81–5.79, p < 0.001; adjuvant chemotherapy: HR: 4.93, 95% CI: 2.94–8.25, p < 0.001) in the patients with CRC. Conclusion: Patients with CRC, who had fewer LN dissections, perforation-related peritonitis, advanced disease, were not receiving adjuvant chemotherapy, and emergency surgery, had a worse prognosis.