Emergency presentation of node-negative colorectal cancer treated with curative surgery is associated with poorer short and longer-term survival

Abstract

The majority of patients with node-negative colorectal cancer have excellent 5-year survival prospects, but up to a third relapse. Strategies to identify patients at higher risk of adverse outcomes are desirable to enable optimal treatment and follow-up. The aim of this study was to examine postoperative mortality and longer-term survival by mode of presentation for patients with node-negative colorectal cancer undergoing surgery with curative intent. Patients from 16 hospitals in the west of Scotland between 2001 and 2004 were identified from a prospectively maintained regional clinical audit database. Postoperative mortality and 5-year relative survival by mode of presentation were recorded. Of 1,877 patients with node-negative disease, 251 (13.4%) presented as an emergency. Those presenting as an emergency were more likely to be older (P = 0.023), have colon rather than rectal cancer (P < 0.001), have pT4 stage disease (P < 0.001), have extramural vascular invasion (P = 0.001), and receive surgery under the care of a nonspecialist surgeon (P < 0.001) compared to those presenting electively. The postoperative mortality rate was 3.3% after elective and 12.8% after emergency presentation (P < 0.001). Five-year relative survival was 91.8% after elective and 66.8% after emergency presentation (P < 0.001). The adjusted relative excess risk ratio for 5-year relative survival after emergency relative to elective presentation was 2.59 (95% CI 1.67-4.01; P < 0.001) and 1.90 (95% CI 1.00-3.62; P = 0.049) after exclusion of postoperative deaths. Emergency presentation of node-negative colorectal cancer treated with curative intent was independently associated with higher postoperative mortality and poorer 5-year relative survival compared to elective presentation.