Emergency Surgery for Complicated Colorectal Cancer

Abstract

Background/Aims: Emergency procedures for colorectal cancer have worse outcomes than elective resections. Temporal trends in emergency surgery are analyzed by comparing two decade-related series of colorectal cancer patients. Methods: The clinical data of 985 patients undergoing colorectal cancer surgery were collected during two decades (1975–1984 and 1995–2004). Rates of emergency surgery, operative mortality, 5-year cancer-related and overall survival were compared retrospectively. Results: The rate of emergency surgery decreased from 81 out of 513 cases (16%) during 1975–1984 to 41 out of 471 cases (9%) during 1995–2004 (p = 0.005). Over the same time, the rate of curative resections in emergency increased from 46% (37/81 cases) to 76% (31/41 cases) (p < 0.001), while patient and tumor characteristics remained similar. Operative mortality after emergency procedures decreased from 14% (11 deaths) to 5% (2 deaths) and cancer-related survival increased from 21 to 42% (p = 0.03). However, when excluding palliative procedures, survival after emergency surgery increased from 52 to 58%, while after elective treatment it increased from 56 to 78% (p < 0.001). Conclusions: Frequency and operative mortality of emergency colorectal cancer surgery decreased substantially from 1975–1984 to 1995–2004. No significant improvement in long-term survival was observed when curative emergency resections only were considered. Further efforts are needed to reverse the diverging trend of long-term outcomes between emergency and elective curative procedures.