Risk factors for urgent complications of colorectal cancer

Abstract

Objective: to identify the main factors associated with an increased risk of urgent complications of colorectal cancer. Materials and methods. This retrospective cohort study included 214 patients with colorectal cancer who had undergone emergency surgery in Smolensk hospitals between January 2016 and January 2020. Their median age was 66 years. We analyzed patients’ sociodemographic characteristics (sex, age, settings (urban or rural), education, employment, profession, and family status), disease history, clinical characteristics (type of urgent complication, comorbidities), morphological tumor characteristics (histological type, pTNM stage, pattern of tumor growth (exo- or endophytic, mixed), tumor length along the intestine (<4 cm, 4–7 cm, >7 cm), presence of lymph node metastases and distant metastases). Multivariate logistic regression was used to analyze factors that were independently associated with an increased risk of decompensated intestinal obstruction and colon perforation. Results. The most significant risk factors for decompensated intestinal obstruction included T4 stage (odds ratio (OR) 3.19; 95 % confidence interval (CI) 1.66–7.12; p <0.001), high-grade tumor G3–G4 (OR 2.93; 95 % CI 0.89–3.97; p = 0.008), and presence of competing diseases (OR 2.03; 95 % CI 1.84–2.39; p <0.001). The risk of perforation was higher among patients with T4 tumors (OR 3.74; 95 % CI 2.61–5.48; p <0.001), lymph node involvement (N+) (OR 1.61; 95 % CI 1.33–2.01; p <0.001), high-grade tumors G3–G4 (OR 3.56; 95 % CI 2.08–4.93; p <0.001), and diabetes mellitus requiring insulin therapy (OR 2.11; 95 % CI 1.78–2.42; p <0.001). Conclusion. Elderly patients with stage III and IV colorectal cancer and high comorbidity are more likely do develop urgent complications, such as decompensated acute intestinal obstruction or tumor perforation.