×
Home Current Archive Editorial board
News Contact
Review paper

Factors affecting mortality in emergency surgery in cases of complicated colorectal cancer

By
Remzi Kızıltan ,
Remzi Kızıltan
Contact Remzi Kızıltan

Department of General Surgery, Dursun Odabaş Medical Center , Van , Turkey

Özkan Yılmaz ,
Özkan Yılmaz
Abbas Aras ,
Abbas Aras
Sebahattin Çelik ,
Sebahattin Çelik
Çetin Kotan
Çetin Kotan

Abstract

Aim
To evaluate retrospectively demographic, clinical and histopathological variables effective on mortality in patients who had
undergone emergency surgery due to complicated colorectal cancer.
Methods
A total of 39 patients underwent urgent surgical interventions due to complicated colorectal cancer at the Department
of General Surgery, Dursun Odabaş Medical Center, between January 2010 and January 2015. Thirty three of these were included in the study. Six patients were excluded because complete medical records had been missing. Medical records of the 33 cases were retrospectively reviewed.
Results
There were 14 (42.5%) male and 19 (57.5%) female patients. Mean age was 60 years (range: 32- 83 years); 14 (42.5%) patients were less than 60 years old , while 19 (57.5%) were 60 years old or older. Operations were performed due to perforation (39.3%) and obstruction (60.6%) in 13 and 20 patients, respectively. Tumor localization was in the right and transverse colon in nine (21.2%) and in the left colon in 24 cases (72.7%). Eleven (33.3%) patients underwent resection and anastomosis, 13 (39.3%) resection and ostomy, and nine (27.2%) patients underwent ostomy alone without any resection. Postoperative mortality occurred in nine cases (27.2%).
Conclusions
High mortality should be expected in females older than 60 years with a left sided colon tumor or with another synchronous tumor and in perforated tumors. Unnecessary major resections should be avoided and primary pathology should be in the focus of treatment in order to decrease the mortality and morbidity
rates. 

References

1.
Mado K, Masuda H, Mazaki T, Ishii Y, Aoki N, Ogame H, et al. The proposal of objective evaluation method of treatment level for patients with colorectal perforation. Jpn J Gastroenterol Surg. 2009;1455–9.
2.
Pampel F, Krueger P, Denney J. Socioeconomic disparities in health behaviors. Annu Rev Sociol. 2010;349–70.
3.
Stewart D, Adams C, Cano M, Correa-Fernández V, Li Y, Waters A, et al. Associations between health literacy and established predictors of smoking cessation. Am J Public Health. 2013;43–9.
4.
Huckle T, You R, Casswell S. Socio-economic status predicts drinking patterns but not alcohol-related consequences independently. Addiction. 2010;1192–202.
5.
Gulliford M, Sedgwick J, Pearce A. Cigarette smoking, health status, socio-economic status and access to health care in diabetes mellitus: a crosssectional survey. BMC Health Serv Res. 2003;4.
6.
Mayor. One in four cases of bowel cancer in England are diagnosed only after emergency admission. BMJ. 2012;7117.
7.
Hwang H. Emergency presentation of colorectal cancer at a regional hospital: an alarming trend? Br Columbia Med J. 2012;83–7.
8.
Goodyear S, Leung E, Menon A, Pedamallu S, Williams N, Wong L. The effects of population based faecal occult blood test screening upon emergency colorectal cancer admissions in Coventry and north Warwickshire. Gut. 2008;218–22.
9.
Liebig C, Ayala G, Wilks J, Verstovsek G, Liu H, Agarwal N, et al. Perineural invasion is an independent predictor of outcome in colorectal cancer. J Clin Oncol. 2009;5131–7.
10.
Betge J, Pollheimer M, Lindtner R, Kornprat P, Schlemmer A, Rehak P, et al. Langner C. Intramural and extramural vascular invasion in colorectal cancer: prognostic significance and quality of pathology reporting. Cancer. 2012;628–38.
11.
Bass G, Fleming C, Conneely J, Martin Z, Mealy K. Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients. Dis Colon Rectum. 2009;678–84.
12.
Wong S, Jalaludin B, Morgan M, Berthelsen A, Morgan A, Gatenby A, et al. Tumor pathology and long-term survival in emergency colorectal cancer. Dis Colon Rectum. 2008;223–30.
13.
Mcardle C, Hole D. Emergency presentation of colorectalcancer is associated with poor 5-year survival. Br J Surg. 2004;605–9.
14.
Quinten C, Martinelli F, Coens C, Sprangers M, Ringash J, Gotay C, et al. Patient Reported Outcomes and Behavioral Evidence (PRO-BE) and the European Organization for Research and Treatment of Cancer (EORTC) Clinical Groups. A global analysis of multi-trial data investigating quality of life and symptoms as prognostic factors for survival in different tumor sites. Cancer. 2013;302–11.
15.
Crucitti F, Sofo L, Doglietto G, Bellantone R, Ratto C, Bossola M, et al. Prognostic factors in colorectal cancer: current status and new trends. J Surg Oncol Suppl. 1991;76–82.
16.
Chen H, Sheen-Chen S. Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery. 2000;370–6.
17.
Tan K, Sim R. Surgery for obstructed colorectal malignancy in an Asian population: predictors of morbidity and comparison between left-and rightsided cancers. J Gastrointest Surg. 2010;295–302.
18.
Tentes A, Mirelis C, Kakoliris S, Korakianitis O, Bougioukas I, Tsalkidou E, et al. Results of surgery for colorectal carcinoma with obstruction. Langenbecks Arch Surg. 2009;49–53.
19.
Edge S, Byrd D, Compton C, Fritz A, Greene F, Trotti A. AJCC Cancer Staging Manual. 2010;
20.
Lewis M, Hendrickson A, Moynihan T. Oncologic emergencies: pathophysiology, presentation, diagnosis, and treatment. CA Cancer J Clin. 2011;287–314.
21.
Scott N, Jeacock J, Kingston R. Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg. 1995;321–3.
22.
Rabeneck L, Paszat L, Li C. Risk factors for obstruction, perforation, or emergency admission at presentation in patients with colorectal cancer: a population-based study. Am J Gastroenterol. 2006;1098–103.
23.
Cameron J, Cameron A. Current Surgical Therapy: Expert consult-online. 11th ed. 2014;213.
24.
Hreinsson J, Jonasson J, Bjornsson E. Bleeding related symptoms in colorectal cancer: a 4-year nationwide population-based study. Aliment Pharmacol Ther. 2014;77–84.
25.
Anantha R, Brackstone M, Parry N, Leslie. An acute care surgery service expedites the treatment of emergency colorectal cancer: a retrospective casecontrol study. World J Emerg Surg. 2014;(9):19.

Citation

Authors retain copyright. This work is licensed under a Creative Commons Attribution 4.0 International License. Creative Commons License

 

Article metrics

Google scholar: See link

The statements, opinions and data contained in the journal are solely those of the individual authors and contributors and not of the publisher and the editor(s). We stay neutral with regard to jurisdictional claims in published maps and institutional affiliations.