[Surgical treatment of carcinoma of the left colon and rectum as an emergency. A new method for assessing operative risk].

BACKGROUND/AIMS: The surgical treatment of the left colon and rectal cancer emergencies is still controversial. In our opinion the choices to be based on the general health status of the patient.

METHODOLOGY

The authors analysed a series of 63 patients submitted to immediate resection and anastomosis.

RESULTS

Factors significantly related to short term results were chronic heart disease, low albumin serum levels, and colonic perforation. The presence of a diverting colostomy did not provide a protective factor against anastomotic dehiscence. We constructed a Colorectal Tumours Emergencies Score made of the identified four factors in which the score of each factor is the approximated odds ratio (chronic renal failure 7 points, low albumin serum levels 6 points, heart disease 5 points, colon perforation 4 points). Each patient was classified as Low Risk (CTES < 4), Moderate Risk (CTES 4-12), High Risk (CTES > 12), mortality and morbidity being 4% and 20%, 19.3% and 61.3%, 88.9% and 88.9% respectively.

CONCLUSIONS

High risk patients may undergo a staged procedure. Moderate risk patients may be treated by immediate resection of the tumor, without anastomosis. Immediate resection and anastomosis may be reserved to low risk patients.