Coco Claudio, Verbo Alessandro, Manno Alberto, Mattana Claudio, Covino Marcello, Pedretti Giorgio, Petito Luigi, Rizzo Gianluca, Picciocchi Aurelio
Department of Surgical Science, Catholic University of the Sacred Heart, Largo A. Gemelli 8, Rome 00161, Italy.
World J Surg. 2005 Nov;29(11):1458-64. doi: 10.1007/s00268-005-7826-9.
The negative results in terms of morbidity, mortality and survival among emergency treated patients affected by colorectal cancer are well known. The specific contribution of emergency surgery to adverse outcome is not clear because of the presence in all series of other possible determinants of a poor prognosis. We used a case-control study design to compare a group of 50 patients operated on for cancer of the rectum and left colon presented as emergencies in our department during the last 14 years, and an equal number of patients who underwent elective procedures during the same period. All records of these patients were reviewed and matched for age, stage, tumor location, and medical comorbidities (coronaropathy, diabetes mellitus, cerebral vascular deficiency, chronic obstructive pulmonary disease). Outcome measures included length of hospital stay, morbidity, mortality, and actuarial 5-year survival. Univariate and multivariate analysis of factors potentially influencing survival was performed on the entire population of 100 patients. Age, tumor location, stage of disease, and medical comorbidities were well matched by intent of the study design. Overall surgical morbidity (44% versus 12% P = 0.0004), length of hospital stay (16, 64 versus 10, 97 days P = 0.0026) and postoperative mortality (4% versus 0% P = 0.4949) resulted higher in the emergency group. Actuarial overall 5-year survival was not different between the two groups. The only variables independently predictive of survival in multivariate analysis were age and rectal location of the tumor. Postoperative surgical mortality and long-term survival appear not to be influenced by emergency presentation of colorectal cancer; the negative impact of the emergency procedures is confined to the immediate postoperative period and is probably connected to the acute medical pathology often presented by patients in emergency situations. Dealing with this kind of patient's accurate preoperative assessment and solution of acute medical pathologies before surgical treatment are mandatory.
结直肠癌急诊治疗患者在发病率、死亡率和生存率方面的负面结果是众所周知的。由于所有系列研究中都存在其他可能导致预后不良的因素，急诊手术对不良结局的具体影响尚不清楚。我们采用病例对照研究设计，比较了过去14年中在我院因直肠癌和左半结肠癌急诊手术的50例患者，以及同期接受择期手术的同等数量患者。对这些患者的所有记录进行了回顾，并在年龄、分期、肿瘤位置和合并症（冠心病、糖尿病、脑血管疾病、慢性阻塞性肺疾病）方面进行了匹配。结局指标包括住院时间、发病率、死亡率和5年精算生存率。对这100例患者的总体人群进行了可能影响生存因素的单因素和多因素分析。根据研究设计的意图，年龄、肿瘤位置、疾病分期和合并症得到了很好的匹配。急诊组的总体手术发病率（44%对12%，P = 0.0004）、住院时间（16.64天对10.97天，P = 0.0026）和术后死亡率（4%对0%，P = 0.4949）更高。两组的5年精算总生存率没有差异。多因素分析中唯一独立预测生存的变量是年龄和肿瘤的直肠位置。结直肠癌的急诊表现似乎不会影响术后手术死亡率和长期生存率；急诊手术的负面影响仅限于术后即刻，可能与急诊患者常出现的急性内科疾病有关。在手术治疗前，对这类患者进行准确的术前评估并解决急性内科疾病是必不可少的。
