Bakker I S, Snijders H S, Grossmann I, Karsten T M, Havenga K, Wiggers T
Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
Colorectal Dis. 2016 Jun;18(6):612-21. doi: 10.1111/codi.13262.
Colon cancer resection in a nonelective setting is associated with high rates of morbidity and mortality. The aim of this retrospective study is to identify risk factors for overall mortality after colon cancer resection with a special focus on nonelective resection.
Data were obtained from the Dutch Surgical Colorectal Audit. Patients undergoing colon cancer resection in the Netherlands between January 2009 and December 2013 were included. Patient, treatment and tumour factors were analysed in relation to the urgency of surgery. The primary outcome was 30-day postoperative mortality.
The study included 30 907 patients. A nonelective colon cancer resection was performed in 5934 (19.2%) patients. There was a 4.4% overall mortality rate, with significantly more deaths after nonelective surgery (8.5% vs 3.4%, P < 0.001). Older patients, male patients and patients with high comorbidity, advanced tumours, perforated tumours, a tumour in the right or transverse colon and postoperative anastomotic leakage were at risk of postoperative death. In nonelective resections, a right-sided tumour and postoperative anastomotic leakage were associated with high mortality.
Nonelective colon cancer resection is associated with high mortality. In particular, right-sided resections and patients with tumour perforation are at particularly high risk. The optimization of patients prior to surgery and expeditious operation after diagnosis might prevent the need for a nonelective resection.
非选择性情况下的结肠癌切除术与高发病率和死亡率相关。这项回顾性研究的目的是确定结肠癌切除术后总体死亡的危险因素，特别关注非选择性切除术。
数据来自荷兰外科结直肠癌审计。纳入2009年1月至2013年12月在荷兰接受结肠癌切除术的患者。分析患者、治疗和肿瘤因素与手术紧迫性的关系。主要结局是术后30天死亡率。
该研究纳入了30907例患者。5934例（19.2%）患者进行了非选择性结肠癌切除术。总体死亡率为4.4%，非选择性手术后死亡人数明显更多（8.5%对3.4%，P<0.001）。老年患者、男性患者以及合并症高、肿瘤晚期、肿瘤穿孔、右半结肠或横结肠癌以及术后吻合口漏的患者有术后死亡风险。在非选择性切除术中，右侧肿瘤和术后吻合口漏与高死亡率相关。
非选择性结肠癌切除术与高死亡率相关。特别是，右侧切除术和肿瘤穿孔患者的风险尤其高。术前优化患者情况并在诊断后迅速手术可能避免非选择性切除的需要。
