Xu Zhaomin, Becerra Adan Z, Aquina Christopher T, Hensley Bradley J, Justiniano Carla F, Boodry Courtney, Swanger Alex A, Arsalanizadeh Reza, Noyes Katia, Monson John R, Fleming Fergal J
Department of Surgery, University of Rochester Medical Center, 601 Elmwood Avenue Box SURG, Rochester, NY, 14642, USA.
Department of Public Health Sciences, Division of Epidemiology, University of Rochester Medical Center, Rochester, NY, USA.
J Gastrointest Surg. 2017 Mar;21(3):543-553. doi: 10.1007/s11605-017-3355-8. Epub 2017 Jan 12.
The purpose of this study was to examine the long-term overall survival (OS) of colon cancer patients who underwent emergent resection versus patients who were resected electively.
The 2006-2012 National Cancer Data Base was queried for colon cancer patients who underwent surgical resection. Emergent resection was defined as resection within 24 h of diagnosis. A mixed-effects logistic regression was used to estimate the effect of emergent resection on 30- and 90-day mortality. A propensity score-matched mixed-effects Cox proportional-hazards model was used to estimate the effect of emergent resection on 5-year OS.
Two hundred fourteen thousand one hundred seventy-four patients met inclusion criteria, 30% of the cohort had an emergent resection. After controlling for patient and hospital factors, pathological stage, lymph node yield, margin status, and adjuvant chemotherapy, emergent resection was associated with increased odds of 30-day mortality (OR = 1.69, 95% CI = 1.60, 1.78) and hazard of death at 5 years (HR = 1.13, 95% CI = 1.09, 1.15) compared to elective resections.
Emergent resection for colon cancer is independently associated with poor short-term outcomes and decreased 5-year OS compared to elective resection. With 30% of cases in this study emergent, these findings underlie the importance of adherence to colon cancer screening guidelines to limit the need for emergent resections.
本研究的目的是比较接受急诊手术切除的结肠癌患者与接受择期手术切除的患者的长期总生存率（OS）。
查询2006 - 2012年国家癌症数据库中接受手术切除的结肠癌患者。急诊切除定义为在诊断后24小时内进行的切除。采用混合效应逻辑回归估计急诊切除对30天和90天死亡率的影响。采用倾向评分匹配的混合效应Cox比例风险模型估计急诊切除对5年总生存率的影响。
214174例患者符合纳入标准，其中30%的队列接受了急诊切除。在控制患者和医院因素、病理分期、淋巴结清扫数量、切缘状态和辅助化疗后，与择期切除相比，急诊切除与30天死亡率增加（OR = 1.69，95% CI = 1.60，1.78）和5年死亡风险增加（HR = 1.13，95% CI = 1.09，1.15）相关。
与择期切除相比，结肠癌急诊切除独立地与短期预后不良和5年总生存率降低相关。本研究中30%的病例为急诊手术，这些发现凸显了遵守结肠癌筛查指南以限制急诊切除需求的重要性。
