Antony Pia, Harnoss Julian C, Warschkow Rene, Schmied Bruno M, Schneider Martin, Tarantino Ignazio, Ulrich Alexis
Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany.
Department of General, Visceral, Endocrine and Transplantation Surgery, Cantonal Hospital St. Gallen, Switzerland.
J Surg Oncol. 2019 Jun;119(8):1170-1178. doi: 10.1002/jso.25469. Epub 2019 Apr 12.
Despite advances in early detection of colon cancer, a minority of patients still require urgent surgery. Whether such urgent conditions result in poor outcome remains a topic of debate.
Using a prospectively maintained database, patients suffering exclusively from colon cancer and receiving either elective or emergent resection between 2001 and 2014 were analyzed with respect to overall, disease-specific, and relative survival using Cox regression and propensity score analyses.
From a total of 877 patients analyzed, 2.7% (24) presented with complications requiring urgent surgery. Propensity-scoring identified strongly biased patient characteristics (0.097 ± 0.069 vs 0.028 ± 0.043; P < 0.001). An unadjusted Cox proportional hazards regression analysis revealed urgent surgery as a statistically significant prognostic factor with an approximately 207% increased risk of mortality (hazard ratio [HR] = 3.07; 95% confidence interval [CI]: 1.62-5.81; P = 0.003). After adjusting the data according to the propensity score analysis, urgent surgery was not associated with a decreased overall (HR = 1.67; 95%CI; 0.84-3.36; P = 0.174), disease-specific (HR = 1.62; 95% CI; 0.81-3.24; P = 0.201) or relative survival (HR = 1.86; 95% CI: 0.92-3.79; P = 0.086).
After risk-adjustment, using multivariable Cox regression and propensity score analyses, no significant disadvantage could be noted with regard to overall, disease-specific, or relative survival in patients with exclusively colon cancer who received emergent oncological resection.
尽管结肠癌的早期检测取得了进展，但仍有少数患者需要紧急手术。这种紧急情况是否会导致不良预后仍是一个有争议的话题。
使用一个前瞻性维护的数据库，对2001年至2014年间仅患有结肠癌并接受择期或急诊切除术的患者进行分析，采用Cox回归和倾向评分分析评估其总生存率、疾病特异性生存率和相对生存率。
在总共分析的877例患者中，2.7%（24例）出现需要紧急手术的并发症。倾向评分显示患者特征存在强烈偏差（0.097±0.069对0.028±0.043；P<0.001）。未经调整的Cox比例风险回归分析显示，紧急手术是一个具有统计学意义的预后因素，死亡风险增加约207%（风险比[HR]=3.07；95%置信区间[CI]：1.62-5.81；P=0.003）。根据倾向评分分析对数据进行调整后，紧急手术与总生存率降低（HR=1.67；95%CI；0.84-3.36；P=0.174）、疾病特异性生存率降低（HR=1.62；95%CI；0.81-3.24；P=0.201）或相对生存率降低（HR=1.86；95%CI：0.92-3.79；P=0.086）均无关联。
在进行风险调整后，使用多变量Cox回归和倾向评分分析，对于仅患有结肠癌且接受急诊肿瘤切除术的患者，在总生存率、疾病特异性生存率或相对生存率方面未发现明显劣势。
