Emergency Surgery and Oncologic Resection for Complicated Colon Cancer: What Can We Expect? A Medium Volume Experience in Romania.

Complicated colon cancer most frequently presents as obstruction and needs emergency surgery. Most of these patients receive their diagnosis when presenting for complicated disease and by that time the disease is usually advanced. While concerned first with the survival of the patient, the curative intent of the resection following the principles of oncologic resection may come in second place. Materials and methods: We retrospectively analyzed 68 consecutive patients with complicated colon cancer that suffered emergency surgery between January 2017 and September 2018. The principles of oncologic resection were analyzed in terms of resection margins and retrieved lymph nodes and/or multivisceral resections in order to achieve clear margins. Intestinal obstruction was observed in 58 patients (85.3%), perforation was found in 8 patients (11.8%) while lower gastrointestinal bleeding complicated 2 cases (2.9%). Twenty-two patients had distant metastases at presentation, and overall 29 patients (42,6%) had stage IV disease. Clear circumferential margins were achieved in 55 cases while longitudinal margins were found to be invaded in 2 cases and the mean number of retrieved lymph nodes was greater than 13.7. The mean hospital stay was 13.9 days and the observed in hospital mortality was 19.1%. The outcomes of surgery for complicated colon cancer in our department fall within the reported literature results. Conclusion: The principles of oncologic resection in terms of surgical margins and retrieved lymph nodescan be respected during emergency surgery and offer the intent of cure for these patients with advanced disease.