Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Institute of Pathology, University of Bern, Bern, Switzerland.
Int J Colorectal Dis. 2019 Dec;34(12):2091-2099. doi: 10.1007/s00384-019-03426-8. Epub 2019 Nov 11.
Long-term outcomes in patients undergoing emergency versus elective resection for colorectal cancer (CRC) are discussed controversially. This study aims to assess long-term outcomes of emergency versus elective CRC surgery.
Single-center retrospective cohort study. Patients undergoing emergency or elective CRC surgery from July 2002 to January 2013 were included. Primary outcome was 5-year survival, secondary outcomes were in-hospital mortality and local tumor recurrence.
Overall, 475 patients were included. Median age was 69.0 (IQR 59.0-77.0) years. A total of 141 patients (30%) were operated for rectal cancer and 334 patients (70%) for colon cancer. Median follow-up was 445 (IQR 67-1409) days. Emergency resection was performed in 105 patients (22%) due to obstruction, perforation, or bleeding. Stage IV tumors and ASA scores≥ 3 were significantly more frequent in the emergency than in the elective resection group (39.0% vs. 33.5%, p < 0.001; 75.5% vs. 61.3%, p = 0.003). The rate of patients with positive lymph nodes was similar in the two groups (46.2% vs. 46.3%, p = 1.000). In-hospital mortality was significantly higher in the emergency CRC versus the elective CRC group (8.4% vs. 3.0%, p = 0.023). Five-year survival (aHR 1.38; 95%CI 0.81-2.37, p = 0.237) or local tumor recurrence (aHR 1.48; 95%CI 0.47-4.66, p = 0.500) were not significantly different in patients undergoing emergency versus elective surgery for CRC.
In-hospital mortality was increased in emergency versus elective CRC resections. However, 5-year survival and local recurrence after surgery for CRC were determined by the tumor stage, and not by the emergency versus elective setting of surgical resection.
对于接受紧急或择期结直肠癌（CRC）切除术的患者，其长期预后存在争议。本研究旨在评估紧急与择期 CRC 手术的长期预后。
单中心回顾性队列研究。纳入 2002 年 7 月至 2013 年 1 月期间接受紧急或择期 CRC 手术的患者。主要结局为 5 年生存率，次要结局为住院死亡率和局部肿瘤复发。
共纳入 475 例患者。中位年龄为 69.0（IQR 59.0-77.0）岁。其中 141 例（30%）为直肠肿瘤患者，334 例（70%）为结肠肿瘤患者。中位随访时间为 445（IQR 67-1409）天。105 例（22%）患者因梗阻、穿孔或出血而接受紧急手术。与择期手术组相比，紧急手术组中 IV 期肿瘤和 ASA 评分≥3 的患者明显更多（39.0%比 33.5%，p<0.001；75.5%比 61.3%，p=0.003）。两组患者阳性淋巴结的比例相似（46.2%比 46.3%，p=1.000）。紧急 CRC 手术的住院死亡率明显高于择期 CRC 手术组（8.4%比 3.0%，p=0.023）。5 年生存率（aHR 1.38；95%CI 0.81-2.37，p=0.237）或局部肿瘤复发（aHR 1.48；95%CI 0.47-4.66，p=0.500）在接受紧急与择期 CRC 手术的患者中无显著差异。
与择期 CRC 切除术相比，紧急 CRC 切除术的住院死亡率增加。然而，CRC 手术后的 5 年生存率和局部复发率取决于肿瘤分期，而不是手术切除的紧急与择期情况。
