Elmessiry Mohamed M, Mohamed Eman Ae
Department of Surgery, Alexandria Faculty of Medicine, Alexandria, Egypt.
Department of Internal Medicine, Alexandria Faculty of Medicine, Alexandria, Egypt.
Ann Med Surg (Lond). 2020 May 13;55:70-76. doi: 10.1016/j.amsu.2020.04.033. eCollection 2020 Jul.
The feasibility and efficacy of emergency curative resection of complicated colorectal cancer is still controversial. This prospective study aim was to assess surgical and oncologic outcomes after emergency compared to elective curative resection of colorectal cancer.
60 consecutive patients presented with complicated colorectal cancer managed by emergency surgery were included and compared to another 155 consecutive patients admitted during the same period with uncomplicated colorectal cancer managed by elective surgery. Both groups were compared regarding curative resection rate, early postoperative mortality and morbidity, 3-years tumor recurrence and survival rates.
Complicated colorectal cancer presented at a more advanced stage with a lower resectability rate and higher postoperative mortality and morbidity rates when compared to uncomplicated ones. Emergency resection of stage I/II colorectal cancer had similar 3-years disease free, overall survival and cancer-specific mortality rates approximating elective. But, emergency resection of stage III tumors had significantly decreased 3-years disease free and overall survival rates although there was no significant increase in cancer specific mortality rate.
Complicated colonic cancers present at a more advanced stage with a lower resectability rate, and higher postoperative morbidity and mortality rates when compared with uncomplicated ones. In medically fit patients, emergency curative resection of complicated colorectal cancer could be done safely with survival outcomes approximating elective resection of uncomplicated cancer in the same stage if proper oncologic resection done by expert surgeon.
复杂性结直肠癌急诊根治性切除的可行性和疗效仍存在争议。本前瞻性研究旨在评估结直肠癌急诊根治性切除与择期根治性切除后的手术及肿瘤学结局。
纳入60例接受急诊手术治疗的复杂性结直肠癌连续患者，并与同期收治的155例接受择期手术治疗的非复杂性结直肠癌连续患者进行比较。比较两组的根治性切除率、术后早期死亡率和发病率、3年肿瘤复发率和生存率。
与非复杂性结直肠癌相比，复杂性结直肠癌处于更晚期阶段，切除率更低，术后死亡率和发病率更高。I/II期结直肠癌的急诊切除与择期切除相比，3年无病生存率、总生存率和癌症特异性死亡率相似。但是，III期肿瘤的急诊切除3年无病生存率和总生存率显著降低，尽管癌症特异性死亡率没有显著增加。
与非复杂性结直肠癌相比，复杂性结肠癌处于更晚期阶段，切除率更低，术后发病率和死亡率更高。对于身体状况良好的患者，如果由专业外科医生进行适当的肿瘤切除，复杂性结直肠癌的急诊根治性切除可以安全进行，生存结局与同期非复杂性癌症的择期切除相近。
