Fahim M, Dijksman L M, van der Nat P, Derksen W J M, Biesma D H, Smits A B
Department of Value Based Healthcare, St Antonius Hospital, Nieuwegein, The Netherlands.
Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
Colorectal Dis. 2020 Dec;22(12):1941-1948. doi: 10.1111/codi.15238. Epub 2020 Aug 2.
Emergency surgery is a known predictor for 30-day mortality. However, its relationship with long-term mortality is still a matter of debate. The aim of this study was to analyse the effect of emergency surgery compared with elective surgery on long-term survival.
Data from the Dutch Colorectal Audit and the Dutch Cancer Centre registry of a large nonacademic teaching hospital were used to analyse outcomes of patients who underwent surgery for colon cancer from 2009 until 2017. Univariable and multivariable Cox regression were used to assess the effect of emergency surgery on long-term mortality with adjustment for patient, tumour and treatment characteristics.
A total of 1139 patients with a median follow-up of 40 months (interquartile range 23-65 months) were included. Emergency surgery was performed in 158 patients (14%). The 5-year survival after emergency surgery was 46% compared with 72% after elective surgery. After adjusting for baseline differences there was an independent and significant association between emergency surgery and increased long-term mortality (hazard ratio 1.79, 95% CI 1.28-2.51, P = 0.001).
Emergency surgery for colon cancer seems to lead to a significantly increased risk of long-term mortality compared with elective surgery. Detection and treatment of early symptoms that can lead to emergency surgery might be the way forward.
急诊手术是30天死亡率的已知预测因素。然而，其与长期死亡率的关系仍存在争议。本研究的目的是分析急诊手术与择期手术相比对长期生存的影响。
使用来自荷兰结直肠癌审计以及一家大型非学术教学医院的荷兰癌症中心登记处的数据，分析2009年至2017年接受结肠癌手术患者的结局。采用单变量和多变量Cox回归，在对患者、肿瘤和治疗特征进行调整的情况下，评估急诊手术对长期死亡率的影响。
共纳入1139例患者，中位随访时间为40个月（四分位间距23 - 65个月）。158例患者（14%）接受了急诊手术。急诊手术后的5年生存率为46%，而择期手术后为72%。在对基线差异进行调整后，急诊手术与长期死亡率增加之间存在独立且显著的关联（风险比1.79，95%可信区间1.28 - 2.51，P = 0.001）。
与择期手术相比，结肠癌急诊手术似乎会导致长期死亡率显著增加。发现并治疗可能导致急诊手术的早期症状或许是解决之道。
