The Long-Term Prognostic Outcomes of Emergent Colon Cancer Surgery: A Single-Center Experience.

AIM

Colorectal cancer (CRC) ranks as the second most diagnosed and third most deadly cancer worldwide. Despite advances in early diagnosis and treatment, CRC remains a leading cause of cancer-related deaths. Up to 30% of CRC patients are diagnosed during emergency department visits, leading to surgical procedures that may not adhere to oncological principles due to complications like obstruction, bleeding, or perforation. This study aims to compare postoperative complications and long-term oncological outcomes between emergent and elective colon cancer surgeries.

METHODS

Retrospective analysis was performed on patients who underwent surgery for colonic adenocarcinoma from January 2018 to December 2021. Patients included were those diagnosed with colonic adenocarcinoma, excluding those under 18 years old or with other pathological results. Patients were examined under the elective and emergent surgery groups. The study investigated demographic data, tumor localization, operation type, postoperative complications, and long-term oncological outcomes. A Cox proportional hazard model was used to perform multivariate analysis in order to identify prognostic variables for overall survival (OS) and disease-free survival (DFS).

RESULTS

A total of 318 patients were included, with 62 undergoing emergent surgery and 256 undergoing elective surgery. Patient demographics were similar between the groups. The emergent surgery group had a significantly lower OS rate at 50 months compared to the elective surgery group (51% vs. 62%, p = 0.002). DFS at 50 months was also lower for the emergent surgery group compared to the elective surgery group (43% vs. 59%), but this difference did not reach statistical significance (p = 0.202). Independent poor prognostic factors included stage N, stage M, tumor diameter, neural invasion, and emergent surgery status.

CONCLUSIONS

Emergency surgery for colon cancer is associated with poor long-term outcomes due to shorter OS and DFS, highlighting the need for increased awareness and screening to reduce emergency colon cancer surgery.