Kim Hyun Ho, Hwang Sanguk, Cho Jinbeom
Department of Surgery, Bucheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Artificial Intelligence, The Catholic University of Korea, Bucheon, Republic of Korea.
Langenbecks Arch Surg. 2025 Feb 22;410(1):81. doi: 10.1007/s00423-025-03653-4.
Emergency surgery in patients with colorectal cancer (CRC) is associated with elevated mortality and morbidity compared to elective operations. This study was conducted to identify the factors influencing both short and long term outcomes in emergent CRC operations, particularly in critically ill patients.
This single center retrospective analysis focuses on patients with stage III or higher CRC who underwent emergency surgery and were admitted to the intensive care unit postoperatively.
Among 64 patients, 46 presented with generalized peritonitis due to free perforation. Non-survivors at 90 days had a higher incidence of preoperative shock (53.3% vs. 4.1%, P = 0.000), elevated perioperative Sequential Organ Failure Assessment scores (P = 0.000; P = 0.013), and fewer retrieved lymph nodes (LN) (P = 0.010). Multivariate analysis identified LNs retrieval as a significant predictor of 90-day mortality (AUC = 0.727). For overall survival, younger age, lower American Society of Anesthesiologists (ASA) physical status, absence of metastasis, adjuvant chemotherapy (CTx), and lower LN ratio (LNR) were associated with improved outcomes. Multivariate analysis showed ASA physical status and adjuvant CTx as significant predictors. In predicting 3-year recurrence (51% of patients), the Random Forest model achieved 65% accuracy. Age and LNR were major predictors, with 0.01 unit increase in LNR raising recurrence risk by 1.025-fold and each additional year of age by 1.035-fold.
The number of retrieved LNs was identified as a predictor of 90 day survival, ASA physical status and adjuvant CTx were identified as prognostic factors for overall survival, and age and the LNR were found to be predictors of disease recurrence within three years.
与择期手术相比，结直肠癌（CRC）患者的急诊手术死亡率和发病率更高。本研究旨在确定影响急诊CRC手术短期和长期预后的因素，尤其是危重症患者。
本单中心回顾性分析聚焦于接受急诊手术且术后入住重症监护病房的III期或更高分期CRC患者。
64例患者中，46例因游离穿孔出现弥漫性腹膜炎。90天内的非幸存者术前休克发生率更高（53.3%对4.1%，P = 0.000），围手术期序贯器官衰竭评估评分升高（P = 0.000；P = 0.013），且获取的淋巴结（LN）数量更少（P = 0.010）。多因素分析确定LN获取是90天死亡率的重要预测因素（AUC = 0.727）。对于总生存期，年龄较小、美国麻醉医师协会（ASA）身体状况评分较低、无转移、辅助化疗（CTx）以及较低的LN比率（LNR）与较好的预后相关。多因素分析显示ASA身体状况和辅助CTx是重要预测因素。在预测3年复发率（51%的患者）时，随机森林模型的准确率达到65%。年龄和LNR是主要预测因素，LNR每增加0.01单位，复发风险增加1.025倍，年龄每增加一岁，复发风险增加1.035倍。
获取的LN数量被确定为90天生存的预测因素，ASA身体状况和辅助CTx被确定为总生存的预后因素，年龄和LNR被发现是三年内疾病复发的预测因素。
