Emergency and Elective Surgery for Colorectal Cancer: A Single-Center Experience
Article Sidebar
Main Article Content
Abstract
Objective: Emergency surgical interventions due to colorectal cancer (CRC) obstruction are risk factors for poor prognosis. This study aims to compare emergency and elective surgeries for colorectal tumours performed in a single center.
Material and Methods: CRC patients operated on between November 2014 and November 2019 were included in the study. Patients were divided into two groups; Patients operated under elective conditions, and patients operated under the emergency diagnosis of ileus or acute abdomen.
Results: A total of 103 CRC patients were included in the study. Forty-five (43.7%) were operated in emergency situations, and 58 (56.3%) electively. 45.6% of the emergency cases were found to be Stage 3B and 4 (p=0.009). Bleeding and constipation were more common in elective cases, whereas in emergency cases, applications related to ileus and perforation were quite frequent (p<0.001). It was found that 62.3% of the tumors in emergency cases were seen in sigmoid and rectosigmoid regions (p=0.015). There was no anastomosis in 60.0% of emergency cases (p<0.001).
Conclusion: In the hospital area where the study was applied, compared to other countries, more patients with CRC underwent emergency surgery for intestinal obstruction. Therefore, necessary measures must be taken to prevent further increases in these rates.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Accepted 2022-01-11
Published 2022-01-12
References
Irvin TT. Abdominal pain: a surgical audit of 1190 emergency admissions. Br J Surg. 1989; 76: 1121–5.
Renzulli P, Krähenbühl L, Sadowski C, al-Adili F, Maurer CA, Büchler MW. Modern diagnostic strategy in ileus. Zentralbl Chir. 1998; 123: 1334-9.
Wysocki A, Krzywoń J. Causes of intestinal obstruction. Przegl Lek 2001; 58: 507-508.
Somwaru AS, Philips S. Imaging of uncommon causes of large-bowel obstruction. AJR Am J Roentgenol. 2017; 209(5): 277-86.
World Health Organization. Cancer. WHO. 12 September 2018 (cited at June 8 2020). Available at http://www.who.int/mediacentre/factsheets/fs297/en/.
Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994; 81(9): 1270-6.
Rault A, Collet D, Sa Cunha A, Larroude D, Ndobo’epoy F, Masson B. Surgical management of obstructed colonic cancer. Ann Chir. 2005; 130: 331-5.
Esteva M, Ruiz A, Ramos M, Casamitjana M, Sánchez-Calavera MA, González-Luján L, et al. Age differences in presentation, diagnosis pathway and management of colorectal cancer. Cancer Epidemiol. 2014; 38: 346-53
Haggar FA, Boushey RP. Colorectal cancer epidemiology: Incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg. 2009; 22: 191-7.
Edwards BK, Howe HL, Ries LA, Thun MJ, Rosenberg HM, Yancik R, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S cancer burden. Cancer. 2002; 94: 2766–2792.
Wydra J, Kruszewski W, Jasiński W, Szajewski M, Ciesielski M, Szefel J, et al. Is age a risk factor of postoperative complications in colorectal cancer? Pol Przegl Chir. 2013; 85: 491–495.
Brenner H, Hoffmeister M, Arndt V, Haug U. Gender differences in colorectal cancer: implications for age at initiation of screening. British journal of cancer. 2007; 96(5): 828-831.
Laghousi D, Jafari E, Nikbakht H, Nasiri B, Shamshirgaran M, Aminisani N. Gender differences in health-related quality of life among patients with colorectal cancer. J Gastrointest Oncol. 2019; 10(3): 453-461.
Boyle P, Leon ME. Epidemiology of colorectal cancer. Br Med Bull. 2002; 64(1): 1-25.
Aykan NF, Yalcin S, Turhal NS, Özdoğan, M, Demir G, Özkan M, et al. Epidemiology of colorectal cancer in Turkey:A cross-sectional disease registry study (A Turkish oncology group trial) Turk J Gastroenterol. 2015; 26: 145–53.
Bayar B, Yılmaz KB, Akıncı M, Şahin A, Kulaçoğlu H. An evaluation of treatment results of emergency versus elective surgery in colorectal cancer patients. Ulus Cerrahi Derg. 2016; 32: 11-17.
Ghazi S, Berg E, Lindblom A, Lindforss U. Low-Risk Colorectal Cancer Study Group. Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases. World J Surg Oncol. 2013; 11: 133.
Merkel S, Meyer C, Papadopoulos T, Meyer T, Hohenberger W. Urgent surgery in colon carcinoma. Zentralbl Chir. 2007; 132: 16-25.
Villar JM, Martinez AP, Villegas MT, Muffak K, Mansilla A, Garrote D, et al. Surgical options for malignant left-sided colonic obstruction. Surg Today. 2005; 35: 275-81
Majumdar SR, Fletcher RH, Evans AT. How does colorectal cancer present? Symptoms, duration, and clues to location. Am J Gastroenterol. 1999; 94: 3039–45.
Selvachandran SN, Hodder RJ, Ballal MS, Jones P, Cade D. Prediction of colorectal cancer by a patient consultation questionnaire and scoring system: a prospective study. Lancet. 2002; 360: 278–84.
Astin M, Griffin T, Neal RD, Rose P, Hamilton W. The diagnostic value of symptoms for colorectal cancer in primary care: a systematic review. Br J Gen Pract. 2011; 61(586): 231-243.
Hamilton W, Lancashire R, Sharp D, Peters TJ, Cheng K, Marshall T. The risk of colorectal cancer with symptoms at different ages and between the sexes: a case-control study. BMC Med. 2009;7:17.
Olsson L, Bergkvist L, Ekbom A. Symptom duration versus survival in non-emergency colorectal cancer. Scand J Gastroenterol. 2004; 39(3): 252-8.
Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol. 2004; 13(2-3): 149-157.
Gürlich R, Maruna P, Kalvach Z, Peskova M, Cermak J, Frasko R. Colon resection in elderly patients: comparison of data of a single surgical department with collective data from the Czech Republic. Arch Gerontol Geriatr. 2005; 41: 183-90.
Jiménez Fuertes M, Costa Navarro D. Resection and primary anastomosis without diverting ileostomy for left colon emergencies: is it a safe procedure? World J Surg. 2012; 36: 1148-53.
Hsu TC. Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon. Am J Surg .2005; 189: 384-7.
Capasso L, D’Ambrosio R, Sgueglia S, Carfora E, Casale LS, De Pascale V, et al. Emergency surgery for neoplastic left colon obstruction: resection and primary anastomosis (RPA) versus Hartmann resection (HR). Ann Ital Chir. 2004; 75: 465-70
Ören D, Öztürk G. Kolorektal kanserlerde güncel acil tedavi. Türkiye Klinikleri J Gen Surg-Special Topics. 2009; 2: 127-33.
Seah DW, Ibrahim S, Tay KH. Hartmann procedure: is it still relevant today? ANZ J Surg. 2005; 75: 436-40
Ribeiro IB, de Moura DTH, Thompson CC, de Moura EGH. Acute abdominal obstruction: Colon stent or emergency surgery? An evidence-based review. World J Gastrointest Endosc. 2019; 11(3): 193–208.
Ozturk E, van Iersel M, Stommel MM, Schoon Y, Ten Broek RR, van Goor H. (2018). Small bowel obstruction in the elderly: a plea for comprehensive acute geriatric care. World Journal of Emergency Surgery. 2018; 13(1): 1-8.