Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes - 13/02/15
Abstract |
Background |
Emergency presentation with colon cancer is intuitively related to advanced disease. We measured its effect on outcomes of surgically treated colon cancer.
Methods |
A retrospective cohort of 1,071 surgical colon cancer patients (2004 to 2011), with 102 emergency cases requiring surgery within the index admission, was analyzed.
Results |
Emergency patients required longer surgeries (median 141 vs 124 minutes; P = .04), longer median admissions (8% vs 5%; P < .001), more readmissions (12.7% vs 7.1%; P = .040), and perioperative mortality (7.8% vs .8%; P < .001). Surgical pathology displayed higher rates of node-positive disease (56.6% vs 38.6%; P < .001), extramural vascular invasion (39.6% vs 29.1%; P = .021), and metastatic disease (19.6% vs 8%; P < .001). Consequently, adjusting for staging, emergency presentations had considerably higher mortality (odds ratio = 2.07; P = .003) and shorter disease-free survival (hazard ratio = 1.39; P = .042).
Conclusions |
Emergency presentation is a stage-independent poor prognostic factor associated with aggressive tumor biology, resulting in longer surgeries and admissions, frequent readmissions, worsening outcomes, and increasing healthcare costs.
Le texte complet de cet article est disponible en PDF.Highlights |
• | We measured the impact of emergency presentation on outcomes of surgically treated colon cancer. |
• | Our retrospective cohort of 1,071 patients (2004 to 2011) included 102 emergency cases. |
• | Emergency patients had higher rates of complicated admissions and readmissions. |
• | Emergency patients had considerably higher stage-adjusted mortality and recurrence rates. |
• | Emergency presentation is a stage-independent poor prognostic factor in colon cancer. |
Keywords : Emergency surgery, Colon cancer, Survival, Disease-free survival, Pathology, Perioperative outcomes
Plan
| This work was conducted with support from Harvard Catalyst, The Harvard Clinical and Translational Science Center (National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health Award 8UL1TR000170-05, and financial contributions from Harvard University and its affiliated academic healthcare centers). The content is solely the responsibility of the authors and does not necessarily represent the official views of Harvard Catalyst, Harvard University, and its affiliated academic healthcare centers, or the National Institutes of Health. This work was also supported in part by the Dutch Cancer Society, the Dutch Digestive Society, the Amsterdam University Funds, the Royal Netherlands Academy of Arts and Sciences, and the Fulbright Foundation. |
|
| There were no relevant financial relationships or any sources of support in the form of grants, equipment, or drugs. |
Vol 209 - N° 2
P. 246-253 - février 2015 Retour au numéro
Article précédent
- Measuring the impact of the American College of Surgeons Oncology Group Z0011 trial on breast cancer surgery in a community health system
- Gerald Paul Wright, Megan E. Mater, Holly L. Sobel, Gregory M. Knoll, Leon D. Oostendorp, Marianne K. Melnik, Mathew H. Chung
- Prevalence of frailty and its association with mortality in general surgery
- Jonathan Hewitt, Susan J. Moug, Maeve Middleton, Mohua Chakrabarti, Micheal J. Stechman, Kathryn McCarthy, Older Persons Surgical Outcomes Collaboration
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?