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. 2016 Mar 11:16:208.
doi: 10.1186/s12885-016-2239-8.

Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease-free survival: a propensity score analysis

Benjamin Weixler  1 , Rene Warschkow  2   3 , Michaela Ramser  1 , Raoul Droeser  1 , Urs von Holzen  1   4 , Daniel Oertli  1 , Christoph Kettelhack  5
Affiliations

Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease-free survival: a propensity score analysis

Benjamin Weixler et al. BMC Cancer. .

Abstract

Background: It remains a matter of debate whether colorectal cancer resection in an emergency setting negatively impacts on survival. Our objective was therefore to assess the impact of urgent versus elective operation on overall and disease-free survival in patients undergoing resection for colorectal cancer by using propensity score adjusted analysis.

Methods: In a single-center study patients operated for colorectal cancer between 1989 and 2013 were identified from a prospectively maintained database. Median follow-up was 44 months. Patients with neoadjuvant treatment were excluded. The impact of urgent operation on overall and disease-free survival was assessed using both Cox regression and propensity score analyses.

Results: Of 747 patients with colorectal cancer, 84 (11%) had urgent and 663 elective cancer resection. The propensity score revealed strongly biased patient characteristics (0.22 ± 0.16 vs. 0.10 ± 0.09; P < 0.001). In unadjusted analysis urgent operation was associated with a 35% increased risk of overall mortality (hazard ratio(HR) of death = 1.35, 95% confidence interval(CI):1.02-1.78, P = 0.045). In risk-adjusted Cox regression analysis urgent operation was not associated with poor overall (HR = 1.08, 95%CI:0.79-1.48; P = 0.629) or disease-free survival (HR = 1.02, 95%CI:0.76-1.38; P = 0.877). Similarly in propensity score analysis urgent operation did not influence overall (HR = 0.98, 95% CI:0.74-1.29), P = 0.872) and disease-free survival (HR = 0.89, 95%CI:0.68 to 1.16, P = 0.387).

Conclusions: This study provides evidence that worse oncologic outcomes after urgent operation for colorectal cancer are caused by clinical circumstances and not due to the urgent operation itself. Urgent operation is not a risk factor for colorectal cancer resection.

Keywords: Colorectal cancer; Disease-free survival; Emergency surgery; Oncological outcome; Overal survival.

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Figures

Fig. 1
Fig. 1
Kaplan–Meier curve for overall and disease-free survival in unadjusted analysis. The number of colorectal cancer patients at risk are given below each plot. Survival curves are provided with 95 % confidence intervals
Fig. 2
Fig. 2
Distribution of propensity scores before and after propensity score analysis. The left upper and lower panels show the distribution of the propensity scores for patients with urgent and elective operation before the matching procedure. The right upper and lower panels demonstrate the distribution of the propensity scores after bipartite propensity score matching
Fig. 3
Fig. 3
Kaplan–Meier curve for overall and disease-free survival in propensity score adjusted analysis. The number of colorectal cancer patients at risk are given below each plot. Survival curves are provided with 95 % confidence intervals
See this image and copyright information in PMC

References

    1. McArdle CS, Hole DJ. Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg. 2004;91(5):605–9. doi: 10.1002/bjs.4456. - DOI - PubMed
    1. Bass G, Fleming C, Conneely J, Martin Z, Mealy K. Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients. Dis Colon Rectum. 2009;52(4):678–84. doi: 10.1007/DCR.0b013e3181a1d8c9. - DOI - PubMed
    1. Oliphant R, Mansouri D, Nicholson GA, Mcmillan DC, Horgan PG, Morrison DS. Emergency presentation of node-negative colorectal cancer treated with curative surgery is associated with poorer short and longer-term survival. Int J Colorectal Dis. 2014;29:591–8. doi: 10.1007/s00384-014-1847-5. - DOI - PubMed
    1. Chiarugi M, Galatioto C, Panicucci S, Scassa F, Zocco G, Seccia M. Oncologic colon cancer resection in emergency: are we doing enough? Surg Oncol. 2007;16(Suppl 1):S73–7. doi: 10.1016/j.suronc.2007.10.019. - DOI - PubMed
    1. Biondo S, Martí-Ragué J, Kreisler E, Parés D, Martín A, Navarro M, et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg. 2005;189(4):377–83. doi: 10.1016/j.amjsurg.2005.01.009. - DOI - PubMed