EMERGENCY COLECTOMY FOR CANCER: AN ADVERSE FACTOR FOR APPROPRIATE ONCOLOGIC SURGERY?

Introduction: For several variables, the principles of a radical resection for colon and intra-peritoneal rectum tumors are usually very difficult to guarantee in emergency 1,2. The aim of this study was to establish if an oncologically adequate colectomy would be possible in such scenario. Material and methods: We reviewed 576 patients undergone colic resection at our Unit for colon-rectum cancer during 2006-2015. 123 (21 %) were excluded from this study because of a M1 stage. The remaining 453 patients were divided in two groups: 91 (20 %) treated in emergency (Group A) for obstruction (75 %), perforation (18 %) or acute bleeding (7 %) and 362 (80 %) in election (Group B). We compared mean age, ASA score, neoplastic stage, number of lymph nodes removed, mean distal colonic margin, morbidity and mortality. Results: Group A patients were meanly older (A:75.58 yr vs B:70.95 yr, p\0,0001) with a main prevalence of III-IV ASA score (63.7 % vs 44,3 %, p\0,0001). A higher prevalence of Stage III/IV tumors in group A (96.7 %) rather than group B (72.9 %) (p\0.0001) was identified. Both groups had a mean adequate free margin distal to the tumor (A:11.3 cm vs B:10.0 cm, p = NS). The mean number of lymph nodes removed did not differ significantly (A: 32[± 20], B: 28[± 14], p = NS). Morbidity (A:7.6 % vs B:3.8 %, p = NS) and mortality (A:14.3 % vs B:1.1 %, p\0,0001) were higher in Group A. Conclusion: From this study, it emerges that emergency does not appear as an adverse factor for a radical resection of complicated colorectal tumors, even if it is related to a higher mortality.