Short term outcome after emergency and elective surgery for colon cancer

Abstract

Objective: Emergency presentation of colon cancer is common, and it is associated with high mortality and morbidity following initial surgical treatment. The purpose of this study was to evaluate postoperative mortality and complications in a consecutive and population based series. Methods: All patients with adenocarcinoma of the colon diagnosed between 1993 and 2007 were registered prospectively. Mortality and complication rates for elective and emergency patients were compared. Logistic regression analysis was used to identify independent risk factors for postoperative complications. Results: In the study period 1129 patients were admitted, 237 (21 %) of whom presented as an emergency. A total of 1001 (89%) patients underwent surgical treatment; 926 patients (82%) had a major resection, and the mortality rate was 3.5 % after elective and 10 % after emergency operation (p<0.01). The complication rate was 24 % and 38 % (p< 0.01), respectively. In patients with left sided obstruction, the mortality rate after Hartmann’s procedure was 19 % as compared to 3 % after resection with primary anastomosis (p< 0.01). Following surgery without tumour resection, the mortality was 17 % and 24 % after elective and emergency operation, respectively. Multivariate analyses demonstrated that emergency operation, increasing age, advanced tumour stage and ASA class IV were independent risk factors for postoperative mortality. Conclusions: Emergency operation for colon cancer was associated with high mortality and complication rates also in this series, indicating that immediate surgery should be avoided if possible. Resection with primary anastomosis is probably preferable to Hartmann’s procedure in left sided colon obstruction if non-operative treatment by endoluminal stenting fails.