Skip to main content

Advertisement

SpringerLink
Log in

Emergency surgery for colorectal cancer does not affect nodal harvest comparing elective procedures: a propensity score-matched analysis

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

About 30% of colorectal cancers (CRCs) present with acute symptoms. The adequacy of oncologic resections is a matter of concern since few authors reported that emergency surgery in these patients results in a lower lymph node harvest (LNH). In addition, emergency resections have been reported with a longer hospital stay and higher morbidity rate. We thus conducted a propensity score-matched analysis with the aim of investigating LNH in emergency specimens comparing with elective ones. Secondary aim was the comparison of morbidity and hospital stay.

Methods

Eighty-seven consecutive R0 emergency surgical procedures were matched with elective CRCs using the propensity score method and the following covariates: age, sex, stage, and localization. Groups were compared using univariate and multivariate analyses. Outcome measures were LNH, nodal ratio, Clavien’s morbidity grades, and hospital stay.

Results

Emergency patients presented more metastatic nodes compared with elective ones (p 0.017); however, both presented a comparable mean LNH. Multivariate analysis documented that a T stage ≥3 was the only variable correlated with a nodal positivity (OR 6.3). On univariate analysis, emergency CRCs had a longer mean hospital stay compared with elective resections (p 0.006) and a higher rate of Clavien ≥4 events (p 0.0173). Finally, emergency resection and an age >66 years were variables independently correlated with a mean hospital stay >10 days (OR, respectively, 3.7 and 3.5).

Conclusions

Emergency CRC resections were equivalent to the elective procedures with respect to LNH. However, emergency surgery correlated with a longer mean hospital stay.

Emergency and Elective resections for CRC provide similar LNH.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ansaloni L, Andersson RE, Bazzoli F, Catena F, Cennamo V, Di Saverio S, Fuccio L, Jeekel H, Leppäniemi A, Moore E, Pinna AD, Pisano M, Repici A, Sugarbaker PH, Tuech JJ (2010) Guidelines in the management of obstructing cancer of the left colon: consensus conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society. World J Emerg Surg 5:29. doi:10.1186/1749-7922-5-29

    Article  PubMed  PubMed Central  Google Scholar 

  2. Scott NA, Jeacock J, Kingston RD (1995) Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg 82:321–323

    Article  CAS  PubMed  Google Scholar 

  3. Wong SK, Jalaludin BB, Morgan MJ, Berthelsen AS, Morgan A, Gatenby AH, Fulham SB (2008) Tumor pathology and long-term survival in emergency colorectal cancer. Dis Colon Rectum 51:223–230

    Article  PubMed  Google Scholar 

  4. Ghazi S, Berg E, Lindblom A, Lindforss U, Low-Risk Colorectal Cancer Study Group (2013) Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases. World J Surg Oncol 11:133. doi:10.1186/1477-7819-11-133

    Article  PubMed  PubMed Central  Google Scholar 

  5. Kermani R, Coury JJ, Dao H, Lee JH, Miller PE, Yee D, Contant C, Hackford AW (2013) A practical mortality risk score for emergent colectomy. Dis Colon Rectum 56:467–474

    Article  PubMed  Google Scholar 

  6. Serpell JW, McDermott FT, Katrivessis H, Hughes ES (1989) Obstructing carcinoma of the colon. Br J Surg 76:965–969

    Article  CAS  PubMed  Google Scholar 

  7. Brown SC, Walsh S, Abraham JS, Sykes PA (1991) Risk factors and operative mortality in surgery for colorectal cancers. Ann R Coll Surg Engl 73:269–272

    CAS  PubMed  PubMed Central  Google Scholar 

  8. Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK (2010) Revised TN categorization for colon cancer based on national survival outcomes data. J Clin Oncol 28:264–271. doi:10.1200/JCO.2009.24.0952

    Article  PubMed  Google Scholar 

  9. La Torre M, Mazzuca F, Ferri M, Mari FS, Botticelli A, Pilozzi E, Lorenzon L, Osti MF, Marchetti P, Enrici RM, Ziparo V (2013) The importance of lymph node retrieval and lymph node ratio following preoperative chemoradiation of rectal cancer. Color Dis 15:e382–e388. doi:10.1111/codi.12242

    Article  Google Scholar 

  10. La Torre M, Lorenzon L, Pilozzi E, Barucca V, Cavallini M, Ziparo V, Ferri M (2012) Number of harvested lymph nodes is the main prognostic factor in stage IIa colorectal cancer patients. J Surg Oncol 106:469–474. doi:10.1002/jso.23101

    Article  PubMed  Google Scholar 

  11. Porter GA, Urquhart R, Bu J, Johnson P, Grunfeld E (2011) The impact of audit and feedback on nodal harvest in colorectal cancer. BMC Cancer 11:2. doi:10.1186/1471-2407-11-2

    Article  PubMed  PubMed Central  Google Scholar 

  12. Patel SV, Patel SV, Brackstone M (2014) Emergency surgery for colorectal cancer does not result in nodal understaging compared with elective surgery. Can J Surg 57:349–353

    Article  PubMed  PubMed Central  Google Scholar 

  13. Bass G, Fleming C, Conneely J, Martin Z, Mealy K (2009) Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients. Dis Colon Rectum 52:678–684

    Article  PubMed  Google Scholar 

  14. McArdle CS, Hole DJ (2004) Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 91:605–609

    Article  CAS  PubMed  Google Scholar 

  15. Metcalfe MS, Norwood MG, Miller AS, Hemingway D (2005) Unreasonable expectations in emergency colorectal cancer surgery. Color Dis 7:275–278

    Article  CAS  Google Scholar 

  16. Costa G, Stella F, Venturini L, Tierno SM, Tomassini F, Fransvea P, Frezza B, Bocchetti T, Di Somma S, Balducci G (2013) The usefulness of a trauma registry and the role of the general surgeon in the multidisciplinary approach to trauma patients: 3-year experience at Sant’Andrea University Hospital in Rome. Ann Ital Chir 84:1–8

    PubMed  Google Scholar 

  17. Lorenzon L, Costa G, Massa G, Frezza B, Stella F, Balducci G (2017) The impact of frailty syndrome and risk scores on emergency cholecystectomy patients. Surg Today 47:74–83

    Article  PubMed  Google Scholar 

  18. www.ncepod.org.uk/classification.htlm

  19. Sjo OH, Merok MA, Svindland A, Nesbakken A (2012) Prognostic impact of lymph node harvest and lymph node ratio in patients with colon cancer. Dis Colon Rectum 55:307–315

    Article  PubMed  Google Scholar 

  20. Ferri M, Lorenzon L, Onelli MR, La Torre M, Mercantini P, Virgilio E, Balducci G, Ruco L, Ziparo V, Pilozzi E (2013) Lymph node ratio is a stronger prognostic factor than microsatellite instability in colorectal cancer patients: results from a 7 years follow-up study. Int J Surg 11:1016–1021. doi:10.1016/j.ijsu.2013.05.031

    Article  PubMed  Google Scholar 

  21. Lorenzon L, Montebelli F, Mercantini P, Sebastiani S, Ziparo V, Ferri M (2016) Right colectomy for cancer: a matched comparison of three different surgical approaches. J Investig Surg 29:405–412

    Article  Google Scholar 

  22. Costa G, La Torre M, Frezza B, Fransvea P, Tomassini F, Ziparo V, Balducci G (2014) Changes in the surgical approach to colonic emergencies during a 15-year period. Dig Surg 31:197–203. doi:10.1159/000365254

    Article  PubMed  Google Scholar 

  23. Ho YH, Seow-Choen F, Leong A, Eu KW, Nyam D, Teoh MK (1999) Randomized, controlled trial of low molecular weight heparin vs no deep vein thrombosis prophylaxis for major colon and rectal surgery in Asian patients. Dis Colon Rectum 42:196–202

    Article  CAS  PubMed  Google Scholar 

  24. Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup; American Academy of Orthopaedic Surgeons; American Association of Critical Care Nurses; American Association of Nurse Anesthetists; American College of Surgeons; American College of Osteopathic Surgeons; American Geriatrics Society; American Society of Anesthesiologists; American Society of Colon and Rectal Surgeons; American Society of Health-System Pharmacists; American Society of PeriAnesthesia Nurses; Ascension Health; Association of periOperative Registered Nurses; Association for Professionals in Infection Control and Epidemiology; Infectious Diseases Society of America; Medical Letter; Premier; Society for Healthcare Epidemiology of America; Society of Thoracic Surgeons; Surgical Infection Society (2004) Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 38:1706–1715

    Article  PubMed  Google Scholar 

  25. Jansen JO, O'Kelly TJ, Krukowski ZH, Keenan RA (2002) Right hemicolectomy: mechanical bowel preparation is not required. J R Coll Surg Edinb 47:557–560

    CAS  PubMed  Google Scholar 

  26. Wasey N, Baughan J, de Gara CJ (2003) Prophylaxis in elective colorectal surgery: the cost of ignoring the evidence. Can J Surg 46:279–284

    PubMed  PubMed Central  Google Scholar 

  27. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kyllönen LE (1987) Obstruction and perforation complicating colorectal carcinoma. Acta Chir Scand 153:607–614

    PubMed  Google Scholar 

  29. Runkel N, Schlag P, Schwarz V, Herfarth C (1991) Outcome after emergency surgery for cancer of the large intestine. Br J Surg 78:183–188

    Article  CAS  PubMed  Google Scholar 

  30. Xu Z, Becerra AZ, Aquina CT, Hensley BJ, Justiniano CF, Boodry C, Swanger AA, Arsalanizadeh R, Noyes K, Monson JR, Fleming FJ (2017) Emergent colectomy is independently associated with decreased long-term overall survival in colon cancer patients. J Gastrointest Surg doi. doi:10.1007/s11605-017-3355-8

  31. Biondo S, Martí-Ragué J, Kreisler E, Parés D, Martín A, Navarro M, Pareja L, Jaurrieta E (2005) A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg 189:377–383

    Article  PubMed  Google Scholar 

  32. Sucullu I, Ozdemir Y, Cuhadar M, Balta AZ, Yucel E, Filiz AI, Gulec B (2015) Comparison of emergency surgeries for obstructed colonic cancer with elective surgeries: a retrospective study. Pak J Med Sci 31:1322–1327

    PubMed  PubMed Central  Google Scholar 

  33. Gonsalves WI, Kanuri S, Tashi T, Aldoss I, Sama A, Al-Howaidi I, Ganta A, Kalaiah M, Thota R, Krishnamurthy J, Fang X, Townley P, Ganti AK, Subbiah S, Silberstein PT (2011) Clinicopathologic factors associated with lymph node retrieval in resectable colon cancer: a veterans’ affairs central cancer registry (VACCR) database analysis. J Surg Oncol 104:667–7134

    Article  PubMed  Google Scholar 

  34. Evans MD, Barton K, Rees A, Stamatakis JD, Karandikar SS (2008) The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes’ stage B disease. Color Dis 10:157–164

    CAS  Google Scholar 

  35. Nedrebo BS, Soreide K, Nesbakken A, Eriksen MT, Soreide JA, Korner H, Norwegian Colorectal Cancer Group (2013) Risk factors associated with poor lymph node harvest after colon cancer surgery in a national cohort. Color Dis 15:e301–e308

    Article  CAS  Google Scholar 

  36. Odermatt M, Miskovic D, Siddiqi N, Khan J, Parvaiz A (2013) Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study. World J Surg 37:2458–2467

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Surgical and Medical Department of Translational Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, Via di Grottarossa 1035-39, 00189, Rome, Italy

    Gianluca Costa, Laura Lorenzon, Giulia Massa, Barbara Frezza, Mario Ferri, Pietro Fransvea, Paolo Mercantini & Genoveffa Balducci

  2. Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Faculty of Medicine and Psychology, “Sapienza” University of Rome, Rome, Italy

    Maria Cristina Giustiniani

  3. Department of Pathology, Università Cattolica del Sacro Cuore–Fondazione Agostino Gemelli, Rome, Italy

    Maria Cristina Giustiniani

Authors
  1. Gianluca Costa
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Laura Lorenzon
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giulia Massa
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Barbara Frezza
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Mario Ferri
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Pietro Fransvea
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Paolo Mercantini
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Maria Cristina Giustiniani
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Genoveffa Balducci
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Laura Lorenzon.

Ethics declarations

A formal IRB approval was not required because of the un-interventional retrospective design; however, a signed consent for the treatment and the evaluation of data was obtained from all patients before the surgical procedures both in the elective and in the emergency settings.

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Costa, G., Lorenzon, L., Massa, G. et al. Emergency surgery for colorectal cancer does not affect nodal harvest comparing elective procedures: a propensity score-matched analysis. Int J Colorectal Dis 32, 1453–1461 (2017). https://doi.org/10.1007/s00384-017-2864-y

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-017-2864-y

Keywords

Search

Navigation