Retrospective Cohort Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pathophysiol. Feb 15, 2018; 9(1): 8-17
Published online Feb 15, 2018. doi: 10.4291/wjgp.v9.i1.8
Emergency resection surgery for colorectal cancer: Patterns of recurrent disease and survival
Joe Littlechild, Muneer Junejo, Anne-Marie Simons, Finlay Curran, Darren Subar
Joe Littlechild, Muneer Junejo, Anne-Marie Simons, Finlay Curran, Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
Darren Subar, Hepatobiliary Surgery Unit, Royal Blackburn Hospital, Blackburn BB2 3HH, United Kingdom
Author contributions: Subar D and Curran F designed the study interpreted findings and prepared manuscript; Littlechild J, Junejo M, Simons AM collected the data, interpreted findings and prepared manuscript.
Institutional review board statement: The study proposal was reviewed, approved and registered by the Audit and Research Department of the Central Manchester Foundation Trust NHS hospital.
Informed consent statement: Patients were not required to give informed consent to the study. Anonymised data was collected and evaluated in a retrospective study following a significant period after primary intervention.
Conflict-of-interest statement: The authors have no conflict of interest.
Data sharing statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Darren Subar, MD, FRCS, Consultant General and Hepatobiliary Surgeon, Hepatobiliary Surgery Unit, Royal Blackburn Hospital, Heslingdon Road, Blackburn BB2 3HH, United Kingdom. darren.subar@elht.nhs.uk
Telephone: +44-1254-735604
Received: March 23, 2017
Peer-review started: March 24, 2017
First decision: May 4, 2017
Revised: November 25, 2017
Accepted: December 4, 2017
Article in press: December 5, 2017
Published online: February 15, 2018
Processing time: 323 Days and 5.7 Hours
Abstract
AIM

To evaluate prognostic pathological factors associated with early metachronous disease and adverse long-term survival in these patients.

METHODS

Clinical and histological features were analysed retrospectively over an eight-year period for prognostic impact on recurrent disease and overall survival in patients undergoing curative resection of a primary colorectal cancer.

RESULTS

A total of 266 patients underwent curative surgery during the study period. The median age of the study cohort was 68 year (range 26 to 91) with a follow-up of 7.9 years (range 4.6 to 12.6). Resection was undertaken electively in 225 (84.6%) patients and emergency resection in 35 (13.2%). Data on timing of surgery was missing in 6 patients. Recurrence was noted in 67 (25.2%) during the study period and was predominantly early within 3 years (82.1%) and involved hepatic metastasis in 73.1%. Emergency resection (OR = 3.60, P = 0.001), T4 stage (OR = 4.33, P < 0.001) and lymphovascular invasion (LVI) (OR = 2.37, P = 0.032) were associated with higher risk of recurrent disease. Emergency resection, T4 disease and a high lymph node ratio (LNR) were strong independent predictors of adverse long-term survival.

CONCLUSION

Emergency surgery is associated with adverse disease free and long-term survival. T4 disease, LVI and LNR provide strong independent predictive value of long-term outcome and can inform surveillance strategies to improve outcomes.

Keywords: Emergency resection, Colorectal cancer, Metachronous disease, Lymph node ratio, Survival

Core tip: Despite increasing uptake of national bowel cancer screening programme in the United Kingdom, majority of patients with colorectal cancer are diagnosed following the urgent 2-wk referral or present as an emergency (53%). Emergency resection surgery for colorectal cancer is associated with a high post-operative morbidity and mortality and adverse long-term survival compared to elective surgery. Although immediate survival may be affected by factors associated with provision of emergency surgery and critical care, long-term disease recurrence and survival is dictated by presence of adverse clinical and histological factors which can guide post-operative surveillance for recurrent disease.