Emergency resection surgery for colorectal cancer: Patterns of recurrent disease and survival

Table 1 Site of primary tumour and histological features in 266 curative resections for colorectal cancer n (%)

Tumour site
Rectum	115 (43.23)
Recto-sigmoid junction	2 (0.75)
Sigmoid	64 (24.06)
Descending/splenic flexure	7 (2.63)
Transverse colon	14 (5.26)
Ascending/hepatic flexure	15 (5.64)
Caecum	49 (18.42)
Tumour size1
T1	8 (3.00)
T2	54 (20.30)
T3	121 (45.49)
T4	66 (24.81)
Missing	18 (6.77)
Nodal status and invasion1
N0	154 (57.89)
N1	65 (24.43)
N2	30 (11.28)
LVI (data missing in 15)	60 (22.56)
PNI (data missing in 15)	14 (5.26)
Resection margin (data missing in 16)
R0	229 (86.09)
R1	14 (5.26)
R2	7 (2.63)
Tumour differentiation (data missing in 17)
Well	22 (8.27)
Moderately	176 (66.17)
Poor	51 (19.17)

¹Values given in parenthesis are percentages. Disease staging was based on postoperative histology findings and stage was not compared with preoperative radiological staging or post neoadjuvant therapy. T: Tumour size; N: Nodal status; LVI: Lymphovascular invasion; PNI: Perineural invasion; R: Resection margin.

Table 2 Patient characteristics for emergency and elective colorectal cancer resection

Variables	Emergency surgery	Elective surgery	P2
n	35	225
Median age in years	70 (41-85)	68 (26-91)	NS
Sex (males/females)	20/15	128/97	NS
Site of CRC			-
Right colon	17 (48.6%)	56 (24.8%)	< 0.001
Left colon	15 (42.9%)	58 (25.8%)	NS
Rectum	3 (8.6%)	111 (49.3%)	< 0.001
Obstruction	26 (74.3%)	21 (0.9%)	< 0.001
Right colon	15 (42.9%)	1 (0.4%)	-
Left colon	10 (28.6%)	0	-
Rectum	1 (2.9%)	1 (0.4%)	-
Perforation	9 (25.7%)	0	< 0.001
Right colon	2 (5.7%)	0	-
Left colon	5 (14.3%)	0	-
Rectum	2 (5.7%)	0	-
Neoadjuvant therapy	1 (2.9%)	53 (23.6%)	0.021
Adjuvant therapy	16 (45.7%)	65 (28.8)	0.047
Poorly differentiated	5 (14.3%)	44 (19.6%)	NS
T4 disease	18 (51.4%)	46 (20.4%)	< 0.001
Positive resection margin	2 (5.7%)	19 (8.4%)	NS
N2 disease	15 (42.9%)	78 (34.7%)	NS
Liver metastasis	16 (42.1%)	30 (13.3%)	< 0.001
Early (< 3 yr)	14 (40.0%)	26 (11.6%)	-
Lung metastasis	3 (8.6%)	10 (4.4%)	NS
Early (< 3 yr)	3 (8.6%)	8 (3.6%)	-
Local metastasis	1 (2.9%)	9 (4.0%)	NS
Early (< 3 yr)	1 (2.9%)	6 (2.7%)	-
Overall recurrence	17 (48.6%)	47 (21.3%)	0.001
Median recurrence in days	280 (112-1155)	420 (70-1855)	NS
Median DFS in days	1120 (105-3892)	2302 (704522)	0.004
Median survival in days	1913 (105-3892)	2359 (194-4522)	0.040

¹Subacute obstructed were managed as a planned resection. Six patients were excluded for missing data from the study cohort of 266 patients;

²Significance at P < 0.05. CRC: Colorectal cancer; DFS: Disease free survival; NS: Not significant.

Table 3 Site of early (< 3 yr) and overall recurrent disease during follow-up

Site of recurrence	Early recurrence (n = 55)	Colonic cancer (n = 151)	Rectal cancer (n = 115)	P1
Liver	41 (74.55%)	25	16	0.554
Lung	11 (20.00%)	6	5	0.879
Local	7 (12.73%)	4	3	0.984
> 1 site	8 (14.55%)	4	4	0.695

¹Significance at P < 0.05, colonic cancer vs rectal cancer. Number in parenthesis is percentage unless stated otherwise.

Table 4 Prognostic factors for early liver recurrence

Early liver recurrence	B	SE		OR	95%CI
T4	0.453	0.440	0.303	1.574	0.664-3.729
N2	0.706	0.540	0.191	2.025	0.703-5.831
LVI	0.974	0.456	0.033	2.648	1.084-6.468
PNI	0.735	0.700	0.294	2.085	0.529-8.214
R1	0.954	0.726	0.189	2.597	0.626-10.777
Obstruction	1.385	0.514	0.007	3.995	1.457-10.949
Perforation	1.958	0.781	0.012	7.086	1.533-32.749

B: Regression coefficient; SE: Standard error; OR: Odds ratio; T: Tumour size; N: Nodal status; LVI: Lymphovascular invasion; PNI: Perineural invasion; R: Resection margin.