Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Nov 24, 2022; 13(11): 896-906
Published online Nov 24, 2022. doi: 10.5306/wjco.v13.i11.896
Is it possible to adopt the same oncological approach in urgent surgery for colon cancer?
Bruno Yuki Yoshida, Raphael L C Araujo, José Francisco M Farah, Alberto Goldenberg
Bruno Yuki Yoshida, Raphael L C Araujo, José Francisco M Farah, Alberto Goldenberg, Department of Surgery, Federal University of Sao Paulo, Sao Paulo 04024-002, Sao Paulo, Brazil
Bruno Yuki Yoshida, José Francisco M Farah, Department of General and Oncological Surgery, Sao Paulo State Employee Hospital, Sao Paulo 04029-000, Sao Paulo, Brazil
Author contributions: Yoshida BY, Farah JFM, and Goldenberg A contributed to the study conception, data preparation, data interpretation, and writing; Araujo RLC contributed to the data preparation, data interpretation, and critical writing of the paper.
Institutional review board statement: This study was performed with the permission of the institutional review board according to the institutional policy for protected health information.
Conflict-of-interest statement: The authors certify that there is no conflict of interest related to the manuscript.
Data sharing statement: Regarding the manuscript entitled: “Is it possible to achieve the same oncological approach in urgent surgery for colon cancer?”, the original anonymous dataset is available on request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Raphael L C Araujo, MD, PhD, Adjunct Professor, Surgical Oncologist, Department of Surgery, Federal University of Sao Paulo, Rua Napoleao de Barros, 715, Second Floor Vila Clementino, Sao Paulo 04024-002, Sao Paulo, Brazil. raphaellcaraujo@gmail.com
Received: June 30, 2022
Peer-review started: June 30, 2022
First decision: August 1, 2022
Revised: August 16, 2022
Accepted: October 27, 2022
Article in press: October 27, 2022
Published online: November 24, 2022
Processing time: 144 Days and 2.7 Hours
Abstract
BACKGROUND

Locoregional complications may occur in up to 30% of patients with colon cancer. As they are frequent events in the natural history of this disease, there should be a concern in offering an oncologically adequate surgical treatment to these patients.

AIM

To compare the oncological radicality of surgery for colon cancer between urgent and elective cases.

METHODS

One-hundred and eighty-nine consecutive patients with non-metastatic colon adenocarcinoma were studied over two years in a single institution, who underwent surgical resection as the first therapeutic approach, with 123 elective and 66 urgent cases. The assessment of oncological radicality was performed by analyzing the extension of the longitudinal margins of resection, the number of resected lymph nodes, and the percentage of surgeries with 12 or more resected lymph nodes. Other clinicopathological variables were compared between the two groups in terms of sex, age, tumor location, type of urgency, surgical access, staging, compromised lymph nodes rate, differentiation grade, angiolymphatic and perineural invasion, and early mortality.

RESULTS

There was no difference between the elective and urgency group concerning the longitudinal margin of resection (average of 6.1 in elective vs 7.3 cm in urgency, P = 0.144), number of resected lymph nodes (average of 17.7 in elective vs 16.6 in urgency, P = 0.355) and percentage of surgeries with 12 or more resected lymph nodes (75.6% in elective vs 77.3% in urgency, P = 0.798). It was observed that the percentage of patients aged 80 and over was higher in the urgency group (13.0% in elective vs 25.8% in urgency, P = 0.028), and the early mortality was 4.9% in elective vs 15.2% in urgency (P = 0.016, OR: 3.48, 95%CI: 1.21–10.06). Tumor location (P = 0.004), surgery performed (P = 0.016) and surgical access (P < 0.001) were also different between the two groups. There was no difference in other clinicopathological variables studied.

CONCLUSION

Oncological radicality of colon cancer surgery may be achieved in both emergency and elective procedures.

Keywords: Colorectal cancer; Intestinal obstruction; Intestinal perforation; Surgical oncology; Lymph node excision

Core Tip: The oncological radicality was compared between patients undergoing elective and urgent surgery for colon cancer. A total of 189 patients with nonmetastatic colorectal cancer who underwent surgical resection as the first therapeutic approach were included over two years in a single institution. The analysis of the oncological principles of the surgery, including the longitudinal margins of resection and the number of resected lymph nodes, revealed no statistical difference between elective and urgent surgeries. Therefore, the oncological principles of colorectal surgery should be followed in urgency as well as in elective cases.