Researchers from the University of Sao Paulo in Brazil examined the oncological resection principles affecting outcomes in emergency surgical treatment of patients with advanced colorectal cancer. The study titled “Can we respect the principles of oncologic resection in an emergency surgery to treat colon cancer?” was published in the World Journal of Emergency Surgery.
According to a study published in CA: A Cancer Journal for Clinicians, Colorectal Cancer (CC) is the third most frequent type of cancer and the second cause of death by cancer in both men and women. Colorectal Cancer estimations are of approximately 850,000 new cases and 500,000 deaths per year worldwide. Despite early detection improvements, 6% to 30% of patients with CC have symptoms or late complications requiring an emergency intervention. Patients admitted to emergency wards usually have cancer in an advanced stage and undergo resection. Colorectal cancer surgical interventions to address an acute obstruction are associated with a mortality of 15% to 20% and a morbidity of 40% to 50%. These high rates are usually related to appearance of CC in its more complicated forms: obstruction, intestinal necrosis, perforation, diffuse or localized peritonitis, which could also be aggravated by others diseases that some patients already suffer from.
Under these circumstances, it needs to be considered if the principles of oncologic resection are observed when colon cancer patients are subjected to an emergency resection. Dr. Frederico Teixeira and colleagues from the São Paulo University School of Medicine in Brazil assessed a total of 87 patients with adenocarcinoma of colon and/or upper rectum submitted to an emergency surgical resection. In their retrospective study, the researchers review the extent of resection performed, the number of dissected regional lymph nodes and the overall survival rate.
Results revealed that 67 patients had intestinal obstruction with perforation observed in 20 patients. Of the specimens examined, seven had circumferential compromised margins (from patients in T4) and poor disease outcome. From all the patients examined, 71% were found to have 12 or more dissected regional lymph nodes. Results also showed that the median stay in the ICU was of 3 days while morbidity and peri-operative mortality stood was of 33.6% and 20%, respectively.
Based on these results, researchers indicate that the outcome of an emergency surgery of colorectal cancer is similar to that found in current available evidence.