M A Gok, PhD, K I Malik, A Jeff, M M Sadat, S J Ward, U A Khan. Macclesfield District General Hospital.
Introduction
Colorectal cancer is the 3rd most common malignancy in men & women in the UK. Colorectal cancer presents as a surgical emergency in 30% of cases as obstruction, perforation, abdominal pain, haemorrhage or sepsis. Emergency colorectal cancer has been associated with high post-operative morbidity & mortality. The aim of the study is to assess emergency colorectal malignant resections at a District General Hospital.
Methods & Procedures
This is a retrospective study carried out since January 2007 till September 2013 at Macclesfield District General Hospital. Descriptive demography, co-morbidities, and surgical outcomes were collected for all elective colorectal resections. A cohort of elective colorectal resections carried out since 2007 were recruited as controls.
| Emergency(n=146) | Elective(n=586)(lap 208:open378) | Man Whitney U test | |
| M:F | 64:82 | 335:251 | p<0.05 |
| Age (yrs) | 74.0 | 71.0 | p<0.05 |
| BMI | 25.1 | 26.1 | NS |
| ASA | 3 | 2 | p<0.05 |
| Op time (mins) | 162.3 | 119.4 | p<0.001 |
| LOS | 12 | 9 | p<0.001 |
| 1st yr survival | 69.7% | 91.6% | Logrank p<0.001 |
| 3rd yr survival | 47.8% | 81.0% | |
| 5th yr survival | 40.3% | 74.0% |
Conclusion
The patients who underwent emergency colorectal resection were generally an older population, with multiple co-morbidities (higher ASA status) and poor outcomes in terms of: longer inpatient stay and reduced survival as compared to the planned elective cases. This study supports the bowel screening initiatives to detect early colorectal cancers. In the emergency situation, an aggressive early management should be employed in the absence of widespread disseminated malignancy