Emergency versus elective colorectal resections management: A single centre experience

M A Gok, S J Ward, M M Sadat, U A Khan. Macclesfield District General Hospital

Introduction Colorectal cancer (CRC) is the 3rd most common & the 2nd most lethal cancer in men & women in the UK. Colorectal cancer presents as a surgical emergency in < 30% of cases; obstruction, perforation, abdominal pain, haemorrhage or sepsis. Emergency CRC has been associated with high post-operative morbidity & mortality. The aim of the study is to assess emergency colorectal malignant resections a District General Hospital

Materials & Methods This is a retospective study carried out since January 2008 at Macclesfield District General Hospital. Patient factors, histopathology & surgical outcomes were evaluated for all emergency colorectal resections. A cohort of elective maligant colorectal resections carried out since 2008 were recruited as controls.

Discussion CRC is more common in males; however emergency presentation of CRC is less predictable. Prolonged operative time in elective cases is attributed to the use of laparoscopy. Emergency CRC patientswere generally ill patients (ASA 3) with sepsis. The greater LB specimen size reflects more diseased LB resections in the emergency CRC resections. Consequently the survival was poorer in the emergency CRC resections.This study supports the bowel screeing initiatives to detect early CRC's.

Results
Emergency CRC (n=144) Elective CRC (n=595) Mann Whitney U test (p value)
Age (yrs) 70.5 71.2 NS
Sex (M : F) 66 : 78 340 : 255 < 0.05
ASA 3 2 < 0.05
Weight (kg) 69.3 74.8 < 0.05
BMI 24.9 26.9 NS
Appendix / Ileum 10 8
Caecum 37 113
Ascending 12 48
Tranverse 27 55
Descending 12 10
Sigmoid 33 123
Rectosigmoid 7 34
Rectum 6 204
Stoma 38 172 NS
Op Time (min) 122.2 163.1 < 0.05
Small bowel length (mm) 118.2 93.7 NS
Large bowel length (mm) 333.3 266.4 < 0.05
Diverticulosis (n) 30 NS
Synchronous tumours (n) 15 93 NS
LN harvest (median) 13 14 NS
LOS (days) 11 9 < 0.05
1st yr survival 69.3 % 92.1 % Logrank p < 0.05
3rd yr survival 47.9 % 81.5 % Logrank p < 0.05
5th yr survival 42.7 % 75.3 % Logrank p < 0.05

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