International Journal of Colorectal Disease

, Volume 33, Issue 11, pp 1525–1532 | Cite as

Long-term oncological outcomes following emergency resection of colon cancer

  • Kerollos Nashat WanisEmail author
  • Michael Ott
  • Julie Ann M. Van Koughnett
  • Patrick Colquhoun
  • Muriel Brackstone
Original Article



The relationship between emergency colon cancer resection and long-term oncological outcomes is not well understood. Our objective was to characterize the impact of emergency resection for colon cancer on disease-free and overall patient survival.


Data on patients undergoing resection for colon cancer from 2006 to 2015 were collected from a prospectively maintained clinical and administrative database. The median follow-up time was 4.4 years. Cox proportional hazards models were used to estimate the hazard ratios for recurrence and death for patients treated with surgery for an emergent presentation. Differences in initiation of, and timeliness of, adjuvant chemotherapy between emergently and electively treated patients were also examined.


Of the 1180 patients who underwent resection for stages I, II, or III colon cancer, 158 (13%) had emergent surgery. After adjustment for patient, tumor, and treatment characteristics, the HR for recurrence was 1.64 (95% CI 1.12–2.40) and for death was 1.47 (95% CI 1.10–1.97). After adjustment for tumor characteristics, patients who underwent emergency resection were similarly likely to receive adjuvant chemotherapy (OR 1.1; 95% CI 0.70–1.76). The time from surgery to initiation of adjuvant chemotherapy was also similar between the groups.


Emergency surgery for localized or regional colon cancer is associated with a greater risk of recurrence and death. This association does not appear to be due to differences in adjuvant treatment. A focus on screening and colon cancer awareness in order to reduce emergency presentations is warranted.


Colon cancer Emergency surgery Recurrence Survival 


Compliance with ethical standards

The database was designed for administrative and research purposes with approval of the Western University Research Ethics Board (REB), and this specific study was also approved.


  1. 1.
    Haggar F, Boushey R (2009) Colorectal cancer epidemiology: incidence, mortality, survival, and risk factors. Clin Colon Rectal Surg 22:191–197CrossRefGoogle Scholar
  2. 2.
    McPhail S, Elliss-Brookes L, Shelton J, Ives A, Greenslade M, Vernon S, Morris EJA, Richards M (2013) Emergency presentation of cancer and short-term mortality. Br J Cancer 109:2027–2034CrossRefGoogle Scholar
  3. 3.
    Shah NA, Halverson J, Madhavan S (2013) Burden of emergency and non-emergency colorectal cancer surgeries in West Virginia and the USA. J Gastrointest Cancer 44:46–53CrossRefGoogle Scholar
  4. 4.
    Chen Y-L, Chang W-C, Hsu H-H, Hsu C-W, Lin Y-Y, Tsai S-H (2013) An evolutionary role of the ED: outcomes of patients with colorectal cancers presenting to the ED were not compromised. Am J Emerg Med 31:646–650CrossRefGoogle Scholar
  5. 5.
    Sjo OH, Larsen S, Lunde OC, Nesbakken A (2009) Short term outcome after emergency and elective surgery for colon cancer. Color Dis 11:733–739CrossRefGoogle Scholar
  6. 6.
    Iversen LH, Antonsen S, Laurberg S, Lautrup MD (2009) Therapeutic delay reduces survival of rectal cancer but not of colonic cancer. Br J Surg 96:1183–1189CrossRefGoogle Scholar
  7. 7.
    Bass G, Fleming C, Conneely J, Martin Z, Mealy K (2009) Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: a review of 356 consecutive Irish patients. Dis Colon rectum 52:678–684CrossRefGoogle Scholar
  8. 8.
    McArdle CS, Hole DJ (2004) Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 91:605–609CrossRefGoogle Scholar
  9. 9.
    In collaboration with the West of Scotland Colorectal Cancer Managed Clinical Network, Oliphant R, Mansouri D, Nicholson GA, McMillan DC, Horgan PG, Morrison DS (2014) Emergency presentation of node-negative colorectal cancer treated with curative surgery is associated with poorer short and longer-term survival. Int J Color Dis 29:591–598Google Scholar
  10. 10.
    Chiarugi M, Galatioto C, Panicucci S, Scassa F, Zocco G, Seccia M (2007) Oncologic colon cancer resection in emergency: are we doing enough? Surg Oncol 16:73–77CrossRefGoogle Scholar
  11. 11.
    Biondo S, Martí-Ragué J, Kreisler E, Parés D, Martín A, Navarro M, Pareja L, Jaurrieta E (2005) A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg 189:377–383CrossRefGoogle Scholar
  12. 12.
    Anderson JH, Hole D, McArdle CS (1992) Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 79:706–709CrossRefGoogle Scholar
  13. 13.
    Smothers L, Hynan L, Fleming J, Turnage R, Simmang C, Anthony T (2003) Emergency surgery for colon carcinoma. Dis Colon rectum 46:24–30CrossRefGoogle Scholar
  14. 14.
    Cuffy M, Abir F, Audisio RA, Longo WE (2004) Colorectal cancer presenting as surgical emergencies. Surg Oncol 13:149–157CrossRefGoogle Scholar
  15. 15.
    Coco C, Verbo A, Manno A, Mattana C, Covino M, Pedretti G, Petito L, Rizzo G, Picciocchi A (2005) Impact of emergency surgery in the outcome of rectal and left colon carcinoma. World J Surg 29:1458–1464CrossRefGoogle Scholar
  16. 16.
    Formisano V, Di Muria A, Connola G, Cione G, Falco L, De Angelis CP, Angrisani L (2014) Our experience in the management of obstructing colorectal cancer. Ann Ital Chir 85:563–568PubMedGoogle Scholar
  17. 17.
    Kelly M, Sharp L, Dwane F, Kelleher T, Comber H (2012) Factors predicting hospital length-of-stay and readmission after colorectal resection: a population-based study of elective and emergency admissions. BMC Health Serv Res 12:77CrossRefGoogle Scholar
  18. 18.
    Abdelrazeq AS, Scott N, Thorn C, Verbeke CS, Ambrose NS, Botterill ID, Jayne DG (2008) The impact of spontaneous tumour perforation on outcome following colon cancer surgery. Color Dis 10:775–780CrossRefGoogle Scholar
  19. 19.
    Jiang JK, Lan YT, Lin TC, Chen WS, Yang SH, Wang HS, Chang SC, Lin JK (2008) Primary vs. delayed resection for obstructive left-sided colorectal cancer: impact of surgery on patient outcome. Dis Colon rectum 51:306–311CrossRefGoogle Scholar
  20. 20.
    Weixler B, Warschkow R, Ramser M, Droeser R, von Holzen U, Oertli D, Kettelhack C (2016) Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease-free survival: a propensity score analysis. BMC Cancer 16:208CrossRefGoogle Scholar
  21. 21.
    Xu Z, Becerra AZ, Aquina CT, Hensley BJ, Justiniano CF, Boodry C, Swanger AA, Arsalanizadeh R, Noyes K, Monson JR, Fleming FJ (2017) Emergent colectomy is independently associated with decreased long-term overall survival in colon cancer patients. J Gastrointest Surg 21:543–553CrossRefGoogle Scholar
  22. 22.
    Pruitt SL, Davidson NO, Gupta S, Yan Y, Schootman M (2014) Missed opportunities: racial and neighborhood socioeconomic disparities in emergency colorectal cancer diagnosis and surgery. BMC Cancer 14:927CrossRefGoogle Scholar
  23. 23.
    Denny K, Davidson MJ (2012) Area-based socio-economic measures as tools for health disparities research, policy and planning. Can J Public Health 103:S4–S6PubMedGoogle Scholar
  24. 24.
    Harrell Jr FE, Harrell Jr MFE (2018) Package ‘Hmisc.’ R Found. Stat. ComputGoogle Scholar
  25. 25.
    Moons KGM, Donders RART, Stijnen T, Harrell FE (2006) Using the outcome for imputation of missing predictor values was preferred. J Clin Epidemiol 59:1092–1101CrossRefGoogle Scholar
  26. 26.
    Amri R, Bordeianou LG, Sylla P, Berger DL (2014) Treatment delay in surgically-treated colon cancer: does it affect outcomes? Ann Surg Oncol 21:3909–3916CrossRefGoogle Scholar
  27. 27.
    Kye B-H, Lee YS, Cho H-M, Kim JG, Oh ST, Lee IK, Kang WK, Ahn CH, Lee SC, Park JK, Kim HJ (2016) Comparison of long-term outcomes between emergency surgery and bridge to surgery for malignant obstruction in right-sided colon cancer: a multicenter retrospective study. Ann Surg Oncol 23:1867–1874CrossRefGoogle Scholar
  28. 28.
    Patel SV, Patel SVB, Brackstone M (2014) Emergency surgery for colorectal cancer does not result in nodal understaging compared with elective surgery. Can J Surg J Can Chir 57:349–353CrossRefGoogle Scholar
  29. 29.
    Ha GS, Kim YW, Choi EH, Kim IY (2017) Factors associated with the lack of adjuvant chemotherapy following curative surgery for stage II and III colon cancer: a Korean National Cohort Study. Anticancer Res 37:915–922CrossRefGoogle Scholar
  30. 30.
    Pande R, Leung E, McCullough P, Smith S, Harmston C (2014) Impact of the United Kingdom national bowel cancer awareness campaign on colorectal services. Dis Colon rectum 57:70–75CrossRefGoogle Scholar
  31. 31.
    Scholefield JH, Robinson MH, Mangham CM, Hardcastle JD (1998) Screening for colorectal cancer reduces emergency admissions. Eur J Surg Oncol 24:47–50CrossRefGoogle Scholar
  32. 32.
    Libby G, Brewster DH, Steele RJC (2014) Impact of faecal occult blood test screening on emergency admissions and short-term outcomes for colorectal cancer: faecal occult blood test screening for colorectal cancer. Br J Surg 101:1607–1615CrossRefGoogle Scholar
  33. 33.
    Hwang M-J, Evans T, Lawrence G, Karandikar S (2014) Impact of bowel cancer screening on the management of colorectal cancer. Color Dis 16:450–458CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Kerollos Nashat Wanis
    • 1
    Email author
  • Michael Ott
    • 1
  • Julie Ann M. Van Koughnett
    • 1
  • Patrick Colquhoun
    • 1
  • Muriel Brackstone
    • 1
  1. 1.Department of SurgeryWestern University, London Health Sciences CentreLondonCanada

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