Short-term outcome of emergency colorectal cancer surgery: results from Bi-National Colorectal Cancer Audit
- 197 Downloads
A significant number of patients with colorectal cancer will have an emergency presentation requiring surgery. This study aims to evaluate short-term outcomes for patients undergoing emergency colorectal cancer surgery in Australasia.
All consecutive CRC from the Bi-National Colorectal Cancer Audit Database was interrogated from 2007 to 2016. Short-term outcomes including length of stay, complication rate and mortality rate were compared between the emergency and elective groups. Logistic regression analysis was performed to identify independent predictors for inpatient mortality. A predictive model for inpatient mortality was constructed using these variables, and its accuracy was then validated by the Bootstrap re-sampling method.
Of 15,676 colorectal cancer cases identified, 13.6% were emergency cases. The emergency group had a higher rate of surgical and medical complications (26.7% vs 22.6%, p < 0.001; 22.8 vs 13.8%, p < 0.001, respectively). Higher inpatient mortality rate was also observed in the emergency group (3.4% vs 2.6%, p = 0.023). Independent predictors for inpatient survival included age, American Society Anaesthesiologists score, emergency surgery and tumour stage. In addition, postoperative complications such as anastomotic leak (odds ratio [OR] 3.78, p < 0.001), sepsis (OR 2.85, p < 0.001) and medical complications (OR 13.88, p < 0.001) had a significant impact in survival in the emergency group. Receiver operating characteristics curve for inpatient mortality was 0.913.
Emergency colorectal cancer surgery carries significant morbidity and mortality. Recognition of the increasing rate of postoperative complications may help minimise the detrimental impact of this event on overall outcomes.
KeywordsEmergency colorectal surgery Colorectal cancer Postoperative outcome
We would like to acknowledge and thank the Bi-National Colorectal Cancer Audit and all the surgeons who contribute to the audit, without whom this study would not be possible. We thank Epworth Healthcare for all the support and assistance.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Ghazi S, Berg E, Lindblom A, Lindforss U, Low-Risk Colorectal Cancer Study Group (2013) Low-risk colorectal Cancer study group. Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases. World J Surg Oncol 11(1):133CrossRefPubMedPubMedCentralGoogle Scholar
- 7.Heriot A, Platell C, Byrne C, et al The Bi-National Colorectal Cancer Audit Report 2017. http://bcca.registry.org.au. Accessed 25/4/2018
- 8.Faiz O, Warusavitarne J, Bottle A, Tekkis PP, Clark SK, Darzi AW, Aylin P (2010) Nonelective excisional colorectal surgery in English National Health Service Trusts: a study of outcomes from hospital episode statistics data between 1996 and 2007. J Am Coll Surg 210(4):390–401CrossRefPubMedGoogle Scholar
- 9.National Bowel Cancer Audit Annual Report 2016 Version 2. https://www.acpgbi.org.uk/content/uploads/2016/07/nati-clin-audi-bowe-canc-2016-rep-v2.pdf. Accessed 25/4/2018
- 14.Oliphant R, Nicholson GA, Horgan PG, Molloy RG, McMillan DC, Morrison DS, in collaboration with the West of Scotland Colorectal Cancer Managed Clinical Network (2013) Contribution of surgical specialization to improved colorectal cancer survival. Br J Surg 100(10):1388–1395CrossRefPubMedGoogle Scholar
- 15.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(927)Google Scholar
- 17.Hewitson P, Glasziou PP, Irwig L et al (2007) Screening for colorectal cancer using the faecal occult blood test, Hemoccult. Cochrane Database Syst Rev (1):CD001216Google Scholar
- 19.Lew JB, St John DJB, Xu XM, Greuter MJE, Caruana M, Cenin DR, He E, Saville M, Grogan P, Coupé VMH, Canfell K (2017) Long-term evaluation of benefits, harms, and cost-effectiveness of the National Bowel Cancer Screening Program in Australia: a modelling study. Lancet Public Health 2(7):e331–e340CrossRefPubMedGoogle Scholar
- 22.The Second Patient Report of the National Emergency Laparotomy Audit (NELA) (2016) http://www.nela.org.uk/Second-Patient-Report-of-the-National-Emergency-Laparotomy-Audit#pt. Accessed 25/4/18