Advertisement

Acute Care and Surgical Risk Assessment

  • Arezo Kanani
  • Hartwig Kørner
  • Kjetil Soreide
Chapter
Part of the Hot Topics in Acute Care Surgery and Trauma book series (HTACST)

Abstract

Approximately one in five patients with colorectal cancer will present acutely. Typically, these patients are old of age and physiologically deranged and have a more advanced stage of disease at presentation, substantially increasing their morbidity and mortality. A systematic approach to this complicated patient group is advised for better management. First, diagnose the type of pathology causing the emergent condition: obstruction, perforation, or hemorrhage. Second, determine the stage of disease: local, locoregional, or disseminated. Third, determine what are the individual patient characteristics, i.e., physiology, cognitive function, comorbidities, and medications. This information is used to determine the risks and benefits of surgery and plan the next steps of treatment, including advanced directives, after collegial discussion and in accordance with the patient. Some useful tools in assessing risk of surgery are ASA, APACHE II, and POSSUM. Presentation with perforation and sepsis will often require immediate surgery. Patients presenting with obstruction usually have time for resuscitation before definitive surgery is performed. Patients presenting with metastatic disease or clearly having an increased risk of dismal outcome after surgery should more often be candidates for nonsurgical treatment, including involving multidisciplinary palliative team to assure better quality of the remaining lifetime.

Keywords

Emergency surgery Colorectal cancer Surgical risk Frailty Risk score 

References

  1. 1.
    Wallace D, Walker K, Kuryba A, Finan P, Scott N, van Der Meulen J. Identifying patients at risk of emergency admission for colorectal cancer. Br J Cancer. 2014;111(3):577.CrossRefGoogle Scholar
  2. 2.
    Schwenter F, Morel P, Gervaz P. Management of obstructive and perforated colorectal cancer. Expert Rev Anticancer Ther. 2010;10(10):1613–9.CrossRefGoogle Scholar
  3. 3.
    Cuffy M, Abir F, Audisio RA, Longo WE. Colorectal cancer presenting as surgical emergencies. Surg Oncol. 2004;13(2):149–57.CrossRefGoogle Scholar
  4. 4.
    Torrance ADW, Powell SL, Griffiths EA. Emergency surgery in the elderly: challenges and solutions. Open Access Emerg Med. 2015;7:55.PubMedPubMedCentralGoogle Scholar
  5. 5.
    Baer C, Menon R, Bastawrous S, Bastawrous A. Emergency presentations of colorectal cancer. Surg Clin. 2017;97(3):529–45.CrossRefGoogle Scholar
  6. 6.
    Bosscher M, Van Leeuwen B, Hoekstra H. Surgical emergencies in oncology. Cancer Treat Rev. 2014;40(8):1028–36.CrossRefGoogle Scholar
  7. 7.
    Kristjansson SR, Nesbakken A, Jordhøy MS, Skovlund E, Audisio RA, Johannessen H-O, et al. Comprehensive geriatric assessment can predict complications in elderly patients after elective surgery for colorectal cancer: a prospective observational cohort study. Crit Rev Oncol Hematol. 2010;76(3):208–17.CrossRefGoogle Scholar
  8. 8.
    Kristjansson SR, Farinella E, Gaskell S, Audisio RA. Surgical risk and post-operative complications in older unfit cancer patients. Cancer Treat Rev. 2009;35(6):499–502.CrossRefGoogle Scholar
  9. 9.
    Tekkis P, Kessaris N, Kocher H, Poloniecki J, Lyttle J, Windsor A. Evaluation of POSSUM and P‐POSSUM scoring systems in patients undergoing colorectal surgery. Br J Surg. 2003;90(3):340–5.CrossRefGoogle Scholar
  10. 10.
    McArdle C, Hole D. Emergency presentation of colorectal cancer is associated with poor 5‐year survival. Br J Surg. 2004;91(5):605–9.CrossRefGoogle Scholar
  11. 11.
    Helsedirektoratet. Nasjonalt handlingsprogram med retningslinjer for diagnostikk, behandling og oppfølging av kreft i tykktarm og endetarm. Oslo: Helsedirektoratet; 2017.Google Scholar
  12. 12.
    Aunan J, Watson M, Hagland H, Søreide K. Molecular and biological hallmarks of ageing. Br J Surg. 2016;103(2):e29.CrossRefGoogle Scholar
  13. 13.
    Lieffers JR, Mourtzakis M, Hall KD, McCargar LJ, Prado CM, Baracos VE. A viscerally driven cachexia syndrome in patients with advanced colorectal cancer: contributions of organ and tumor mass to whole-body energy demands. Am J Clin Nutr. 2009;89(4):1173–9.CrossRefGoogle Scholar
  14. 14.
    Porporato P. Understanding cachexia as a cancer metabolism syndrome. Oncogenesis. 2016;5(2):e200.CrossRefGoogle Scholar
  15. 15.
    Desserud K, Veen T, Søreide K. Emergency general surgery in the geriatric patient. Br J Surg. 2016;103(2):e52.CrossRefGoogle Scholar
  16. 16.
    Stahel PF. Schein’s common sense emergency abdominal surgery. 4th ed. London: BioMed Central; 2015.Google Scholar
  17. 17.
    McConnell KW, Coopersmith CM. Organ failure avoidance and mitigation strategies in surgery. Surg Clin. 2012;92(2):307–19.CrossRefGoogle Scholar
  18. 18.
    American College of Surgeons Committee on T. Advanced trauma life support: ATLS: student course manual. 9th ed. Chicago, IL: American College of Surgeons; 2012.Google Scholar
  19. 19.
    Maxwell RA, Bell CM. Acute kidney injury in the critically ill. Surg Clin. 2017;97(6):1399–418.CrossRefGoogle Scholar
  20. 20.
    Douglas WG, Uffort E, Denning D. Transfusion and management of surgical patients with hematologic disorders. Surg Clin. 2015;95(2):367–77.CrossRefGoogle Scholar
  21. 21.
    Van PY, Schreiber MA. Hematologic issues in the geriatric surgical patient. Surg Clin. 2015;95(1):129–38.CrossRefGoogle Scholar
  22. 22.
    Biffl WL, Biffl SE. Rehabilitation of the geriatric surgical patient: predicting needs and optimizing outcomes. Surg Clin. 2015;95(1):173–90.CrossRefGoogle Scholar
  23. 23.
    Hübner M, Hahnloser D. Perioperative management. Coloproctology. New York, NY: Springer; 2017. p. 409–19.Google Scholar
  24. 24.
    Pelosi P, Gregoretti C. Perioperative management of obese patients. Best Pract Res Clin Anaesthesiol. 2010;24(2):211–25.CrossRefGoogle Scholar
  25. 25.
    Richards CH, Leitch FE, Horgan PG, McMillan DC. A systematic review of POSSUM and its related models as predictors of post-operative mortality and morbidity in patients undergoing surgery for colorectal cancer. J Gastrointest Surg. 2010;14(10):1511–20.CrossRefGoogle Scholar
  26. 26.
    American Society of Anesthesiologists. ASA physical status classification system. Washington, DC: American Society of Anesthesiologists; 2014. Available from: https://www.asahq.org/resources/clinical-information/asa-physical-status-classification-system.Google Scholar
  27. 27.
    Daabiss M. American Society of Anaesthesiologists physical status classification. Indian J Anaesth. 2011;55(2):111.CrossRefGoogle Scholar
  28. 28.
    Oliver C, Walker E, Giannaris S, Grocott M, Moonesinghe S. Risk assessment tools validated for patients undergoing emergency laparotomy: a systematic review. Br J Anaesth. 2015;115(6):849–60.CrossRefGoogle Scholar
  29. 29.
    Al-Homoud S, Purkayastha S, Aziz O, Smith JJ, Thompson MD, Darzi AW, et al. Evaluating operative risk in colorectal cancer surgery: ASA and POSSUM-based predictive models. Surg Oncol. 2004;13(2-3):83–92.CrossRefGoogle Scholar
  30. 30.
    Søreide K, Desserud KF. Emergency surgery in the elderly: the balance between function, frailty, fatality and futility. Scand J Trauma Resusc Emerg Med. 2015;23(1):10.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Arezo Kanani
    • 1
  • Hartwig Kørner
    • 1
    • 2
  • Kjetil Soreide
    • 1
    • 2
    • 3
  1. 1.Department of Gastrointestinal SurgeryStavanger University HospitalStavangerNorway
  2. 2.Clinical MedicineUniversity of BergenBergenNorway
  3. 3.Clinical SurgeryUniversity of Edinburgh and Royal Infirmary of EdinburghEdinburghUK

Personalised recommendations