Acute Care and Surgical Risk Assessment

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.

Conflict of interest: None declared.