Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
International Journal of Colorectal Disease
Erschienen in:

28.07.2017 | Original Article

Emergency surgery for colorectal cancer does not affect nodal harvest comparing elective procedures: a propensity score-matched analysis

verfasst von: Gianluca Costa, Laura Lorenzon, Giulia Massa, Barbara Frezza, Mario Ferri, Pietro Fransvea, Paolo Mercantini, Maria Cristina Giustiniani, Genoveffa Balducci

Erschienen in: International Journal of Colorectal Disease | Ausgabe 10/2017

Einloggen, um Zugang zu erhalten

Abstract

Purpose

About 30% of colorectal cancers (CRCs) present with acute symptoms. The adequacy of oncologic resections is a matter of concern since few authors reported that emergency surgery in these patients results in a lower lymph node harvest (LNH). In addition, emergency resections have been reported with a longer hospital stay and higher morbidity rate. We thus conducted a propensity score-matched analysis with the aim of investigating LNH in emergency specimens comparing with elective ones. Secondary aim was the comparison of morbidity and hospital stay.

Methods

Eighty-seven consecutive R0 emergency surgical procedures were matched with elective CRCs using the propensity score method and the following covariates: age, sex, stage, and localization. Groups were compared using univariate and multivariate analyses. Outcome measures were LNH, nodal ratio, Clavien’s morbidity grades, and hospital stay.

Results

Emergency patients presented more metastatic nodes compared with elective ones (p 0.017); however, both presented a comparable mean LNH. Multivariate analysis documented that a T stage ≥3 was the only variable correlated with a nodal positivity (OR 6.3). On univariate analysis, emergency CRCs had a longer mean hospital stay compared with elective resections (p 0.006) and a higher rate of Clavien ≥4 events (p 0.0173). Finally, emergency resection and an age >66 years were variables independently correlated with a mean hospital stay >10 days (OR, respectively, 3.7 and 3.5).

Conclusions

Emergency CRC resections were equivalent to the elective procedures with respect to LNH. However, emergency surgery correlated with a longer mean hospital stay.
Literatur
1.
Ansaloni L, Andersson RE, Bazzoli F, Catena F, Cennamo V, Di Saverio S, Fuccio L, Jeekel H, Leppäniemi A, Moore E, Pinna AD, Pisano M, Repici A, Sugarbaker PH, Tuech JJ (2010) Guidelines in the management of obstructing cancer of the left colon: consensus conference of the World Society of Emergency Surgery (WSES) and Peritoneum and Surgery (PnS) Society. World J Emerg Surg 5:29. doi:10.​1186/​1749-7922-5-29 CrossRefPubMedPubMedCentral
2.
Scott NA, Jeacock J, Kingston RD (1995) Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg 82:321–323CrossRefPubMed
3.
Wong SK, Jalaludin BB, Morgan MJ, Berthelsen AS, Morgan A, Gatenby AH, Fulham SB (2008) Tumor pathology and long-term survival in emergency colorectal cancer. Dis Colon Rectum 51:223–230CrossRefPubMed
4.
5.
Kermani R, Coury JJ, Dao H, Lee JH, Miller PE, Yee D, Contant C, Hackford AW (2013) A practical mortality risk score for emergent colectomy. Dis Colon Rectum 56:467–474CrossRefPubMed
6.
Serpell JW, McDermott FT, Katrivessis H, Hughes ES (1989) Obstructing carcinoma of the colon. Br J Surg 76:965–969CrossRefPubMed
7.
Brown SC, Walsh S, Abraham JS, Sykes PA (1991) Risk factors and operative mortality in surgery for colorectal cancers. Ann R Coll Surg Engl 73:269–272PubMedPubMedCentral
8.
9.
La Torre M, Mazzuca F, Ferri M, Mari FS, Botticelli A, Pilozzi E, Lorenzon L, Osti MF, Marchetti P, Enrici RM, Ziparo V (2013) The importance of lymph node retrieval and lymph node ratio following preoperative chemoradiation of rectal cancer. Color Dis 15:e382–e388. doi:10.​1111/​codi.​12242 CrossRef
10.
La Torre M, Lorenzon L, Pilozzi E, Barucca V, Cavallini M, Ziparo V, Ferri M (2012) Number of harvested lymph nodes is the main prognostic factor in stage IIa colorectal cancer patients. J Surg Oncol 106:469–474. doi:10.​1002/​jso.​23101 CrossRefPubMed
11.
12.
Patel SV, Patel SV, Brackstone M (2014) Emergency surgery for colorectal cancer does not result in nodal understaging compared with elective surgery. Can J Surg 57:349–353CrossRefPubMedPubMedCentral
13.
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 52:678–684CrossRefPubMed
14.
McArdle CS, Hole DJ (2004) Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 91:605–609CrossRefPubMed
15.
Metcalfe MS, Norwood MG, Miller AS, Hemingway D (2005) Unreasonable expectations in emergency colorectal cancer surgery. Color Dis 7:275–278CrossRef
16.
Costa G, Stella F, Venturini L, Tierno SM, Tomassini F, Fransvea P, Frezza B, Bocchetti T, Di Somma S, Balducci G (2013) The usefulness of a trauma registry and the role of the general surgeon in the multidisciplinary approach to trauma patients: 3-year experience at Sant’Andrea University Hospital in Rome. Ann Ital Chir 84:1–8PubMed
17.
Lorenzon L, Costa G, Massa G, Frezza B, Stella F, Balducci G (2017) The impact of frailty syndrome and risk scores on emergency cholecystectomy patients. Surg Today 47:74–83CrossRefPubMed
18.
19.
Sjo OH, Merok MA, Svindland A, Nesbakken A (2012) Prognostic impact of lymph node harvest and lymph node ratio in patients with colon cancer. Dis Colon Rectum 55:307–315CrossRefPubMed
20.
Ferri M, Lorenzon L, Onelli MR, La Torre M, Mercantini P, Virgilio E, Balducci G, Ruco L, Ziparo V, Pilozzi E (2013) Lymph node ratio is a stronger prognostic factor than microsatellite instability in colorectal cancer patients: results from a 7 years follow-up study. Int J Surg 11:1016–1021. doi:10.​1016/​j.​ijsu.​2013.​05.​031 CrossRefPubMed
21.
Lorenzon L, Montebelli F, Mercantini P, Sebastiani S, Ziparo V, Ferri M (2016) Right colectomy for cancer: a matched comparison of three different surgical approaches. J Investig Surg 29:405–412CrossRef
22.
Costa G, La Torre M, Frezza B, Fransvea P, Tomassini F, Ziparo V, Balducci G (2014) Changes in the surgical approach to colonic emergencies during a 15-year period. Dig Surg 31:197–203. doi:10.​1159/​000365254 CrossRefPubMed
23.
Ho YH, Seow-Choen F, Leong A, Eu KW, Nyam D, Teoh MK (1999) Randomized, controlled trial of low molecular weight heparin vs no deep vein thrombosis prophylaxis for major colon and rectal surgery in Asian patients. Dis Colon Rectum 42:196–202CrossRefPubMed
24.
Bratzler DW, Houck PM, Surgical Infection Prevention Guidelines Writers Workgroup; American Academy of Orthopaedic Surgeons; American Association of Critical Care Nurses; American Association of Nurse Anesthetists; American College of Surgeons; American College of Osteopathic Surgeons; American Geriatrics Society; American Society of Anesthesiologists; American Society of Colon and Rectal Surgeons; American Society of Health-System Pharmacists; American Society of PeriAnesthesia Nurses; Ascension Health; Association of periOperative Registered Nurses; Association for Professionals in Infection Control and Epidemiology; Infectious Diseases Society of America; Medical Letter; Premier; Society for Healthcare Epidemiology of America; Society of Thoracic Surgeons; Surgical Infection Society (2004) Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis 38:1706–1715CrossRefPubMed
25.
Jansen JO, O'Kelly TJ, Krukowski ZH, Keenan RA (2002) Right hemicolectomy: mechanical bowel preparation is not required. J R Coll Surg Edinb 47:557–560PubMed
26.
Wasey N, Baughan J, de Gara CJ (2003) Prophylaxis in elective colorectal surgery: the cost of ignoring the evidence. Can J Surg 46:279–284PubMedPubMedCentral
27.
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213CrossRefPubMedPubMedCentral
28.
Kyllönen LE (1987) Obstruction and perforation complicating colorectal carcinoma. Acta Chir Scand 153:607–614PubMed
29.
Runkel N, Schlag P, Schwarz V, Herfarth C (1991) Outcome after emergency surgery for cancer of the large intestine. Br J Surg 78:183–188CrossRefPubMed
30.
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 doi. doi:10.​1007/​s11605-017-3355-8
31.
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 189:377–383CrossRefPubMed
32.
Sucullu I, Ozdemir Y, Cuhadar M, Balta AZ, Yucel E, Filiz AI, Gulec B (2015) Comparison of emergency surgeries for obstructed colonic cancer with elective surgeries: a retrospective study. Pak J Med Sci 31:1322–1327PubMedPubMedCentral
33.
Gonsalves WI, Kanuri S, Tashi T, Aldoss I, Sama A, Al-Howaidi I, Ganta A, Kalaiah M, Thota R, Krishnamurthy J, Fang X, Townley P, Ganti AK, Subbiah S, Silberstein PT (2011) Clinicopathologic factors associated with lymph node retrieval in resectable colon cancer: a veterans’ affairs central cancer registry (VACCR) database analysis. J Surg Oncol 104:667–7134CrossRefPubMed
34.
Evans MD, Barton K, Rees A, Stamatakis JD, Karandikar SS (2008) The impact of surgeon and pathologist on lymph node retrieval in colorectal cancer and its impact on survival for patients with Dukes’ stage B disease. Color Dis 10:157–164
35.
Nedrebo BS, Soreide K, Nesbakken A, Eriksen MT, Soreide JA, Korner H, Norwegian Colorectal Cancer Group (2013) Risk factors associated with poor lymph node harvest after colon cancer surgery in a national cohort. Color Dis 15:e301–e308CrossRef
36.
Odermatt M, Miskovic D, Siddiqi N, Khan J, Parvaiz A (2013) Short- and long-term outcomes after laparoscopic versus open emergency resection for colon cancer: an observational propensity score-matched study. World J Surg 37:2458–2467CrossRefPubMed
Metadaten
Titel
Emergency surgery for colorectal cancer does not affect nodal harvest comparing elective procedures: a propensity score-matched analysis
verfasst von
Gianluca Costa
Laura Lorenzon
Giulia Massa
Barbara Frezza
Mario Ferri
Pietro Fransvea
Paolo Mercantini
Maria Cristina Giustiniani
Genoveffa Balducci
Publikationsdatum
28.07.2017
Verlag
Springer Berlin Heidelberg
Erschienen in
International Journal of Colorectal Disease / Ausgabe 10/2017
Print ISSN: 0179-1958
Elektronische ISSN: 1432-1262
DOI
https://doi.org/10.1007/s00384-017-2864-y

Weitere Artikel der Ausgabe 10/2017

Nonoperative management of perforated acute diverticulitis with extraluminal air: results and risk factors of failure

  • Short Communication

Successful treatment of chronic refractory pouchitis with vedolizumab

  • Letter to the Editor

The DGAV risk calculator: development and validation of statistical models for a web-based instrument predicting complications of colorectal cancer surgery

  • Original Article

Diverticulitis recurrence after percutaneous abscess drainage

  • Review

The robotic approach significantly reduces length of stay after colectomy: a propensity score-matched analysis

  • Original Article

Multicentre, controlled, randomized clinical trial to compare the efficacy and safety of ambulatory treatment of mild acute diverticulitis without antibiotics with the standard treatment with antibiotics

  • Clinical Study Protocol

Neu im Fachgebiet Chirurgie

Verbände und Cremes gegen Dekubitus: „Wir wissen nicht, was sie bringen!“

Die Datenlage zur Wirksamkeit von Verbänden oder topischen Mitteln zur Prävention von Druckgeschwüren sei schlecht, so die Verfasser einer aktuellen Cochrane-Studie. Letztlich bleibe es unsicher, ob solche Maßnahmen den Betroffenen nutzen oder schaden.

Nackenschmerzen nach Bandscheibenvorfall: Muskeltraining hilft!

Bei hartnäckigen Schmerzen aufgrund einer zervikalen Radikulopathie schlägt ein Team der Universität Istanbul vor, lokale Steroidinjektionen mit einem speziellen Trainingsprogramm zur Stabilisierung der Nackenmuskulatur zu kombinieren.

US-Team empfiehlt Gastropexie nach Hiatushernien-Op.

Zur Vermeidung von Rezidiven nach Reparatur einer paraösophagealen Hiatushernie sollte einem US-Team zufolge der Magen bei der Op. routinemäßig an der Bauchwand fixiert werden. Das Ergebnis einer randomisierten Studie scheint dafür zu sprechen.

Mit Lidocain kommt der Darm nicht schneller in Schwung

Verzögertes Wiederanspringen der Darmfunktion ist ein Hauptfaktor dafür, wenn Patientinnen und Patienten nach einer Kolonresektion länger als geplant im Krankenhaus bleiben müssen. Ob man diesem Problem mit Lidocain vorbeugen kann, war Thema einer Studie.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise