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Emergency treatment of complicated colorectal cancer

Authors Tebala GD, Natili A, Gallucci A, Brachini G, Khan AQ, Tebala D, Mingoli A

Received 28 November 2017

Accepted for publication 17 January 2018

Published 20 April 2018 Volume 2018:10 Pages 827—838


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Antonella D'Anneo

Giovanni Domenico Tebala,1 Andrea Natili,1,2 Antonio Gallucci,1 Gioia Brachini,2 Abdul Qayyum Khan,1 Domenico Tebala,3 Andrea Mingoli2

1Colorectal Team, Noble’s Hospital, Strang, Douglas, Isle of Man, UK; 2Emergency Surgery Unit, “P.Valdoni” Department of Surgery, “Umberto I” University Hospital, Rome, Italy; 3National Institute of Statistics (ISTAT), Catanzaro, Italy

Aim: To find evidence to suggest the best approach in patients admitted as an emergency for complicated colorectal cancer.
Methods: The medical records of 131 patients admitted as an emergency with an obstructing, perforated, or bleeding colorectal cancer to Noble’s Hospital, Isle of Man, and the Umberto I University Hospital, Rome, were retrospectively evaluated. Patients were divided in 3 groups on the basis of the emergency treatment they received, namely 1) immediate resection, 2) damage control procedure and elective or semielective resection, and 3) no radical treatment. Demographic variables, clinical data, and treatment data were considered, and formed the basis for the comparison of groups. Primary endpoints were 90-day mortality and morbidity. Secondary endpoints were length of stay, number of lymph nodes analyzed, rate of radical R0 resections, and the number of patients who had chemoradiotherapy.
Results: Forty-two patients did not have any radical treatment because the cancer was too advanced or they were too ill to tolerate an operation, 78 patients had immediate resection and 11 had damage control followed by elective resection. There was no statistically significant difference between immediate resections and 2-stage treatment in 90-day mortality and morbidity (mortality: 15.4% vs 0%; morbidity: 26.9% vs 27.3%), number of nodes retrieved (16.6±9.4 vs 14.9±5.7), and rate of R0 resections (84.6% vs 90.9%), but mortality was slightly higher in patients who underwent immediate resection. The patients who underwent staged treatment had a higher possibility of receiving a laparoscopic resection (11.5% vs 36.4%).
Conclusion: The present study failed to demonstrate a clear superiority of one treatment with respect to the other, even if there is an interesting trend favoring staged resection.

Keywords: colorectal cancer, colorectal surgery, obstructing colorectal cancer, perforated colorectal cancer, emergency surgery

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