背景:结直肠癌(CRC)急诊与择期切除患者的长期预后仍存在争议。本研究旨在评估急诊与择期CRC手术的短期和长期结果。
方法:在这项单中心回顾性队列研究中,纳入2013年1月至2017年12月接受CRC急诊或择期结肠切除术的患者.主要结果是长期生存。作为次要结果,我们试图分析在术后发病率和手术切除的肿瘤标准方面的潜在差异.使用Kaplan-Meier曲线和Cox比例风险模型比较各组之间的生存率。
结果:总体而言,包括225例CRC患者。在这192(85.3%)中,有选修手术,有33(14.7%)进行了紧急手术。紧急迹象是由于阻塞,穿孔,或出血。急诊组患者ASA评分较高(p=0.023),较高的Charlsson合并症指数(CCI,p=0.012),比选修组的年龄大,平均年龄为70岁(IQR63-79)岁和78岁(IQR68-83)岁,对于选修和紧急情况,分别(p=0.020)。术前没有观察到其他差异。急诊组患者的主要并发症明显增多(12.1%vs.3.6%,p=0.037),更多吻合口漏(12.1%vs.1.6%,p=0.001),需要再次手术(12.1%vs.3.1%,p=0.021),和术后死亡率(2例患者与0,p<0.001)。最终病理阶段没有差异,也没有观察到淋巴结清扫术的准确性。在紧急手术的情况下,总生存率明显变差,估计中位数为41个月vs.在选择性病例中未达到(p<0.001)。在多变量分析中,紧急手术被确认为生存的独立不利决定因素(危险率HR=1.97,p=0.028),与年龄(HR=1.05,p<0.001),术后主要发病率(HR=3.18,p=0.012),晚期(HR=5.85,p<0.001),需要输血(HR=2.10,p=0.049)。
结论:急诊与择期CRC切除相比,术后发病率和死亡率增加。尽管在切除的准确性和病理分期方面没有显着差异,接受急诊手术的患者的总生存率明显较差,并且独立于其他生存决定因素。
BACKGROUND: Long-term outcomes in patients undergoing emergency versus elective resection for colorectal cancer (CRC) remain controversial. This study aims to assess short- and long-term outcomes of emergency versus elective CRC surgery.
METHODS: In this single-center retrospective cohort study, patients undergoing emergency or elective colonic resections for CRC from January 2013 to December 2017 were included. Primary outcome was long-term survival. As secondary outcomes, we sought to analyze potential differences on postoperative morbidity and concerning the oncological standard of surgical resection. The Kaplan-Meier curves and Cox proportional hazard model were used to compare survival between the groups.
RESULTS: Overall, 225 CRC patients were included. Of these 192 (85.3%) had an elective and 33 (14.7%) an emergency operation. Emergency indications were due to obstruction, perforation, or bleeding. Patients in the emergency group had higher ASA score (p = 0.023), higher Charlsson comorbidity index (CCI, p = 0.012), and were older than those in the elective group, with median age 70 (IQR 63-79) years and 78 (IQR 68-83) years, for elective and emergency, respectively (p = 0.020). No other preoperative differences were observed. Patients in the emergency group experienced significantly more major complications (12.1% vs. 3.6%, p = 0.037), more anastomotic leakage (12.1% vs. 1.6%, p = 0.001), need for reoperation (12.1% vs. 3.1%, p = 0.021), and postoperative mortality (2 patients vs. 0, p < 0.001). No differences in terms of final pathological stage, nor in accuracy of lymphadenectomy were observed. Overall survival was significantly worse in case of emergency operation, with estimated median 41 months vs. not reached in elective cases (p < 0.001). At the multivariate analysis, emergency operation was confirmed as independent unfavorable determinant of survival (with hazard rate HR = 1.97, p = 0.028), together with age (HR = 1.05, p < 0.001), postoperative major morbidity (HR = 3.18, p = 0.012), advanced stage (HR = 5.85, p < 0.001), and need for transfusion (HR = 2.10, p = 0.049).
CONCLUSIONS: Postoperative morbidity and mortality were increased in emergency versus elective CRC resections. Despite no significant differences in terms of accuracy of resection and pathological stages, overall survival was significantly worse in patients who underwent emergency procedure, and independent of other determinants of survival.