Emergency surgeries for complicated colorectal cancer performed in hospitals for general surgery: multivariate analysis of short-term and long-term treatment outcomes

Abstract

Objective: to evaluate the outcomes of emergency surgeries for complicated colorectal cancer performed in hospitals for general surgery and to assess risk factors and their impact on both short-term and long-term treatment outcomes.Materials and methods. This study included 677patients that underwent emergency surgeries for complicated colorectal cancer in 3 hospitals for general surgery in Smolensk over the last 13 years. Severity of postoperative complications was graded using the Clavien—Dindo classification. The length of follow-up varied between 0 and 60 months. Kaplan—Meier survival curves were constructed to assess relapse-free and overall survival. The Cox proportional regression model was used to estimate the risk factors for survival.Results. The main risk factors affecting short-term treatment outcomes were the severity of the overall condition (grave and critical) and time from symptom onset to hospital admission (>24 h). Using univariate and multivariate analysis, we identified independent prognostic factors associated with poorer 5-year relapse-free survival. They included presence of cancer cells at the resection margin (R1 resection) (hazard ratio (HR) 1.36; 95 % confidence interval (CI) 1.284—1.450; p <0.0001), rectal tumor (HR 1.085; 95 % CI 0.974—1.209; p = 0.009), and one-stage surgery (HR 1.141; 95 % CI 1.034—1.259;p <0.0001).Conclusions. Positive resection margin (R1 resection) was an independent prognostic factor associated with poorer overall and relapse-free survival in patients with complicated colorectal cancer.

Keywords

• complicated colorectal cancer
• emergency surgery
• prognostic factors
• survival