Assessing the risk of postoperative mortality in patients undergoing emergency surgery for complicated colorectal cancer

Abstract

Objective: to analyze factors affecting the mortality of patients who have undergone emergency surgeries for complicated colorectal cancer.Materials and methods. In this retrospective study, we evaluated treatment outcomes of 112 patients who underwent surgeries for complicated colorectal cancer in 3 clinical hospitals of Smolensk between 2014 and 2019. We included patients with moderate or severe disease (ASA II or III) who have undergone emergency resections for intestinal obstruction or tumor perforation. We assessed clinical, laboratory, and tumor‑associated factors affecting postoperative mortality.Results. Patients’ gender had no significant impact on postoperative mortality (p = 0.69). Mean age of study participants was 65 years (range: 43–86 years). Age also did not affect postoperative mortality; most of the patients both among those died (n = 19) and survived (n = 93) were older than 60 years (p = 0.46). We observed no significant correlation between tumor location and postoperative mortality (p = 0.27). Of 19 patients with lethal outcomes, five died due to pulmonary embolism. They have elevated level of D‑dimer, which was significantly higher than that in survivors (p = 0.014). The lowest mortality was observed in patients who have undergone two‑stage surgeries with tumor removed at the second stage compared to patients operated on using other techniques (p = 0.041). Using multivariate logistic regression, we identified independent factors that affected mortality. They included: tumor perforation (odds ratio (OR) 2.8; 95 % confidence interval (CI) 1.2–7.6; p = 0.003), severe comorbidity (OR 1.6; 95 % CI 1.7–8.2; p = 0.02), D‑dimer level >510.1 ± 10.2 ng/L (OR 1.5; 95 % CI 1.3–4.5; p = 0.01), type of surgery, namely resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage (OR 1.2; 95 % CI 1.1–6.3; p = 0.04).Conclusions. Tumor perforation, cardiovascular disease in combination with other comorbidities, type of surgery (resections with primary anastomosis formation and two‑stage surgeries with tumor removal at the first stage), and elevated preoperative level of D‑dimer had the most significant impact on postoperative mortality.

Keywords

• emergency surgery
• colorectal cancer
• intestinal obstruction
• perforation
• postoperative mortality