Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease-free survival: a propensity score analysis

BMC Cancer

Research Article

Rene Warschkow¹  Benjamin Weixler²  Christoph Kettelhack²  Daniel Oertli²  Raoul Droeser²  Michaela Ramser²  Urs von Holzen³ 

[1] Department of Surgery, Kantonsspital St. Gallen, 9007, St. Gallen, Switzerland;Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany;Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland;Department of Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland;Goshen Center for Cancer Care, 46507, Goshen, IN, USA;

关键词: Colorectal cancer;    Emergency surgery;    Oncological outcome;    Overal survival;    Disease-free survival;   

DOI  :  10.1186/s12885-016-2239-8

 received in 2015-06-05, accepted in 2016-03-01,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundIt remains a matter of debate whether colorectal cancer resection in an emergency setting negatively impacts on survival. Our objective was therefore to assess the impact of urgent versus elective operation on overall and disease-free survival in patients undergoing resection for colorectal cancer by using propensity score adjusted analysis.MethodsIn a single-center study patients operated for colorectal cancer between 1989 and 2013 were identified from a prospectively maintained database. Median follow-up was 44 months. Patients with neoadjuvant treatment were excluded. The impact of urgent operation on overall and disease-free survival was assessed using both Cox regression and propensity score analyses.ResultsOf 747 patients with colorectal cancer, 84 (11 %) had urgent and 663 elective cancer resection. The propensity score revealed strongly biased patient characteristics (0.22 ± 0.16 vs. 0.10 ± 0.09; P < 0.001). In unadjusted analysis urgent operation was associated with a 35 % increased risk of overall mortality (hazard ratio(HR) of death = 1.35, 95 % confidence interval(CI):1.02–1.78, P = 0.045). In risk-adjusted Cox regression analysis urgent operation was not associated with poor overall (HR = 1.08, 95 %CI:0.79–1.48; P = 0.629) or disease-free survival (HR = 1.02, 95 %CI:0.76–1.38; P = 0.877). Similarly in propensity score analysis urgent operation did not influence overall (HR = 0.98, 95 % CI:0.74–1.29), P = 0.872) and disease-free survival (HR = 0.89, 95 %CI:0.68 to 1.16, P = 0.387).ConclusionsThis study provides evidence that worse oncologic outcomes after urgent operation for colorectal cancer are caused by clinical circumstances and not due to the urgent operation itself. Urgent operation is not a risk factor for colorectal cancer resection.

【 授权许可】

CC BY   
© Weixler et al. 2016