Emergency presentation: a risk factor for poor disease outcome in node-negative colorectal cancer

This study examined the impact of emergency presentation on the outcomes of patients with node-negative colorectal cancer undergoing curative surgery.

Node-negative colorectal cancer is cancer that has not spread to the nearby lymph nodes. Curative surgery (surgical removal of all of the cancer cells) is the most common treatment option for this type of cancer. Emergency presentation is when the patient presents to the hospital or doctor in need of immediate surgical intervention. This can be as a result of obstruction, perforation (penetration of the wall of the colon or rectum) or rectal bleeding.

Emergency presentation in colorectal cancer patients has been associated with poor outcomes. Its impact on the outcomes of patients with node-negative colorectal cancer undergoing surgery with curative intent has not been established.

The outcomes of emergency surgery were compared with those of elective surgery (a surgical procedure that is scheduled in advance).

A total of 1,877 node-negative colorectal cancer patients who underwent surgery with curative intent were involved in this study. Of these, 1,626 patients presented electively and 251 as an emergency.

Emergency presentation was independently associated with poorer short-term survival rates. The post-operative (after surgery) patient mortality rate was 3.3 % after elective presentation compared to 12.8% after emergency presentation. Compared to those who presented electively, those presenting as an emergency had a more than a three-fold increased risk of death within 30 days of surgery.

Emergency presentation was independently associated with poorer long-term survival rates. The five-year relative survival rate after surgery was 91.8 % after elective presentation compared to 66.8 % in emergency presentation. Patients presenting as an emergency had a significantly increased risk of death from colorectal cancer at 5 years compared to those presenting electively.

In addition, patients undergoing emergency surgery were more likely to be older, have colon cancer, have more advanced tumor stages, have tumors penetrating deeply into the mesorectum (a fold of membrane attached to the rectum)and receive surgery under the care of a non-specialist surgeon.

In summary, this study concluded that emergency presentation of node-negative colorectal cancer treated with curative intent was independently associated with poorer short and long-term survival rates. Therefore, emergency presentation of node-negative colorectal cancer is a significant independent risk factor for poor outcome.

There was lack of data regarding the mode of surgery used, the smoking habits of the patients and comorbidities (additional diseases).