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Decreased overall survival after resection for colorectal cancer outside working hours
Background
Colorectal cancer (CRC) is one of the most common malignant neoplasms worldwide. Emergency presentations occur in up to 30 % of CRC cases. Studies describe a decreased overall survival after emergency surgery. In addition to the critically ill state of the patient, the surgical treatment outside regular working hours might be associated with worse outcome. The aim of this study was to compare the outcome of patients who underwent an emergency colon resection with a matched pair operated under elective conditions.
Methods
In this retrospective study perioperative and survival data of all patients undergoing resection for CRC between January 2003 and December 2018 at the Department of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Austria were analysed. Patients with an emergency resection at night or on weekends were classified as emergencies and compared to resections performed in regular working hours (elective). For survival analysis matched pairs regarding gender, age and cancer stage out of the elective patients were assigned to the emergency patients.
Results
59 (4.5 %) out of 1 297 patients were classified as emergencies. The median age (range) was 69 (23-101) years. 546 (42.1 %) patients were female, who were significantly older, with a median (range) of 71 (31-101) years vs. 68 (23-97) years in male patients (p= 0.027). 50.8 % of the patients in the emergency group were female compared to 41.7 % in the elective group (p= 0.164). The UICC stage was significantly higher in the emergency group (p= 0.013). After matching the groups, the mean follow-up for survival analysis was 4.7 years. The survival was lower in the emergency group than in the matched elective group with 88.1 % vs. 95.8 % (p= 0.051) after 30 days, 81.4 % vs. 92.4 % (p= 0.021) after 90 days, 72.9 % vs. 86.4 % (p= 0.017) after 1 year, 45.8 % vs. 75.4 % (p< 0,05) after 3 years and 35.6 % vs. 64.4 % (p< 0,05) after 5 years. The overall survival of women was worse in the elective group with a median of 77.7 vs. 105.7 months and better in the emergency group with 34.6 vs. 24.8 months (p= 0.512).
Conclusions
Our data show that patients undergoing resection for CRC outside working hours have a decreased overall survival compared to patients after elective resection. Furthermore, female patients have a worse survival than male in the elective setting. These findings confirm the importance of CRC awareness and screening to reduce emergent resections.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosures
All authors have declared no conflicts of interest.
