Prognostic Analysis in Colorectal Cancers Requiring Emergency Operations

ABSTRACT

Purpose: Emergency operative interventions for colorectal cancers are usually required in those patients with obstruction and perforation, even though they represent poor prognosis and low resectability. The purpose of this study is to evaluate clinical characteristics and survival rates of colorectal cancer patients with obstruction, perforation or both. METHODS: The clinical characteristics, resectabilities and survival rates of 433 patients with colorectal cancers who were operated on at the department of surgery, Hanyang University from March 1999 to March 2003 were retrospectively analyzed through medical records and telephone surveys. The patients were grouped as follows Group1, without obstruction or perforation (n=387), Group2, with obstruction only (n=22), Group3, with perforation only (n=14) and Group4, with both complications (n=10). RESULTS: Patients with complications had higher operative mortality (group2 9.1%, group3 14.3%, group4 10%) than those without complications (2.6%). Patients with perforation only (group 3) and with both complications (group 4) had poorer 5-year survival rates (group 3 25%, group 4 25%) than group1 (51.1%), however there was no statistical significance for the group with obstruction only. Conclusion: Colorectal cancer patients with perforation had poorer operative mortalities and survival rates, and the obstructed cases had poorer operative mortality. These poor prognosis appeared to be largely a function of more advanced stage of disease due to peritoneal seeding of cancer cells for the perforated cases and higher operative mortality because of other secondary complications for obstructed cases. Earlier diagnosis and prompt operative interventions should be attempted in those with suspected complications.