Challenge in diagnosis and treatment of colonic carcinoma emergencies

ABSTRACT

Despite advances in perioperative care and operative techniques, urgent colorectal operations are still associated with higher mortality and morbidity than elective surgery. This study was to identify the challenge in diagnosis and treatment of emergencies caused by colon carcinoma; and to assess its outcome. This included 59 consecutive patients treated with emergency surgical intervention for colonic carcinoma; and other 59 patients of elective colonic surgery. Morbidity rates were 27.1% versus 10.2% after emergency and elective surgery. Rates of 1-, 2- and 3-year survival were 64.4%, 57.6% and 47.5% respectively after emergency surgery; and 71.2%, 62.7% and 50.8% respectively after elective surgery. Challenge included presentation of undiagnosed patients with difficult or impossible colon preparation, colonoscopy, tissue biopsy or tumor staging; in addition to associated diseases and/or old age. Mortality and morbidity rates after emergency surgery were higher than elective surgery. Selection of the surgical procedure was guided by the tumor staging, co-morbidities and intraoperative assessment. Emergency resection, when possible, could approximate survival of elective resection. Total colectomy could obtain good outcome and survival when compared to other emergency procedures