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Researchers measure survival following emergent resection for colon cancer

Monday, October 20 2008 | Comments
Evidence Grade 0 What's This?
By David MacDougall

The presence of perforation or obstruction at presentation is associated with a significantly decreased 5-year survival rate in patients undergoing emergent resection of colon cancer, researchers report.

"A large proportion of colon cancer patients present emergently," said Dr. Emily Paulson from the Hospital of the University of Pennsylvania in Philadelphia. "This is alarming because of the implications for prognosis."

The findings emerged in a retrospective cohort study of 14,824 patients who underwent elective resection and 10,012 patients who underwent emergent resection between 1996 and 2003. Both study groups were enrolled in the Surveillence, Epidemiology, and End Results (SEER) Medicare database.

Stepwise Cox proportional hazards models were used to evaluate the possible effects of specific factors on the relationship between emergent resection and disease-specific survival. These factors included disease stage, demographics, comorbidities, hospital volume, surgeon type, number of nodes harvested, use of postoperative chemotherapy, and diagnoses of bleeding, obstruction, and perforation.

The proportion of patients with ER increased with cancer stage. Of the 10,102 patients with emergent resection, 30%, 44%, and 45.5% had stage I, II, and III colon cancer, respectively.

In unadjusted analysis, the mortality risk was twice as high in the emergent resection group as in the elective resection group (P<.001). Adjustment for relevant variables resulted in an attenuated, although still significant (P<.001), increased mortality risk (hazard ratio, 1.42) associated with emergent resection.

The variables with the greatest influence on mortality risk in the emergent resection group were disease stage, age, and presence of obstruction, perforation, or bleeding. In the emergent resection group, the 5-year survival rate was 92%, 81%, and 55% in those with stage I, II, and III colon cancer, respectively. In emergent resection patients with stage III colon cancer, 6.2% presented with perforation, 35.2% with obstruction, and 38.3% with bleeding.

The increased mortality risk associated with emergent resection was not influenced by surgeon specialty, hospital type or volume, number of nodes harvested, or postoperative chemotherapy for stage III colon cancer.

"The hazard associated with emergent resection is partially explained by stage, age and presence of obstruction or perforation," concluded Dr. Paulson and colleagues. "Research examining more specific tumor, surgeon and patient factors may further explain the poor disease-specific survival associated with emergent resection and allow for improvement." (Surgical Forum 19: Quality, Outcomes and Costs II: Cancer, Endocrine, Vascular)

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