Urgent surgery in colon carcinoma

INTRODUCTION: About 10% of all operations in colon carcinoma are performed in emergency situations because of severe preoperative complications. PATIENTS AND METHOD: The prospectively collected data of 1496 patients with colon carcinoma treated from 1987 to 2002 at the Department of Surgery of the University of Erlangen were analysed with special interest on postoperative morbidity and long-term prognosis after elective and urgent surgery. RESULTS: The rate of urgent surgery was 11%. The most frequent complication was bowel obstruction (73%) followed by perforation (20%). Emergency patients were significantly older (p<0.001) and in worse general condition (p<0.001). The rates of surgical and nonsurgical postoperative complications were higher in urgent surgery than in elective surgery (28.8% vs. 19.8%, p=0.015) and also postoperative mortality was significantly higher (10.1% vs. 4.0%, p<0.001). The rates of locoregioanal recurrences and distant metastases were significantly higher. Urgent surgery was found to be an independent prognostic factor for distant metastasis (relative risk 1.8) and cancer-related survival (relative risk 1.6). DISCUSSION: Urgent surgery in colon carcinoma is usually performed in advanced tumours of elderly patients. This operation can be a challenge for the treating surgeon. Adequate medical emergency supply needs to provide an experienced surgeon for those interventions.