Obstructing colorectal carcinoma: outcome and risk factors for morbidity and mortality

BACKGROUND/AIMS: Emergency surgery for colorectal cancer is widely thought to be associated with high morbidity and mortality. The aim of this study was to assess the operative results of patients who had emergency operations for obstructing colorectal cancer. Clinical factors that might influence the outcome were also evaluated. PATIENTS AND METHODS: This is a retrospective study including 83 patients who underwent emergency operations for completely obstructing colorectal cancers from 1991 to 2002. Demographic, clinical, and pathological variables were examined. Their influence on major morbidity and mortality was assessed using univariate and multivariate analyses. RESULTS: The overall and major morbidity rate was 67.5 and 32.5%, respectively. Mortality was 10.8%. Univariate analysis showed that high ASA class and perioperative blood transfusion were significantly associated with major complication, whereas older age and high APACHE II were linked to mortality. Independent risk factors for major morbidity were perioperative blood transfusion and high ASA class. The only independent predictor of postoperative death was high APACHE II score. CONCLUSIONS: Emergency surgery for obstructing colorectal carcinoma carries a negative impact on outcome. Patients with risk factors should undergo safe and least risky procedures. Moreover, their presence might help in selecting patients for intensive treatment after surgery.