Emergency surgery for complicated colorectal cancer – What we choose: a retrospective cohort study

Introduction: Despite the progress that has been made regarding the diagnosis, a worrying percentage of patients are still admitted in an emergency, with complicated colorectal tumors, which often require interventions without a curative visa. The study aims to analyze the factors involved in choosing the type of surgical treatment. Patients and methods: We included in the study a group of 431 patients admitted and operated in an emergency for complicated colorectal cancer in the Surgery II Clinic of the Clinical Emergency County Hospital “Sf. Ap. Andrei” from Galați, between 2008-2017. We retrospectively analyzed the patients’ data and we made statistical correlations between the type of emergency surgery and epidemiological, clinical, paraclinical, and intraoperative factors. Results: Colostomy was mainly practiced in older patients (p<0.01), from rural areas (p<0.01), with associated cardiac diseases (p<0.01), with hydro electrolytic disorders (p<0.03), rectal tumors (p<0.01), peritoneal carcinomatosis (p<0.02), frozen pelvis (p<0.01). Hartmann's operations were associated with patients with: leukocytosis (p<0.01), intestinal perforation (p<0.01), sigmoid tumors (p<0.01). Internal derivations were associated with patients with: liver metastases (p<0.01), splenic angle tumors (p<0.01), tumors invading other organs (p<0.01), and stage IV of the disease (p<0.01). Resections with anastomosis were associated with transverse colon tumors (p<0.01), well-differentiated tumors (p<0.01). Conclusions: The type of emergency surgery performed correlated well with the age of patients, the area, the comorbidities, the history of the disease, cachexia, anemia, oligoanuria, hydroelectrolyte disorders, tumor complication, and location of the tumor, hepatic metastases, and tumors’ invasion in other organs, tumor grading and stage of the disease.