Emergency surgeries for complicated colorectal cancer performed in hospitals for general surgery: multivariate analysis of short-term and long-term treatment outcomes
https://doi.org/10.17650/2220-3478-2019-9-2-38-46
Abstract
Objective: to evaluate the outcomes of emergency surgeries for complicated colorectal cancer performed in hospitals for general surgery and to assess risk factors and their impact on both short-term and long-term treatment outcomes.
Materials and methods. This study included 677patients that underwent emergency surgeries for complicated colorectal cancer in 3 hospitals for general surgery in Smolensk over the last 13 years. Severity of postoperative complications was graded using the Clavien—Dindo classification. The length of follow-up varied between 0 and 60 months. Kaplan—Meier survival curves were constructed to assess relapse-free and overall survival. The Cox proportional regression model was used to estimate the risk factors for survival.
Results. The main risk factors affecting short-term treatment outcomes were the severity of the overall condition (grave and critical) and time from symptom onset to hospital admission (>24 h). Using univariate and multivariate analysis, we identified independent prognostic factors associated with poorer 5-year relapse-free survival. They included presence of cancer cells at the resection margin (R1 resection) (hazard ratio (HR) 1.36; 95 % confidence interval (CI) 1.284—1.450; p <0.0001), rectal tumor (HR 1.085; 95 % CI 0.974—1.209; p = 0.009), and one-stage surgery (HR 1.141; 95 % CI 1.034—1.259;p <0.0001).
Conclusions. Positive resection margin (R1 resection) was an independent prognostic factor associated with poorer overall and relapse-free survival in patients with complicated colorectal cancer.
About the Author
S. N. Shchaeva
Smolensk State Medical University, Ministry of Health of Russia
Russian Federation
Russian Federation
28Krupskoy St., 214019 Smolensk
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