Short term outcome after emergency and elective surgery for colon cancer
Short term outcome after emergency and elective surgery for colon cancer
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DOI：
10.1111/j.1463-1318.2008.01613.x
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发表时间：
2009-09-01
影响因子：
3.4
通讯作者：
Nesbakken, A.
中科院分区：
文献类型：
--
作者：
Sjo, O. H.;Larsen, S.;Nesbakken, A.
目的结肠癌的紧急表现很常见，并且与手术治疗后的高死亡率和发病率相关。本研究的目的是评估连续的、基于人群的系列中的术后死亡率和并发症。方法对 1993 年至 2007 年间诊断的所有结肠腺癌患者进行前瞻性登记。比较择期患者和急诊患者的术后死亡率和并发症发生率。使用逻辑回归分析来确定术后并发症的独立危险因素。结果在研究期间，共收治了 1129 名患者，其中 279 名 (25%) 因急诊就诊。共有999名（89%）患者接受了手术治疗； 924 名患者 (82%) 接受了大切除术。择期手术死亡率为3.5%，急诊切除手术死亡率为10%（P < 0.01），并发症发生率分别为24%和38%（P < 0.01）。在左侧梗阻的患者中，Hartmann 手术后的死亡率为 19%，而一期吻合切除术后的死亡率为 3%（P < 0.01）。多因素分析显示急诊手术、年龄增加、肿瘤分期晚期和ASA IV级是术后死亡的独立危险因素。结论结肠癌急诊手术并发症和死亡率较高，应尽可能避免立即手术。用支架减压左侧梗阻似乎很有希望，但如果支架置入失败，则无法得出关于最佳手术的结论；在这项研究中，哈特曼手术与高死亡率和发病率相关。
ObjectiveEmergency presentation of colon cancer is common and associated with high mortality and morbidity following surgical treatment. The purpose of this study was to evaluate postoperative mortality and complications in a consecutive and population based series.MethodAll patients with adenocarcinoma of the colon diagnosed between 1993 and 2007 were registered prospectively. Postoperative mortality and complication rates in elective and emergency patients were compared. Logistic regression analysis was used to identify independent risk factors for postoperative complications.ResultsIn the study period 1129 patients were admitted, of whom 279 (25%) presented as an emergency. A total of 999 (89%) patients underwent surgical treatment; 924 patients (82%) had a major resection. The mortality rate was 3.5% after elective and 10% after emergency operation with resection (P < 0.01), and the complication rate was 24% and 38% (P < 0.01), respectively. In patients with left-sided obstruction, the mortality rate after Hartmann's procedure was 19% compared to 3% after resection with primary anastomosis (P < 0.01). Multivariate analyses demonstrated that emergency operation, increasing age, advanced tumour stage and ASA class IV were independent risk factors for postoperative mortality.ConclusionEmergency operation for colon cancer was associated with high rates of complications and mortality, indicating that immediate surgery should be avoided if possible. Decompression of left sided obstruction with a stent seems promising, whereas no conclusion can be made with regard to optimal procedure if stent placement fails; in this study Hartmann's procedure was associated with high mortality and morbidity.