The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer
The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer
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DOI：
10.1002/bjs.5269
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发表时间：
2006-04-01
影响因子：
9.6
通讯作者：
Hole, DJ
中科院分区：
文献类型：
--
作者：
McArdle, CS;McMillan, DC;Hole, DJ
背景资料：先前的研究已经引起了人们对结肠癌急诊患者术后高死亡率和低生存率的关注。然而，这些患者是一个异质性群体。本研究的目的是建立，调整病例组合，手术后死亡率和5年生存率之间的差异的大小，作为一个紧急的出血，梗阻和perforation.Methods证据：该研究包括2068例结肠癌患者在1991年至1994年在苏格兰。结果：有失血、梗阻或穿孔症状的患者术后30天死亡率高于择期手术患者（P < 0.005）。在潜在的治愈性手术后，5年癌症特异性生存率为74.6%，而在失血、梗阻和穿孔的患者中分别为60.9%、51.6%和46.5%（均P < 0.001）。相应的调整后风险比相对于择期手术患者，癌症特异性生存率（95%置信区间）为1.62（1-22至2.15）、2.22（1-78至2.75）和2-93（1-82至4.70）对于有失血、梗阻或穿孔证据的患者结论：与择期手术的结肠癌患者相比，有出血、梗阻或穿孔的急诊结肠癌患者的术后死亡率更高，肿瘤特异性生存率更低。
Background: Previous studies have drawn attention to the high postoperative mortality and poor survival of patients who present as an emergency with colon cancer. However, these patients are a heterogeneous group. The aim of the present study was to establish, having adjusted for case mix, the size of the differences in postoperative mortality and 5-year survival between patients presenting as an emergency with evidence of blood loss, obstruction and perforation.Methods: The study included 2068 patients who presented with colon cancer between 1991 and 1994 in Scotland. Five-year survival rates and the adjusted hazard ratios were calculated.Results: Thirty-day postoperative mortality following potentially curative resection was consistently higher in patients who presented with evidence of blood loss, obstruction or perforation (all P < 0.005) than in elective patients. Following potentially curative surgery, cancer-specific survival at 5 years was 74.6 per cent compared with 60.9, 51-6 and 46.5 per cent in those who presented with blood loss, obstruction and perforation respectively (all P < 0.001). The corresponding adjusted hazard ratios (95 per cent confidence interval) for cancer-specific survival, relative to elective patients, were 1.62 (1-22 to 2.15), 2.22 (1-78 to 2.75) and 2-93 (1-82 to 4.70) for patients presenting with evidence of blood loss, obstruction or perforation (all P < 0.001).Conclusion: Compared with patients who undergo elective surgery for colon cancer, those who present as an emergency with evidence of blood loss, obstruction or perforation have higher postoperative mortality rates and poorer cancer-specific survival.