Emergency First Presentation of Colorectal Cancer Predicts Significantly Poorer Outcomes: A Review of 356 Consecutive Irish Patients
Emergency First Presentation of Colorectal Cancer Predicts Significantly Poorer Outcomes: A Review of 356 Consecutive Irish Patients
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DOI：
10.1007/dcr.0b013e3181a1d8c9
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发表时间：
2009-04-01
影响因子：
3.9
通讯作者：
Mealy, Kenneth
中科院分区：
文献类型：
--
作者：
Bass, Gary;Fleming, Cathy;Mealy, Kenneth
目的：结直肠癌通常首先表现为急症，并且可能因肠梗阻/穿孔而变得复杂，需要更困难的手术，结果更差。对 2000 年至 2006 年期间在爱尔兰韦克斯福德总医院诊断的患者进行的所有手术进行了分析，以在我们的西欧人群中验证这一假设。方法：对前瞻性维护的患者人口统计、诊断、手术和就诊方式（选择性、急诊）数据库进行回顾性分析。结果：2000 年至 2006 年期间，共有 356 名结直肠癌患者接受了 498 次手术。 2006年，进行了84例紧急内窥镜检查和100例紧急肠切除术。阻塞性病变更有可能需要紧急切除（P < 0.001）。择期治疗患者的中位生存时间为 82 个月，而紧急治疗患者的中位生存时间为 59 个月。 结论：在所有结肠切除术中，34% 是紧急进行的，并且并发梗阻或穿孔的可能性明显更高（P < 0.001）。紧急切除与显着较低的围手术期死亡率和五年生存率相关（P < 0.001）。在内窥镜检查中诊断出的结直肠癌中，有 41% 是在紧急情况下首次发现的。这些数据引起了公众对结直肠癌认识和资源分配的担忧，并再次强调了国家结直肠筛查计划的必要性。
PURPOSE: Colorectal cancer commonly presents first as an emergency and is likely to be complicated by bowel obstruction/perforation requiring more difficult procedures, with poorer outcomes. Analysis of all of the procedures performed on patients diagnosed in Wexford General Hospital, Ireland, during the period 2000 to 2006 was carried out to validate this hypothesis in our western European population.METHODS: Retrospective analysis of a prospectively maintained database of patient demographics, diagnosis, procedures, and mode of presentation (elective, emergency) was undertaken.RESULTS: A total of 356 patients with colorectal cancer underwent 498 procedures during the years 2000 to 2006. Eighty-four emergency endoscopies and 100 emergency bowel resections were performed. Obstructive lesions were more likely to require emergency resection (P < 0.001). Median survival time for patients treated electively was 82 months vs. 59 months for patients treated on an emergency basis.CONCLUSIONS: Of all colonic resections, 34 percent were carried out as emergencies and were significantly more likely to be complicated by obstruction or perforation (P < 0.001). Emergency resections were associated with a significantly poorer perioperative mortality and five-year survival rate (P < 0.001). Forty-one percent of colorectal cancers diagnosed at endoscopy were first seen emergently. These data raise concerns regarding public awareness of colorectal cancer and resource allocation and reemphasize the need for a national colorectal screening program.