EMERGENCY SURGERY FOR OBSTRUCTING COLON CANCER: MORBIDITY AND RISK FACTORS OF EARLY POSTOPERATIVE MORTALITY – A COHORT STUDY OF 118 CASES

• Published in: Arquivos brasileiros de cirurgia digestiva : ABCD 2022-01, Vol.35
• Main Authors: ZAAFOURI, Haithem, CHERIF, Mona, KHEDHIRI, Nizar, MESBAHI, Meryam, ZEBDA, Helmo, JOUINI, Raja, BELLALI, Hedia, BEN MAAMER, Anis
• Format: Article
• Language: English
• Subjects: Colonic Neoplasms; Emergency Treatment; Indicators of Morbidity and Mortality; Mortality; Original
• ISSN: 0102-6720; 2317-6326
• DOI: 10.1590/0102-672020220002e1706

ABSTRACT BACKGROUND: Occlusion is the most common complication of colon cancer. Surgical treatment is associated with the highest morbidity and mortality rate (10–27%) and has the worst prognosis. It is necessary for immediate management, avoiding colic perforation and peritonitis. The increase in mortality in emergency colon cancer surgery is multifactorial. AIMS: The aim of this study was to identify the risk factors for early postoperative mortality that highlights the therapeutic strategy in the management of obstructive colon cancer. METHODS: A retrospective study was performed on patients admitted from 2008 to 2020 at the Department of General Surgery due to obstructive colon cancer and operated on as an emergency (within 24 h of admission). RESULTS: In all, 118 patients with colon cancer were operated, and the early postoperative mortality was 10.2%. The univariate analysis highlighted that the American Society of Anesthesiology score III or IV, perforation tumor, one postoperative complication, and two simultaneous postoperative complications were considered significant risk factors for early postoperative mortality after emergent surgery. Multivariate analysis showed that only tumor perforation and the occurrence of two postoperative complications were significant risk factors. CONCLUSION: This study showed that postoperative complication is the leading cause of early postoperative mortality after emergency surgery for obstructive colon cancer. Optimizing the postoperative management of these higher risk patients is still necessary and may reduce the mortality rate. RESUMO RACIONAL: A oclusão é a complicação mais comum do câncer de cólon. A cirurgia está associada à elevada morbimortalidade (10–27%) e pior prognóstico. É necessário indicação imediata, evitando perfuração cólica e peritonite. O aumento da mortalidade na cirurgia de emergência do câncer de cólon é multifatorial. OBJETIVOS: Identificar os fatores de risco de mortalidade pós-operatória precoce que levaram a destacar a estratégia terapêutica no manejo do câncer de cólon obstrutivo. MÉTODOS: Estudo retrospectivo em pacientes admitidos no Departamento de Cirurgia Geral, entre 2008 e 2020, por câncer de cólon obstrutivo e operados de emergência (dentro de 24 horas da admissão). RESULTADOS: Foram operados 118 pacientes e a mortalidade pós-operatória precoce foi de 10,2%. A análise univariada destacou que escore American Society of Anesthesiology III ou IV, tumor perfurado, uma complicação