Equivalent Operative Outcomes for Emergency Colon Cancer Resections Among Acute Care Surgeons and Specialists in Colorectal Surgery

• Published in: The American surgeon 2022-05, Vol.88 (5), p.959-963
• Main Authors: Cairns, Ashley L., Hess, Alexis B., Rieken, Holly, Lin, Nicholas, Rao, Shambavi, Jee, Yoonsun, Ashburn, Jean H., Miller, Preston R., Carmichael, Samuel P., Mowery, Nathan T.
• Format: Article
• Language: English
• Subjects: Cancer therapies; Chemotherapy; Colon; Colon cancer; Colonic Neoplasms - surgery; Colorectal cancer; Colorectal Surgery; Critical Care; Humans; Lymph nodes; Lymphatic system; Metastases; Metastasis; Morbidity; Mortality; Oncology; Patients; Retrospective Studies; Specialization; Statistical analysis; Surgeons; Surgery; Tumors
• ISSN: 0003-1348; 1555-9823
• DOI: 10.1177/00031348211050820

Objectives Improved screening has decreased but not eliminated the need for emergent surgery for colon cancer (CC), many of which are performed by acute care surgery (ACS) surgeons. This retrospective review compares outcomes for CC resections on the ACS service to the surgical oncology and colorectal services (SO/CRS). Methods Retrospective review was performed for CC operations between 2014 and 2019. Data for margin status, cancer stage, number of lymph nodes dissected, time to medical oncology follow-up, and time to initiation of chemotherapy were collected. Patients with curative resection, who chose comfort care, presented on alternative services or with non-CC indications as well as those were lost to follow-up were excluded. Results 36 ACS patients and 269 SO/CRS patients underwent CC resections. Most ACS patients presented emergently compared to the SO/CC group (83.3% vs 1%, P < .05) as well as with more advanced tumor stage. There were no statistically significant differences for presence of metastatic disease, number of lymph nodes obtained, or time to post-surgical care (in days) and chemotherapy initiation (in days). 3 (8%) EGS patients had positive margins compared to 6 (2%) CRS/SO patients due to the presence of perforated tumors in the ACS group (p < .05). There were no statistically significant differences in 30- day or 1-year mortality despite the emergent presentation of the ACS patients. Discussion These findings suggest that despite emergent presentation and advanced disease burden, ACS surgeons provide quality care to CC patients, both in the operating room and in coordination of care.