N. Tehrani1, S. Ganai1, M. Garfinkel1 1Southern Illinois University School Of Medicine,General Surgery,Springfield, IL, USA
Introduction: The practice of surgery is being increasingly subjected to quality improvement measures, including metrics for oncologic adequacy. The acute care surgeon often does not have the luxury of pre-operative optimization nor the ability to defer intervention but is still subject to these measures. The goal of our study was to evaluate oncologic adequacy as well as perioperative morbidity for resections done for colon cancers presenting electively versus emergently. We hypothesized that emergent cancer operations will have decreased compliance with oncologic metrics.
Methods: A retrospective chart review was performed of a sample of patients who underwent colectomy for colon cancer at an academic-affiliated community hospital from 2010-2014. Cases of rectal cancer were excluded. Metrics related to oncologic adequacy of the resections, including margins and nodes sampled, as well as perioperative complication rates and blood loss were collected for the two populations. Fisher’s exact and Student’s T-tests were used to make comparisons between groups with significance defined by p<0.05.
Results: Forty-four patients were identified with 19 emergent and 25 elective cancer resections. There was no difference in proportion of open cases among the two groups (94.7 vs 80%, p=0.21). Emergent and elective cases had no significant difference in presentation with pT3 or pT4 tumors (84.2 vs 56%, p=0.06). Adequate proximal and distal surgical margins—defined as greater than 5cm—were achieved in 94.7% of emergent colectomies and 84% of elective cases (p=0.37). Adequate node sampling (>12 lymph nodes) was achieved in 100% of emergent cases vs 94.7% in elective cases (p=1.00). Greater blood loss was seen in emergent cases (294 vs 167ml, p<0.05). Similarly, emergent cases demonstrated higher perioperative complication rates (78.6 vs 33.3%, p=0.02) as well as ICU admissions (57.1 vs 8.7%, p=0.002).
Conclusions: Contrary to our hypothesis, we demonstrated a similar rate of oncologically adequate resections for emergent colectomies, although this study may be underpowered to detect any clinically-important difference. The study will benefit from expanding our sample size to include all cases of colon cancer contained within local tumor registries for the same time period. Finally, an analysis of long-term recurrence rates controlled for cancer stage is warranted.