Published online Nov 24, 2022. doi: 10.5306/wjco.v13.i11.896
Peer-review started: June 30, 2022
First decision: August 1, 2022
Revised: August 16, 2022
Accepted: October 27, 2022
Article in press: October 27, 2022
Published online: November 24, 2022
Locoregional complications may occur in up to 30% of patients with colon cancer. As they are frequent events in the natural history of this disease, there should be a concern in offering an oncologically adequate surgical treatment to these patients.
To compare the oncological radicality of surgery for colon cancer between urgent and elective cases.
One-hundred and eighty-nine consecutive patients with non-metastatic colon adenocarcinoma were studied over two years in a single institution, who underwent surgical resection as the first therapeutic approach, with 123 elective and 66 urgent cases. The assessment of oncological radicality was performed by analyzing the extension of the longitudinal margins of resection, the number of resected lymph nodes, and the percentage of surgeries with 12 or more resected lymph nodes. Other clinicopathological variables were compared between the two groups in terms of sex, age, tumor location, type of urgency, surgical access, staging, compromised lymph nodes rate, differentiation grade, angiolymphatic and perineural invasion, and early mortality.
There was no difference between the elective and urgency group concerning the longitudinal margin of resection (average of 6.1 in elective vs 7.3 cm in urgency, P = 0.144), number of resected lymph nodes (average of 17.7 in elective vs 16.6 in urgency, P = 0.355) and percentage of surgeries with 12 or more resected lymph nodes (75.6% in elective vs 77.3% in urgency, P = 0.798). It was observed that the percentage of patients aged 80 and over was higher in the urgency group (13.0% in elective vs 25.8% in urgency, P = 0.028), and the early mortality was 4.9% in elective vs 15.2% in urgency (P = 0.016, OR: 3.48, 95%CI: 1.21–10.06). Tumor location (P = 0.004), surgery performed (P = 0.016) and surgical access (P < 0.001) were also different between the two groups. There was no difference in other clinicopathological variables studied.
Oncological radicality of colon cancer surgery may be achieved in both emergency and elective procedures.
Core Tip: The oncological radicality was compared between patients undergoing elective and urgent surgery for colon cancer. A total of 189 patients with nonmetastatic colorectal cancer who underwent surgical resection as the first therapeutic approach were included over two years in a single institution. The analysis of the oncological principles of the surgery, including the longitudinal margins of resection and the number of resected lymph nodes, revealed no statistical difference between elective and urgent surgeries. Therefore, the oncological principles of colorectal surgery should be followed in urgency as well as in elective cases.