Retrospective Cohort Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Nov 24, 2022; 13(11): 896-906
Published online Nov 24, 2022. doi: 10.5306/wjco.v13.i11.896
Is it possible to adopt the same oncological approach in urgent surgery for colon cancer?
Bruno Yuki Yoshida, Raphael L C Araujo, José Francisco M Farah, Alberto Goldenberg
Bruno Yuki Yoshida, Raphael L C Araujo, José Francisco M Farah, Alberto Goldenberg, Department of Surgery, Federal University of Sao Paulo, Sao Paulo 04024-002, Sao Paulo, Brazil
Bruno Yuki Yoshida, José Francisco M Farah, Department of General and Oncological Surgery, Sao Paulo State Employee Hospital, Sao Paulo 04029-000, Sao Paulo, Brazil
Author contributions: Yoshida BY, Farah JFM, and Goldenberg A contributed to the study conception, data preparation, data interpretation, and writing; Araujo RLC contributed to the data preparation, data interpretation, and critical writing of the paper.
Institutional review board statement: This study was performed with the permission of the institutional review board according to the institutional policy for protected health information.
Conflict-of-interest statement: The authors certify that there is no conflict of interest related to the manuscript.
Data sharing statement: Regarding the manuscript entitled: “Is it possible to achieve the same oncological approach in urgent surgery for colon cancer?”, the original anonymous dataset is available on request from the corresponding author.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Raphael L C Araujo, MD, PhD, Adjunct Professor, Surgical Oncologist, Department of Surgery, Federal University of Sao Paulo, Rua Napoleao de Barros, 715, Second Floor Vila Clementino, Sao Paulo 04024-002, Sao Paulo, Brazil.
Received: June 30, 2022
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
Research background

Locoregional complications of colon cancer may occur in up to 30% of patients. Many of these patients will need a surgical resection in an urgent scenario. Because of the patient's clinical deterioration, the oncological principles of surgery may be jeopardized.

Research motivation

We intended to determine whether the same oncological principles and surgical outcomes can be achieved in both urgent and elective colon cancer surgery.

Research objectives

This study aims to compare the oncological radicality of urgent surgery for colon cancer in comparison to elective cases.

Research methods

A total of 189 consecutive patients with colon cancer who underwent surgical resection as the first therapeutic approach were selected over two years in a single institution. The institution where the study was performed has a high volume of colorectal cancer patients (over 100 cases per year) and there are experienced surgeons in both elective and urgent situations. Patients were assigned to two groups: elective (123) and urgency (66). Clinicopathological variables were analyzed and compared retrospectively, including the longitudinal margin of resection and the number of harvested lymph nodes, between the two groups.

Research results

There was no significant difference between the two groups concerning the longitudinal margins of resection and the number of resected lymph nodes. A higher percentage of patients aged 80 and over was observed in the urgency group (25.8% vs. 13.0% in elective group, P = 0.028). Early mortality was higher in the urgency group (15.2% vs 4.9%), as expected according to previous studies.

Research conclusions

The oncological principles of colon cancer surgery can be adopted in urgency as well as in elective cases.

Research perspectives

Further studies are necessary to elucidate which patients should undergo classical oncological resection in urgency, especially in patients aged 80 and over, due to the higher early mortality in urgent approaches for this population. Intermediate interventions in urgent cases, such as derivative surgery or colonic prosthesis, require further studies as an alternative approach in high-risk patients.