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 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.
We intended to determine whether the same oncological principles and surgical outcomes can be achieved in both urgent and elective colon cancer surgery.
This study aims to compare the oncological radicality of urgent surgery for colon cancer in comparison to elective cases.
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.
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.
The oncological principles of colon cancer surgery can be adopted in urgency as well as in elective cases.
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.