Surgical outcomes of curative intent management in emergency vs. elective colon cancer: A retrospective single center study

BACKGROUND: Presentation affects several surgical parameters and post-operative outcomes. This study compares emergency versus elective colon cancer outcomes and prognostic factors associated with postoperative complications. METHODS: All colon cancer patients who underwent curative resection between July 2015 and December 2019 were retrospectively reviewed and analyzed. Patients were divided into emergency and elective groups based on their presentation. RESULTS: A total of 215 patients were included; 70 patients (32.6%) in the emergency group. Of them, 61 patients presented with obstruction, and nine with free perforation. The elective group had a higher laparoscopic approach (82.8%) with primary anastomosis (90.3%) compared to the emergency group (57.1% and 68.6%, respectively, P < 0.001). Postoperative complications were clinically higher in the emergency group (30% vs. 20.7%, P = 0.171). ICU/HDU admission was higher in the emergency group (40% vs. 17.2%, P < 0.001), and had a longer hospital stay (15 vs. 10 days, P < 0.003). Regression analysis revealed increased risk of complications among patients with comorbidities (OR 3.21; 95% CI, P = 0.002), albumin levels <30g/dl (OR 2.20; 95% CI, P = 0.01), complete obstruction (OR 2.42; 95% CI, P = 0.017), perforation (OR 9.98; 95% CI, P < 0.001), and open surgery (OR 4.84; 95% CI, P < 0.001). CONCLUSION: Emergency presentation rate was high among our patients with less-favorable surgical outcomes. Open surgery and stoma creation were more prevalent in the emergency group. Complete obstruction, perforation, open surgery, hypo-albuminemia, and presence of comorbidities were independent risk factors for complications.