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Emergent Colectomy Is Independently Associated With Decreased Long-Term Overall Survival in Colon Cancer Patients
Zhaomin Xu*, Christopher T. Aquina, Reza Arsalani-Zadeh, Adan Z. Becerra, Bradley J. Hensley, Katia Noyes, John R. Monson, Fergal Fleming
Surgery, University of Rochester, Rochester, NY
Background: Emergent resection for complications of colon cancer has worse short-term outcomes compared to elective resections of colon cancer. However, there is little data on the long-term outcomes of emergently resected patients. The purpose of this study was to examine the long term overall survival (OS) of colon cancer patients who underwent emergent resection versus patients who were resected electively in a national hospital based cancer registry.
Methods: The 2006-2011 National Cancer Data Base was queried for all colon cancer patients who underwent surgical resection. An emergent resection was defined as any resection that occurred within 24 hours of diagnosis. A mixed-effects logistic regression model was used to identify independent factors associated with undergoing an emergent resection versus an elective resection. Mixed-effect Cox proportional-hazards models were subsequently used to estimate the adjusted effect of emergent versus elective resection on 5-year overall survival.
Results: A total of 208,636 patients met inclusion criteria, of which, 32% of the cohort had an emergent resection. Factors and outcomes associated with emergent resection are presented in the table. Patients who underwent emergent resection had a lower 5-year overall survival rate compared to those who underwent elective resection (63.5% vs 69.5%, Log-Rank P<0.0001). After controlling for patient factors, pathological stage, lymph node yield, positive margin status, receipt of adjuvant chemotherapy, and hospital factors, emergent resection was independently associated with an increased odds of 30-day mortality (OR=1.58, 95% CI=1.47-1.73) and increased hazard of death at 5 years (HR=1.27, 95% CI=1.25-1.29) compared to elective resections.
Conclusion: Emergent resection for colon cancer is independently associated with poor short-term outcomes and decreased 5-year overall survival compared to elective resection, irrespective of patient factors, pathological stage, adequate lymph node yield, positive margin status, receipt of adjuvant chemotherapy, and hospital factors. With almost one third of cases in this study being performed emergently, these findings underlie the importance of adherence to colon cancer screening guidelines to limit the need for emergent resections and potentially improve overall survival for colon cancer in the U.S.
Patient, Tumor and Hospital Characteristics and Outcomes Associated with Emergent Colon Cancer Resections
| | Emergent (N=66,144) (31.7%) | Elective (N=146,609) (68.3%) | P-Value | | Patient Characteristics | | Age (Median) (IQR) | 69 (58-79) | 69 (59-79) | <0.0001 | | Uninsured | 2,858 (4.3) | 3,950 (2.8) | <0.0001 | | Charlson-Deyo Score | | | <0.0001 | | | 0 | 45,818 (69.3) | 95,338 (66.9) | | | | 1 | 14,873 (22.5) | 33,776 (23.7) | | | | 2+ | 5,453 (8.2) | 13,378 (9.4) | | | Pathological Staging | | | <0.0001 | | | pT0 | 4,084 (6.2) | 4,050 (2.8) | | | | pT1 | 7,005 (10.6) | 16,876 (11.8) | | | | pT2 | 7,745 (11.7) | 22,450 (15.8) | | | | pT3 | 35,175 (53.2) | 81,513 (57.2) | | | | pT4 | 12,135 (18.3) | 17,603 (12.4) | | | | pN0 | 37,420 (56.6) | 83,893 (58.9) | | | | pN1 | 15,881 (24.0) | 33,668 (23.6) | | | | pN2 | 12,843 (19.4) | 24,931 (17.5) | | | Positive Proximal/Distal Margins | 5,766 (8.7) | 8,523 (6.0) | <0.0001 | | Total Lymph Node Yield (>12) | 51,430 (77.7) | 115,827 (81.3) | <0.0001 | | Stage III Receiving Adjuvant Chemotherapy | 14,042 (64.7) | 31,232 (69.4) | <0.0001 | | Hospital Characteristics | | Academic Hospital | 14,657 (22.2) | 37,381 (26.2) | <0.0001 | | Colon Cancer Resections Annually | | | <0.0001 | | | Low (1-32) | 22,831 (34.5) | 45,230 (31.7) | | | | Medium (33-56) | 22,805 (34.5) | 47,956 (33.7) | | | | High (>56) | 20,508 (31.0) | 49,306 (34.6) | | | Outcomes | | Length of Stay >6 days | 29,499 (43.0) | 53,578 (36.0) | <0.0001 | | 30-day Mortality | 3,349 (5.0) | 4,361 (3.1) | <0.0001 | | 90-day Mortality | 5,551 (8.4) | 8,283 (5.8) | <0.0001 |
 Kaplan-Meier survival curves of emergent vs eletive colectomies. Log-Rank P<0.0001.
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