Elective- versus emergency surgery for right-sided colon carcinomas: a propensity matched analysis of a national database.
EAES Academy. kertzman b. 07/05/22; 366517; P234
Mr. bas kertzman
Contributions
Contributions
Abstract
Aims
In past studies, anastomotic leakage rates following resection for right-sided colon carcinoma (RSCC) have been reported to be lower compared to left-sided resections. Because of this, resection with primary anastomosis for RSCC is deemed safe, in both elective- as well as the emergency setting. Recent studies however suggest higher complication rates, including anastomotic leakage, following emergency surgery. The aim of this study is therefore to determine the difference in complication rates between elective- and emergency resections.
Methods
All Dutch patients who underwent resection for a RSCC from 2010 until 2019 were identified from the Dutch Colorectal Audit (DCRA), a national database for colorectal cancer. Patients undergoing emergency resection were compared to patients undergoing resection in an elective setting following one-to-one propensity score matching.
Results
Of the 39601 patients with a RSCC in the DCRA, 5625 underwent emergency surgery. 4631 were matched one-to-one to an electively operated patient. After matching, no differences in baseline characteristics were found. Anastomotic leakage rates did not differ between the treatment groups (5.7 vs. 5.8%, p₌0.904), while mortality was twice as high in the emergency surgery group (table 1). Furthermore, emergency surgery patients had more 90-day complications (42.2 vs. 34.5%, p<0.001) and significantly fewer radical resections (92.1 vs. 94.6%, p<0.001).
Conclusion
Emergency resection for RSCC, when compared to elective surgery, is associated with a higher risk of complications and a mortality-rate that is twice as high. A bridge-to-elective surgery, which has seen a surge in popularity for left-sided obstructions, might therefore also be beneficial for these patients. Further research is needed.
In past studies, anastomotic leakage rates following resection for right-sided colon carcinoma (RSCC) have been reported to be lower compared to left-sided resections. Because of this, resection with primary anastomosis for RSCC is deemed safe, in both elective- as well as the emergency setting. Recent studies however suggest higher complication rates, including anastomotic leakage, following emergency surgery. The aim of this study is therefore to determine the difference in complication rates between elective- and emergency resections.
Methods
All Dutch patients who underwent resection for a RSCC from 2010 until 2019 were identified from the Dutch Colorectal Audit (DCRA), a national database for colorectal cancer. Patients undergoing emergency resection were compared to patients undergoing resection in an elective setting following one-to-one propensity score matching.
Results
Of the 39601 patients with a RSCC in the DCRA, 5625 underwent emergency surgery. 4631 were matched one-to-one to an electively operated patient. After matching, no differences in baseline characteristics were found. Anastomotic leakage rates did not differ between the treatment groups (5.7 vs. 5.8%, p₌0.904), while mortality was twice as high in the emergency surgery group (table 1). Furthermore, emergency surgery patients had more 90-day complications (42.2 vs. 34.5%, p<0.001) and significantly fewer radical resections (92.1 vs. 94.6%, p<0.001).
Conclusion
Emergency resection for RSCC, when compared to elective surgery, is associated with a higher risk of complications and a mortality-rate that is twice as high. A bridge-to-elective surgery, which has seen a surge in popularity for left-sided obstructions, might therefore also be beneficial for these patients. Further research is needed.
Aims
In past studies, anastomotic leakage rates following resection for right-sided colon carcinoma (RSCC) have been reported to be lower compared to left-sided resections. Because of this, resection with primary anastomosis for RSCC is deemed safe, in both elective- as well as the emergency setting. Recent studies however suggest higher complication rates, including anastomotic leakage, following emergency surgery. The aim of this study is therefore to determine the difference in complication rates between elective- and emergency resections.
Methods
All Dutch patients who underwent resection for a RSCC from 2010 until 2019 were identified from the Dutch Colorectal Audit (DCRA), a national database for colorectal cancer. Patients undergoing emergency resection were compared to patients undergoing resection in an elective setting following one-to-one propensity score matching.
Results
Of the 39601 patients with a RSCC in the DCRA, 5625 underwent emergency surgery. 4631 were matched one-to-one to an electively operated patient. After matching, no differences in baseline characteristics were found. Anastomotic leakage rates did not differ between the treatment groups (5.7 vs. 5.8%, p₌0.904), while mortality was twice as high in the emergency surgery group (table 1). Furthermore, emergency surgery patients had more 90-day complications (42.2 vs. 34.5%, p<0.001) and significantly fewer radical resections (92.1 vs. 94.6%, p<0.001).
Conclusion
Emergency resection for RSCC, when compared to elective surgery, is associated with a higher risk of complications and a mortality-rate that is twice as high. A bridge-to-elective surgery, which has seen a surge in popularity for left-sided obstructions, might therefore also be beneficial for these patients. Further research is needed.
In past studies, anastomotic leakage rates following resection for right-sided colon carcinoma (RSCC) have been reported to be lower compared to left-sided resections. Because of this, resection with primary anastomosis for RSCC is deemed safe, in both elective- as well as the emergency setting. Recent studies however suggest higher complication rates, including anastomotic leakage, following emergency surgery. The aim of this study is therefore to determine the difference in complication rates between elective- and emergency resections.
Methods
All Dutch patients who underwent resection for a RSCC from 2010 until 2019 were identified from the Dutch Colorectal Audit (DCRA), a national database for colorectal cancer. Patients undergoing emergency resection were compared to patients undergoing resection in an elective setting following one-to-one propensity score matching.
Results
Of the 39601 patients with a RSCC in the DCRA, 5625 underwent emergency surgery. 4631 were matched one-to-one to an electively operated patient. After matching, no differences in baseline characteristics were found. Anastomotic leakage rates did not differ between the treatment groups (5.7 vs. 5.8%, p₌0.904), while mortality was twice as high in the emergency surgery group (table 1). Furthermore, emergency surgery patients had more 90-day complications (42.2 vs. 34.5%, p<0.001) and significantly fewer radical resections (92.1 vs. 94.6%, p<0.001).
Conclusion
Emergency resection for RSCC, when compared to elective surgery, is associated with a higher risk of complications and a mortality-rate that is twice as high. A bridge-to-elective surgery, which has seen a surge in popularity for left-sided obstructions, might therefore also be beneficial for these patients. Further research is needed.
{{ help_message }}
{{filter}}