The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer

Background: Previous studies have drawn attention to the high postoperative mortality and poor survival of patients who present as an emergency with colon cancer. However, these patients are a heterogeneous group. The aim of the present study was to establish, having adjusted for case mix, the size of the differences in postoperative mortality and 5-year survival between patients presenting as an emergency with evidence of blood loss, obstruction and perforation. Methods: The study included 2068 patients who presented with colon cancer between 1991 and 1994 in Scotland. Five-year survival rates and the adjusted hazard ratios were calculated. Results: Thirty-day postoperative mortality following potentially curative resection was consistently higher in patients who presented with evidence of blood loss, obstruction or perforation (all P < 0.005) than in elective patients. Following potentially curative surgery, cancer-specific survival at 5 years was 74.6 per cent compared with 60.9, 51-6 and 46.5 per cent in those who presented with blood loss, obstruction and perforation respectively (all P < 0.001). The corresponding adjusted hazard ratios (95 per cent confidence interval) for cancer-specific survival, relative to elective patients, were 1.62 (1-22 to 2.15), 2.22 (1-78 to 2.75) and 2-93 (1-82 to 4.70) for patients presenting with evidence of blood loss, obstruction or perforation (all P < 0.001). Conclusion: Compared with patients who undergo elective surgery for colon cancer, those who present as an emergency with evidence of blood loss, obstruction or perforation have higher postoperative mortality rates and poorer cancer-specific survival.