Emergency Left Colectomy for Colon Cancer is Not Associated with Worst Oncologic Resection Quality Compared to Elective Surgery

Abstract

Abstract Purpose: Emergency colectomy of the left colon and sigma carries a higher risk of complication than elective colectomy. The aim of our study was to evaluate our results and to compare the outcome of these two operations. Methods Each patient included in this retrospective analysis underwent laparoscopic or open colectomy for malignant neoplasms with curative intent between 2011 and 2019. Surgical techniques were defined as emergency or elective depending on the timing of the operation, regardless of operational technique. Results A total of 242 patients were recruited, of which 125 had had emergency colectomies. Comparatively, 117 such patients underwent elective colectomies. There were no differences between the groups in factors such as age, gender, demographics and co-morbidities. The main reason for emergency operation included perforation in 105 patients (84%), and obstruction in 20 patients (16%). No difference in the number of lymph nodes harvested (LNH) were found between the 2 groups (mean of 17 LNH, SD +-8). The length of stay (LOH) and time to first flatulence was different between the groups (8.72 +-4.17 days for the elective surgery vs. 19.28+-23.5 days for the emergency surgery for LOH, and 3+-1 days for the elective group Vs. 9+-11.5 days for the emergency group for time to first flatulence, p<0.001 in both). The emergency group exhibited more serious complications (G III IV) than the elective group in the Clavien-Dindo classification. No difference was noted with regards to 30 days' survivals, length of operation and blood loss. Conclusion Our study suggests that the outcome of emergency colectomy of the left colon demonstrated excellent oncologic results compared to that of the elective group. However, emergency operation carries some degree of higher complication rate that need to be taken into account. Best results will be achieved by tailoring each patient’s status with the utilization of the best operation and operative team experience.