UBC Theses and Dissertations
Emergency management of patients with colorectal cancer Al Shehhi, Ruqaiya Mohammed
Background: According to the literature, up to 30% patients with colorectal cancers (CRCs) present to the emergency department (ED) with surgical emergencies. The most common surgical presentations of these patients are: intestinal obstruction, perforation and bleeding. Palliative surgical interventions in these patients are believed to carry high risks of morbidity and mortality. Moreover, management options tend to be individualized in most cases, if not all. Methodology: A systematic review of published literature was conducted. Articles meeting inclusion criteria were summarized. Quantitative data regarding study characteristics were analyzed and expressed as descriptive statistics. Primary outcomes of interest were post-operative complications, mortality and 5-year disease free status. Results: 304 articles were collected from searching online data bases. Eight articles were found to match the research question and underwent a full text review. Five more articles were added from searching the grey literature. After final review, 11 articles were selected to be included in the systematic review. Papers were assessed for methodological validity. 81.8% of studies used regression models in their analyses. Mean number of patients included in the papers was 3,567 (min= 145, max= 30,790). 50.2% of all patients were males. Most of the included studies reported mean age of more than 60 years. The mean follow-up period in days was 399.5. Analysis of different variables revealed that, CRC patients who received emergency surgery had more comorbidities (95% CI, OR=1.42 P=0.05), higher American Society of Anesthesiology classes (95% CI, OR=1.33 P=0.08), and more advanced disease (95% CI, OR=1.09 P=0.02) than CRC patients who receive surgical intervention on elective basis. Moreover, resection rate was higher in the elective group (95% CI, OR=0.5 P=0.04). In contrast, stoma creation rate was higher in the emergency group (95% CI, OR=5.08 P=0.003). Furthermore, emergency patients had higher rates of postoperative complications (95% CI, OR=4.6 P=0.007) and mortality (95% CI, OR=5.38 P=0.0001). Conclusion: Patients requiring emergency surgery for CRC often have complex comorbidities and acute instability, and are at very high risk of postoperative complications. These findings highlight an important opportunity for the development of comprehensive systems of emergency surgical care, and, ultimately, improvement of patient outcomes.
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