A Study on Acute Management of Colorectal Cancer Presenting as an Emergency

TL;DR

This study examines how colorectal cancer patients presenting as emergencies are managed and their outcomes in Greater Manchester.

Contribution

The study provides real-world data on emergency colorectal cancer management and outcomes in a regional setting.

Findings

Most patients presented with obstruction symptoms and had locally advanced or metastatic cancers.

Surgery was performed in 63% of cases, with high rates of postoperative complications and ICU admission.

A 25% 30-day mortality rate was observed among emergency colorectal cancer patients.

Abstract

Introduction

Many patients in Greater Manchester underwent emergency/urgent surgery, but limited data are available about managing these patients and their outcomes. We aimed to study the clinico-demographic profile, management trends, and outcomes of the patients presenting to the ED in the real world.

Methods

All patients with lower GI cancer (known or newly diagnosed on the present visit) in the ED requiring admission under surgeons for treatment were identified prospectively over six months and were included in the study.

Results

Nineteen patients were admitted (13 (69%) colon, 5 (26%) rectum, 1 (5%) anal cancer), with a median age of 67 years, and 10 (52.6%) were female. Ten (53%) patients were on the two-week wait pathway, and 14 (73.6%) patients presented with obstruction symptoms. Only 3 (15.7%) patients had received neoadjuvant therapy. Most had moderately differentiated adenocarcinoma. All had CT of the abdomen on admission, with 9 (52.6%) having CT of the thorax. All had locally advanced or metastatic cancers. Twelve (63%) patients underwent surgery (6 (50%) definitive, 6 (50%) diversion stoma). Nine (75%) patients had early postoperative complications, and 6 (50%) required ICU admission. The median postoperative stay was 9.5 days, with a 30-day mortality rate of 25%.

Conclusion

This study provides a snapshot of the management and outcomes of patients presenting in emergencies. A further study at the regional/national level is needed to investigate the increasing emergency presentations of colorectal cancer (CRC) despite an established screening program.

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