Clinical Outcomes and Perioperative Morbidity in Obstructive Versus Elective Colorectal Cancer: A 10-Year Retrospective Analysis

TL;DR

Patients with colorectal cancer presenting as an emergency obstruction have worse outcomes, including higher mortality and fewer completed treatments, compared to those with planned surgeries.

Contribution

This study provides a 10-year retrospective analysis comparing clinical outcomes between obstructive and elective colorectal cancer cases.

Findings

Obstructed patients had higher 30-day mortality (25.7% vs. 3.6%) and more surgical site infections.

Obstructive cases were associated with advanced tumor stages and longer hospital stays.

Adjuvant therapy completion rates were significantly lower in obstructed patients (52.9% vs. 75.4%).

Abstract

Introduction

Obstructive colorectal cancer (CRC) at presentation is associated with advanced stage, higher perioperative risk, and interrupted adjuvant therapy. This study aimed to compare perioperative and clinical outcomes of colorectal cancer patients presenting with emergency large-bowel obstruction to those undergoing planned elective resection.

Methods

This retrospective cohort study reviewed 237 adult CRC resections performed during the study period. Seventy patients (29.5%) presented as emergent cases with radiologic or endoscopic obstruction, while 167 patients (70.5%) underwent elective procedures. Data collected included demographics, presenting symptoms, serum albumin levels, carcinoembryonic antigen (CEA) values, tumor location, histology, American Joint Committee on Cancer (AJCC) stage, surgical details, 30-day mortality, surgical site infection (SSI) rates, length of hospital stay, and adjuvant therapy completion rates. Categorical variables were compared using chi-square or Fisher's exact tests, while continuous variables were analyzed using Mann-Whitney U test, with significance set at p<0.05.

Results

Both groups demonstrated similar demographics with mean age of approximately 56 years. The obstructed group had 52 males (74.3%) and 18 females (25.7%), while the non-obstructed group had 102 males (61.1%) and 65 females (38.9%) (p=0.07). Obstructed patients more frequently presented with abdominal pain (52.9% vs. 17.4%), vomiting (58.6% vs. 1.2%), constipation (30.0% vs. 7.8%), and abdominal distension (22.9% vs. 1.2%) (all p<0.001). Advanced tumor stage was significantly more common in the obstruction group, with Stage I occurring in 2.9% versus 34.7% and Stage IV in 40.0% versus 28.7% of non-obstructed cases (p<0.001). Emergency cases demonstrated significantly higher 30-day mortality (25.7% vs. 3.6%; p<0.001), increased surgical site infections (28.6% vs. 15.0%; p=0.024), prolonged hospital stays (mean 15.6±5.5 vs. 10.3±4.7 days; p<0.0001), and lower adjuvant therapy completion rates (52.9% vs. 75.4%; p=0.001).

Conclusion

Obstructive colorectal cancer presentation significantly worsens perioperative mortality, morbidity, and therapy completion rates compared to elective resection cases. Early detection strategies, optimized perioperative care protocols, and treatment at high-volume centers are critical interventions needed to improve outcomes for patients presenting with obstructive colorectal cancer.

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