Colon cancer surgery following emergency presentation: Effects on admission and stage-adjusted outcomes

Background Emergency presentation with colon cancer is intuitively related to advanced disease. We measured its effect on outcomes of surgically treated colon cancer. Methods A retrospective cohort of 1,071 surgical colon cancer patients (2004 to 2011), with 102 emergency cases requiring surgery within the index admission, was analyzed. Results Emergency patients required longer surgeries (median 141 vs 124 minutes; P =.04), longer median admissions (8% vs 5%; P <.001), more readmissions (12.7% vs 7.1%; P =.040), and perioperative mortality (7.8% vs.8%; P <.001). Surgical pathology displayed higher rates of node-positive disease (56.6% vs 38.6%; P <.001), extramural vascular invasion (39.6% vs 29.1%; P =.021), and metastatic disease (19.6% vs 8%; P <.001). Consequently, adjusting for staging, emergency presentations had considerably higher mortality (odds ratio = 2.07; P =.003) and shorter disease-free survival (hazard ratio = 1.39; P =.042). Conclusions Emergency presentation is a stage-independent poor prognostic factor associated with aggressive tumor biology, resulting in longer surgeries and admissions, frequent readmissions, worsening outcomes, and increasing healthcare costs.