Treatment tactics for colon cancer complicated by acute obstruction: comparison of short-term outcomes in right-sided and left-sided tumors
TL;DR
Surgical duration exceeding 90 minutes at the emergency operation increases the risk of serious postoperative complications by 1.64 times, and independent predictors that influenced the risk of developing complications Clavien—Dindo Grade IIIb–V were identified.
Abstract
Objectives. To evaluate of short-term outcomes of emergency surgeries for right-sided and left-sided colon cancer complicated by acute obstruction, to determine the independent predictors of postoperative complications. Material. A cohort retrospective study was performed, including 250 patients: group 1‑patients who underwent emergency operations for cancer of the right colon complicated by acute obstruction, n = 73 (29,2 %); group 2‑patients who underwent emergency surgeries for cancer of the left colon complicated by acute obstruction, n = 177 (70,8 %). The study included the period from 01.09.2016 to 10.11.2025 in clinical hospitals in Smolensk. All complications, were analysed within 60 days after surgery. Results. Statistically significant differences between the groups were found in degree of acute obstruction severity (p = 0.042), preoperative leukocyte level (p = 0.001), hemoglobin level (p < 0.0001), and C-reactive protein levels (p = 0.032). Preoperatively, patients in group 1 had a lower hemoglobin level (< 120 g / L) and more cases with subcompensated obstruction, while those in group 2 had more cases with decompensated obstruction, higher leukocytosis, and elevated C-reactive protein levels above 10 mg / l. Postoperative complications Clavien—Dindo Grade IIIb-V occurred more frequently among patients suffering from right-sided colon cancer complicated by acute obstruction compared to left-sided colon cancer (39.7 % vs. 10.7 %, respectively, p = 0.0031). In group 1, colon resection with primary anastomosis formation were performed more often during the first emergency stage. Conclusions. Independent predictors that influenced the risk of developing complications Clavien—Dindo Grade IIIb–V were: age ≥ 70 years, Charlson Comorbidity Index (CCI) ≥ 7, overall status by ASA ≥ 3, preoperative hemoglobin level < 100 g / L, emergency colon resection, blood loss during surgery ≥ 400 ml, operation time ≥ 90 min, pT4 criterion, positive status for regional lymph nodes (pN+), presence of moderate or severe COVID-19. The study indicates that surgical duration exceeding 90 minutes at the emergency operation increases the risk of serious postoperative complications by 1.64 times.