Emergency Curative Resection of Colorectal Cancer

Emergency Curative Resection of Colorectal Cancer, Do it With Caution. A Comparative Case Series

The feasibility and efficacy of emergency curative resection of complicated colorectal cancer is still controversial. This prospective study aim is to assess surgical and oncologic outcomes after emergency compared to elective curative resection of colorectal cancer

Study Overview

• Status: Completed
• Conditions: Colorectal Cancer; Oncologic Complications and Emergencies
• Intervention / Treatment: Procedure: Curative resection of colorectal cancer

Detailed Description

60 consecutive patients presented with complicated colorectal cancer managed by emergency surgery were included and compared to another 155 consecutive patients admitted during the same period with uncomplicated colorectal cancer managed by elective surgery. Both groups were compared regarding curative resection rate, early postoperative mortality and morbidity, 3-years tumor recurrence and survival rates.

• Study Type: Observational
• Enrollment (Actual): 215

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 70 years (ADULT, OLDER_ADULT)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Probability Sample

Study Population

This study included 60 consecutive patients presented by complicated colorectal cancer treated by emergency surgery at Alexandria University hospital between January 2015 and January 2017 (Group I). Another 155 patients with uncomplicated colorectal cancer treated by elective surgery during the same period were included (Group II).

Description

Inclusion Criteria:

• All patients presented with Potentially operable colorectal cancer
• No clinical or radiological evidence of metastatic disease

Exclusion Criteria:

• Patients received preoperative chemoradiation
• Patients with clinical or radiological evidence of metastatic disease
• Patients with intraoperative evidence of metastatic disease
• Patients with intraoperative evidence of irresectable disease
• Patients with incomplete follow up

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Emergency group; Patients presented to emergency by complicated colorectal cancer ( Obstruction, bleeding or perforation)	Procedure: Curative resection of colorectal cancer
Elective group; Patients presented with uncomplicated colorectal cancer for resection treatment	Procedure: Curative resection of colorectal cancer

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Adequate oncologic resection	Negative resection margins + adequate lymphadenectomy ( Lymph Nodes retrieved > 12)	histopathological assessment of surgical specimens within 2 weeks postoperative
early postoperative mortality after curative resection of colorectal cancer	early death due to cause related to surgery	within 90 days after surgery
early postoperative morbidity after curative resection of colorectal cancer	surgery-related complications	within 90 days after surgery

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Tumor recurrence	either local or distant	By the end of the 3 years follow up period
Disease free survival	% of patients survived without recurrence	By the end of the 3 years follow up period
Overall survival	% of all patients survived either with or without recurrence	By the end of the 3 years follow up period

Collaborators and Investigators

• Sponsor: University of Alexandria
• Investigators: Principal Investigator: Mohamed Elmessiry, MD, PhD, Ass. Professor of Surgery

Publications and helpful links

General Publications

• Ghazi S, Berg E, Lindblom A, Lindforss U; Low-Risk Colorectal Cancer Study Group. Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases. World J Surg Oncol. 2013 Jun 11;11:133. doi: 10.1186/1477-7819-11-133.
• Biondo S, Marti-Rague J, Kreisler E, Pares D, Martin A, Navarro M, Pareja L, Jaurrieta E. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg. 2005 Apr;189(4):377-83. doi: 10.1016/j.amjsurg.2005.01.009.
• Kim J, Mittal R, Konyalian V, King J, Stamos MJ, Kumar RR. Outcome analysis of patients undergoing colorectal resection for emergent and elective indications. Am Surg. 2007 Oct;73(10):991-3.

Study record dates

Study Major Dates

• Study Start (ACTUAL): January 1, 2015
• Primary Completion (ACTUAL): December 1, 2019
• Study Completion (ACTUAL): February 1, 2020

Study Registration Dates

• First Submitted: February 25, 2020
• First Submitted That Met QC Criteria: February 25, 2020
• First Posted (ACTUAL): February 28, 2020

Study Record Updates

• Last Update Posted (ACTUAL): February 28, 2020
• Last Update Submitted That Met QC Criteria: February 25, 2020
• Last Verified: February 1, 2020

More Information

Terms related to this study

• Keywords: Complicated colorectal cancer; Curative resection; Surgical and oncologic outcomes
• Additional Relevant MeSH Terms: Digestive System Diseases; Pathologic Processes; Neoplasms; Neoplasms by Site; Disease Attributes; Gastrointestinal Neoplasms; Digestive System Neoplasms; Gastrointestinal Diseases; Colonic Diseases; Intestinal Diseases; Intestinal Neoplasms; Rectal Diseases; Emergencies; Colorectal Neoplasms
• Other Study ID Numbers: 0302761

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: UNDECIDED

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No