Acil onkolojik kolorektal cerrahinin baþarýsýndan hala þüphe etmeli miyiz?: Geriye dönük çalýþma

AMAÇ: Son yýllarda birçok yayýnda, kolorektal kanser (KRK) cerrahisinde onkolojik prensiplerin önemi vurgulanmaktadýr. Acil ameliyalatlarýn yüksek morbidite ve mortalite oranlarýna sahip olduðu bilinmekle birlikte, onkolojik prensipleri saðlamadaki yeterliliði ve prognozu hala tartýþmalýdýr. Bu çalýþmanýn amacý, acil ve elektif cerrahi rezeksiyon yapýlan KRK hastalarýnýn klinikopatolojik özelliklerini karþýlaþtýrmak, onkolojik ilkelere uygunluðunu ve kýsa/uzun dönem sonuçlarýný deðerlendirmektir.
GEREÇ VE YÖNTEM: Kolorektal kanser tanýsýyla ameliyat edilen 564 hasta çalýþmaya alýndý. Hastalar ameliyat koþuluna göre acil (Grup 1) ve elektif (Grup 2) olmak üzere iki gruba ayrýldý. Hastalarýn demografik, klinikopatolojik özellikleri, prognostik faktörleri ve saðkalýmlarý geriye dönük olarak deðerlendirildi.
BULGULAR: Grup 1’de 104 (%18.4), grup 2’de 460 (%81.6) hasta vardý. Hastalarýn %61.2’si erkek ve yaþ ortalamasý 64.27 idi. Gruplar arasý yaþ daðýlýmý, tümör lokalizasyonu, uygulanan cerrahi prosedür, T- N sýnýflamasý, AJCC evresi, müsin alt tipi, lenfovasküler ve perinöral invazyonu mevcudiyeti açýsýndan istatistiksel önemli farklýlýklar mevcut idi. Ortalama tümör çapý 5.23±3.48 cm idi. Gruplar arasý, low anterior rezeksiyon yapýlan hastalar haricinde, disseke edilen lenf nodu yeterliliði açýsýndan farklýlýk yok idi. Ortalama saðkalým süresi 475.212 gün ve ortanca saðkalým süresi 376 gündü. Hastalýksýz ve genel saðkalým oranlarý grup 2’de daha yüksek idi.
TARTIÞMA: Acil þartlarda ameliyat edilen KRK hastalarý, uygun onkolojik rezeksiyon uygulanmasýna raðmen, elektif þartlara göre daha kötü kýsa ve uzun dönem sonuçlara sahipti. Bu nedenle, acil cerrahi oranlarýný azaltmak için kolorektal kanser tarama programlarýnýn yaygýnlýðýnýn artýrýlmasý gerektiðini düþünüyoruz.

Should we still doubt the success of emergency oncologic colorectal surgery?: A retrospective study

BACKGROUND: In recent years, the importance of oncologic principles in colorectal cancer (CRC) surgery has been emphasized in many studies. Although emergency surgery is related to high morbidity and mortality rates, their adequacy and prognosis in maintaining oncologic principles are still controversial. This study aims to compare the clinicopathological features of CRC patients who underwent emergency and elective surgical resection and also to evaluate their compatibility with oncologic principles and to evaluate their short/long term results.
METHODS: Of the patients who underwent surgery for CRC, 564 were included in this study. The patients were divided into two groups according to their surgical conditions as an emergency (Group 1) and elective (Group 2). Demographics, clinicopathological features, prognostic factors and survival rates of the patients were evaluated retrospectively.
RESULTS: There were 104 (18.4%) patients in group 1 and 460 (81.6%) patients in group 2. 61.2% of the patients were male and the mean age was 64.27. There were statistically significant differences between the groups in age distribution, tumor localization, surgical procedures, T- N classification, AJCC stage, presence of mucinous subtype, lymphovascular and perineural invasion. The mean tumor diameter was 5.23±3.48 cm. There was no difference between the groups concerning the adequacy of lymph node harvest, except in patients who underwent low anterior resection. The mean survival time was 475.212 days, and the median survival time was 376 days. The disease-free and overall survival rates were higher in group 2.
CONCLUSION: Despite the appropriate oncologic resection, CRC patients operated under emergency conditions had worse short-term and long-term results than the CRC patients operated under elective conditions. Thus, we believe that the prevalence of colorectal cancer screening programs should be increased to reduce the rate of emergency surgery.