THE SURGICAL EMERGENCY TREATMENT OF LEFT COLON AND RECTAL CANCER. A NEW METHOD FOR THE EVALUATION OF THE OPERATORY RISKS

Abstract

Background/aims: the surgical treatment of the left colon and rectal cancer emergencies is still controversial. In our opinion the choiceis to be based on the general health status of the patient.

Methodology: the authors analised a series of 63 patients submitted to immediate resection and anastomosis.

Results: factors significantly related to short term results were chronic heart disease, low albumin serum levels, and colonic perforation. The presence of a diverting colostomy did not result a protective factor toward anastomotic dehiscence. We constructed a Colorectal Tumours Emergencies Score made of the identified four factors in which the score of each factor is the approximated odds ratio (chronic renal failure 7 points, low albumin serum levels 6 points, heart disease 5 points, colon perforation 4 points). Each patient was classified as Low Risk (CTES < 4), Moderate Risk (CTES 4 - 12), High Risk (CTES >12), mortality and morbidity being 4% and 20%, 19,3% and 61,3%, 88,9% and 88,9 % respectively.

Conclusions: high risk patients may undergo a staged procedure. Moderate risk patients may be treated by immediate resection of the tumor, without anastomosis. Immeadiate resection and anastomosis may be reserved to low risk patients