Cirugía urgente del cáncer de colon como factor pronóstico de recidiva y supervivencia

Abstract

El 20-30 % de los canceres de colon debutan como una urgencia. Nuestro objetivo es analizar si la cirugía urgente del cáncer de colon es un factor de riesgo independiente de recurrencia y supervivencia. Métodos: Estudio retrospectivo de 504 pacientes intervenidos de cáncer de colon con intención curativa entre 2003 y 2012, 84 pacientes precisaron cirugía urgente. Resultados: La cirugía urgente asocia un mayor riesgo de recidiva local y una menor supervivencia específica. El riesgo de recidiva local ajustado por ASA y edad, se multiplica casi por 5 [Reg Cox, HR:4.94 (95%IC: 1.39-17.56, p=0.014)] en el estadio II, y por 2.5 [HR: 2.54 (95%IC: 1.17-5.53; p=0.019)] en el estadio III. La mayor morbilidad asociada a la cirugía urgente (p=0.004) no condiciona estos peores resultados oncológicos. Conclusiones: La cirugía urgente es un factor de riesgo independiente de recidiva local y está asociada a una peor supervivencia específica.

Background: Between 20 and 30% of colon cancers present as surgical emergencies. This study aimed to determine if emergency surgery of colon cancer is an independent risk factor for increased tumour recurrence and diminished survival. Methods: This is a retrospective study including all 504 patients operated on for a colon cancer between 2003 and 2012 with curative procedures. In 84 patients an urgent surgery was required. Results: After adjusting for age and ASA risk, our study determined an increase risk of local recurrence in those patients who received an emergency surgery (Reg Cox, adjusted HR: 4,94; 95% CI, 1.39-17.56; p= 0.014 for stage II, and adjusted HR 2.54: 95% CI, 1.17-5.53; p= 0.019 for stage III). The need of urgent surgery was associated with a lower specific survival. The increased morbidity associated to emergency surgery (p=0.004) had no influence in oncologic results. Conclusions: Emergency surgery of colon cancer is an independent risk factor for local recurrence, and is associated with a worse specific survival.