Evaluation of clinical outcomes with propensity-score matching for colorectal cancer presenting as an oncologic emergency.

ABSTRACT

Aim: Oncologic emergencies such as perforation and obstruction associated with colorectal cancer are serious diseases that can lead to sepsis. Peritoneal dissemination and other factors may cause cancer progression and worsen the patients' long-term prognosis. In this study, we investigated the effect of colorectal cancer presenting as oncologic emergencies on the patients' clinical course. Methods: We performed a retrospective study that included 448 patients with colorectal cancer who underwent primary resection at our institution between January 2014 and December 2018. The primary outcome was overall survival, while secondary outcomes were 30-day mortality and postoperative complications. Cox regression was used to estimate the hazard ratio (HR) for overall survival. Results: We identified 56 patients who presented with oncologic emergencies (OE group) and 392 patients who presented with no emergencies (NE group). Propensity-score matching yielded 56 patients in the OE group and 55 in the NE group with balanced baseline covariates. We found a strong association between overall survival (OS) and oncologic emergencies (HR = 2.4; 95% confidence interval [CI], 1.1-5.5). The 30-day mortality was not significantly different between the OE and NE groups (4% vs 0%, P = .25). The incidence of severe postoperative complications (Clavien-Dindo classification ≥grade 3) did not differ significantly between the groups (25% vs 15%, P = .23). Conclusion: Colorectal cancer presenting as an oncologic emergency could be safely operated on without increasing the 30-day mortality rate and the incidence of severe postoperative complications. However, the long-term prognosis was poor.