Emergency Presentation of Colon Cancer Is Most Frequent During Summer

Colorectal Dis. 2011 Jun;13(6):663-8. doi: 10.1111/j.1463-1318.2010.02270.x. Epub 2010 Mar 23.

Abstract

Aim: The frequency of emergency colon cancer (ECC) was determined using a reproducible definition of 'emergency' to analyse the impact of mode of presentation on long-term prognosis and to search for risk factors for an emergency presentation.

Method: All patients with colon cancer treated at one Swedish GDH between 1996 and 2005 (N = 604) were eligible. Patients admitted through the emergency room, operated on within three days and with an emergency condition confirmed at surgery were classified as ECC. Survival was analysed by Kaplan-Meier estimates and risk of death by Cox regression.

Results: The rate of ECC was 97/585 (17%). Patients with ECC were older (median 77 vs 74, P = 0.02), they had more stage III and IV cancers (65%vs 47%; χ(2) = 9.4, P < 0.001) and had a cancer located in the caecum less often (20%vs 33%, χ(2) = 4.3 P = 0.04). ECC were most frequent between June and August (36%), whereas elective cases were evenly distributed throughout the year (χ(2) = 7.8; P = 0.049), Crude 5-year survival was 18% in ECC and 38% in the elective group (P < 0.001). The hazard ratio for death within five years in ECC, with 30-day mortality excluded and adjusted for age and sex was 2.25 (95% CI; 1.42-3.55).

Conclusion: Emergency presentation of colon cancer is an independent and adverse risk factor for long-term survival. The causes of a seasonal variation need to be clarified.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Case-Control Studies
  • Colonic Neoplasms / complications
  • Colonic Neoplasms / mortality*
  • Colonic Neoplasms / pathology
  • Colonic Neoplasms / surgery*
  • Emergencies
  • Female
  • Humans
  • Intestinal Obstruction / etiology
  • Intestinal Obstruction / surgery*
  • Intestinal Perforation / etiology
  • Intestinal Perforation / surgery*
  • Kaplan-Meier Estimate
  • Male
  • Middle Aged
  • Prognosis
  • Proportional Hazards Models
  • Seasons*
  • Survival Rate