EP772 - Urgent Colectomies for Cancer: Unveiling the Impact of Specialized Colorectal Surgeons

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Purpose/Background: Urgent colectomies constitute a significant portion of acute care surgeries, necessitated by various benign and malignant conditions. While general surgeons typically perform colonic resections, more complex cases, particularly those involving colorectal cancer and inflammatory bowel disease, may demand a higher level of expertise. This study examines the outcomes of colo-rectal cancer related urgent colectomies with end stoma performed by Specialized Colo-Rectal Surgeons (CRS) compared to those conducted by General Surgeons (GS).

Methods/Interventions: This study analyzed data from patients who underwent emergency colectomy with end stoma due to complications related to colon cancer at a single tertiary hospital between 2013 and 2023. The primary outcome measured was the incidence of perioperative complications, including mortality. Patients were grouped based on whether a CRS was involved in the surgery. perioperative outcomes including lymphadenectomy were compared between the groups (CRS vs. GS).

Results/Outcomes: The study included 98 cases, 32 (32.7%) performed by a CRS, with an average age of 70.05 ± 14.6 years and a gender distribution of 60 females to 38 males. The Charlson comorbidity score averaged 4.01 ± 2.6. No significant differences were found in baseline characteristics between the groups. The 90-day complication rate was similar between the CRS and GS groups (40.6% vs. 36.9%, p=0.724), as was the rate of major complications (Clavien-Dindo ≥3, 12.5% vs. 19.7%, p=0.378). The 90-day mortality rate was lower in the CRS group (6.45% vs. 15.1%), but this difference was not statistically significant (p=0.225). The number of lymph nodes (LN) in the specimen was significantly higher in the CRS group (24.6 ± 13.4 vs. 19.1 ± 8.8, p=0.019), however inadequate lymphadenectomy rate (defined as fewer than 12 LN) did not differ between the groups (p=0.991). Positive margins were rare, with all occurrences found in the GS group (4 radial, 1 distal). Other perioperative outcomes, including estimated blood loss (p=0.895), blood product infusion rate (p=0.725), duration of surgery (p=0.327), hospital length of stay (p=0.16), ICU admission rate (p=0.123), and ICU length of stay (p=0.433), showed no significant differences between the groups. Kaplan-Meier survival curves indicated no significant difference in overall survival (log-rank p=0.236) over a median follow-up of 1.5±2.67 years, though the CRS group's curve was consistently higher than that of the GS group.

Conclusion/Discussion: Urgent colectomies related to colon cancer show comparable outcomes when performed by GS and CRS, with the exception of a higher lymphadenectomy yield in the CRS group. Given the limitations of the study's small sample size and retrospective design, which may result in underpowering, there is a potential trend toward improved survival and reduced major complication rates for the CRS group that did not reach statistical significance. Future research should investigate this issue in a larger, prospective study.