Prognostic determinants in surgical critial patients undergoing emergency surgery for Stage III or higher colorectal cancer.

Abstract

Purpose: Emergency surgery in patients with colorectal cancer (CRC) is associated with elevated mortality and morbidity compared to elective operations. This study was conducted to identify the factors influencing both short and long term outcomes in emergent CRC operations, particularly in critically ill patients.

Method: This single center retrospective analysis focuses on patients with stage III or higher CRC who underwent emergency surgery and were admitted to the intensive care unit postoperatively.

Results: Among 64 patients, 46 presented with generalized peritonitis due to free perforation. Non-survivors at 90 days had a higher incidence of preoperative shock (53.3% vs. 4.1%, P = 0.000), elevated perioperative Sequential Organ Failure Assessment scores (P = 0.000; P = 0.013), and fewer retrieved lymph nodes (LN) (P = 0.010). Multivariate analysis identified LNs retrieval as a significant predictor of 90-day mortality (AUC = 0.727). For overall survival, younger age, lower American Society of Anesthesiologists (ASA) physical status, absence of metastasis, adjuvant chemotherapy (CTx), and lower LN ratio (LNR) were associated with improved outcomes. Multivariate analysis showed ASA physical status and adjuvant CTx as significant predictors. In predicting 3-year recurrence (51% of patients), the Random Forest model achieved 65% accuracy. Age and LNR were major predictors, with 0.01 unit increase in LNR raising recurrence risk by 1.025-fold and each additional year of age by 1.035-fold.

Conclusion: The number of retrieved LNs was identified as a predictor of 90 day survival, ASA physical status and adjuvant CTx were identified as prognostic factors for overall survival, and age and the LNR were found to be predictors of disease recurrence within three years.