Clinical Characteristics and Outcomes of Oncologic Surgical Emergencies: A Retrospective Study.

Abstract

Background: Oncologic surgical emergencies (OSEs) are increasing, with rising cancer incidences and prolonged patient survival. However, prior OSEs studies have been limited by a narrow focus. This study aimed to determine whether a five-category classification for OSEs can effectively guide clinical decision-making based on patient outcomes.

Methods: This retrospective cohort study used prospectively collected data from 1 May 2015 to 31 December 2023 at Zhongshan Hospital, Fudan University. Among in-patients undergoing emergency general surgery, 2908 patients with OSEs were included. The OSEs were classified into five categories based on the tumor course: (1) emergency as the initial symptom, (2) emergency due to tumor progression or recurrence, (3) complications from non-invasive treatments, (4) complications from invasive treatments, and (5) emergencies unrelated to tumors but with a history of malignancy. The primary outcome was in-hospital mortality.

Results: Obstruction was the most common emergency (58.0%), and gastrointestinal tumors were the primary source (79.8%). Category 1 emergencies were the most frequent (42.8%), followed by categories 2 (16.4%), 4 (16.0%), 5 (19.5%), and 3 (5.5%). The patients with OSEs had a higher in-hospital mortality rate than those with other types of emergencies (4.0% vs. 1.5%; p < 0.001). Perforation, age ≥ 65 years, and male sex were independent risk factors for in-hospital mortality.

Conclusions: The comprehensive five-category classification system for OSEs provided a valuable framework that may enhance clinical decision-making and guide management strategies for this patient population. Thus, it has potential to be integrated into clinical practice.