Oncology and Acute Care Surgery: Examining Outcomes in Cancer Patients Requiring Emergent Laparotomy

Introduction

Patients presenting with abdominal emergencies requiring emergent laparotomy are at high risk of morbidity and mortality. The impact of an active cancer diagnosis on the short-term outcomes of emergent laparotomy is not well described.

Methods

A retrospective analysis was conducted using an institutional database comprised of patients admitted from 2015 to 2019 who underwent exploratory laparotomy within 6 h of surgical consultation. The postoperative outcomes of patients with and without an active cancer diagnosis were compared using univariate and multivariable analysis with adjustment for clinical and demographic variables.

Results

Among 409 patients who met inclusion criteria, 320 (78.2%) were without an active cancer diagnosis and 89 (21.8%) had an active cancer diagnosis. Patients with cancer were older (median [interquartile range], 63 [56, 70] y versus 59 y [49, 69], P = 0.0001) and presented with higher number of acute severity measures (17.9% versus 13.1%, P = 0.017). Patients with cancer had higher odds of 90-d mortality (adjusted odds ratio: 12.0, 95% confidence interval: [4.9, 29.3]) and 90-d systemic complications (adjusted odds ratio 2.4, 95% confidence interval: [1.26, 4.50]). Patients with cancer who died during index hospitalization received more inpatient palliative care consultations (53.3% versus 25.7%, P = 0.0336) and experienced more systemic complications postoperatively (45.2% versus 17.0%, P = 0.0038).

Conclusions

An active cancer diagnosis is independently associated with worse postoperative outcomes following emergent laparotomy. These findings should inform individual and shared decision-making regarding the role of emergency surgery and are relevant for future patient-centered research in oncologic emergencies.