Skip to main content

Advertisement

Log in

Emergency Room Presentation of Colorectal Cancer: A Consecutive Cohort Study

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Emergency room presentation (ERP) in colorectal cancer (CRC) is associated with worse cancer-related outcomes. The goal of this study was to determine the frequency of ERP and identify factors associated with ERP of CRC.

Methods

We performed a prospective consecutive cohort study of all patients undergoing resection for CRC from 02/2002 to 02/2004. Standardized data collection involved hospital record review, patient interview, and prospective follow-up. ERP was defined as the diagnosis and/or surgical treatment of CRC as a result of presentation to the emergency department.

Results

Of the 455 patients in the study 108 (24%) had ERP. Presentation of those with ERP was obstruction in 46 (43%), bleeding/anemia in 35 (32%), pain in 25 (23%), and other (2%). The ERP cohort was older (mean age 70.8 vs. 67.0 years, P = 0.005). ERP was more common amongst females (29.7 vs. 18.2%, = 0.004) and obesity appears to be associated with increased rates of ERP. ERP of CRC was associated with more advanced TNM stage. The ERP cohort had longer length of stay in hospital (median 10 vs. 8 days respectively, P < 0.001). Peri-operative mortality was higher in ERP patients (7.4 vs. 2.3%, P = 0.03).

Conclusions

ERP in CRC was not infrequent and appeared to be associated with female gender and weight. The known negative prognostic impact of ERP, combined with the increased peri-operative mortality and length of stay, would suggest a potential benefit to targeted strategies aimed at reducing the use of the emergency room in the diagnosis and treatment of CRC.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

REFERENCES

  1. Muir CS. Epidemiology, basic science and the prevention of cancer: Implications for the future. Cancer Res 1990; 50:6441–8

    PubMed  CAS  Google Scholar 

  2. National Cancer Institute of Canada: Canadian Cancer Statistics 2005. Toronto, Canada, 2005

  3. Ponz de Leon, et al. Descriptive epidemiology of colorectal cancer in Italy: The 6 year experience of a specialized registry. Eur J Cancer 1993; 29(3):367–71

  4. Phang PT, et al. Effect of emergent presentation on outcome from rectal cancer management. Am J Surg 2003; 185:450–4

    Article  PubMed  Google Scholar 

  5. Scott NA, Jeacock J, Kingston RD. Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg 1995; 82:321–3

    Article  PubMed  CAS  Google Scholar 

  6. Umpleby HC, Bristol JB, Rainey JB, Williamson RC. Survival of 727 patients with single carcinomas of the large bowel. Dis Colon Rectum 1984; 27(12):803–10

    Article  PubMed  CAS  Google Scholar 

  7. Nilsson E, Gregersen NP, Hartvig B, Sjodahl R. Carcinoma of the colon and rectum. Results of treatment in 284 cases. Acta Chir Scand. 1984; 150(2):177–82

    PubMed  CAS  Google Scholar 

  8. Alvarez JA, Baldonedo RF, Bear IG, Truan N, Pire G, Alvarez P. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 2005; 190(3):376–82

    Article  PubMed  Google Scholar 

  9. Buechter KJ, Boustany C, Caillouette R, et al. Surgical management of the acutely obstructed colon. Am J Surg 1988; 156:163–8

    Article  PubMed  CAS  Google Scholar 

  10. Chen HS, Sheen-Chen SM. Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery 2000; 127:370–6

    Article  PubMed  CAS  Google Scholar 

  11. Rabeneck L, Paszat LF, Rothwell DM, He J. Temporal trends in new diagnoses of colorectal cancer with obstruction, perforation, or emergency admission in Ontario: 1993–2001. Am J Gastroenterol. 2005; 100(3):672–6

    Article  PubMed  Google Scholar 

  12. Phillips RK, Hittinger R, Fry JS, et al. Malignant large bowel obstruction. Br J Surg 1985; 72:296–302, 849–53

    Google Scholar 

  13. García-Valdecasas JC, Llovera JM, de Lacy AM, et al. Obstructing colorectal carcinomas. Prospective study. Dis Colon Rectum 2001; 34:759–62

    Article  Google Scholar 

  14. Fielding LP, Stewart-Brown S, Blesovsky L. Large bowel obstruction caused by cancer: a prospective study. Br Med J 1979; 2:515–7

    PubMed  CAS  Google Scholar 

  15. Kriwanek S, Armbruster C, Dittrich K, et al. Perforated colorectal cancer. Dis Colon Rectum 1996; 39:1409–14

    Article  PubMed  CAS  Google Scholar 

  16. Runkel NS, Schlag P, Schwarz V, et al. Outcome after emergency surgery for cancer of the large intestine. Br J Surg 1991; 78:183–8

    Article  PubMed  CAS  Google Scholar 

  17. Campbell NC, Elliott AM, Sharp L, Ritchie LD, Cassidy J, Little J. Rural and urban differences in stage at diagnosis of colorectal and lung cancers. Br J Cancer 2001; 84(7):910–4

    Article  PubMed  CAS  Google Scholar 

  18. Launoy G, Le Coutour X, Gignoux M, Pottier D, Dugleux G. Influence of rural environment on diagnosis, treatment, and prognosis of colorectal cancer. J Epidemiol Community Health 1992; 46(4):365–7

    Article  PubMed  CAS  Google Scholar 

  19. Jestin P, Nilsson J, Heurgren M, Pahlman L, Glimelius B, Gunnarsson U. Emergency surgery for colonic cancer in a defined population. Br J Surg 2005; 92(1):94–100

    Article  PubMed  CAS  Google Scholar 

  20. Rabeneck L, Paszat LF, Li C. Risk factors for obstruction, perforation, or emergency admission at presentation in patients with colorectal cancer: a population-based study. Am J Gastroenterol 2006; 101(5):1098–103

    Article  PubMed  Google Scholar 

  21. Singh SM, Paszat LF, Li C, et al. The association of socioeconomic status and receipt of colorectal investigations in Ontario, Canada: A population-based retrospective cohort study. CMAJ 2004; 171:461–5

    PubMed  Google Scholar 

  22. Farraye FA, Wong M, Hurwitz S, et al. Barriers to endoscopic colorectal screening: Are women different than men? Am J Gastro 2004; 99:341–9

    Article  Google Scholar 

  23. Menees SB, Inadomi JM, Kornes S, et al. Women patients’ preference for women physicians is a barrier to colon cancer screening. Gastrointest Endosc 2005; 62:219–23

    Article  PubMed  Google Scholar 

  24. Kudenchik PJ, Maynard C, Martin JS, Wirkus M, Weaver WD. Comparison of presentation, treatment, and outcome of acute myocardial infarction in men versus women. Am J Cardiol 1996; 78:9–14

    Article  Google Scholar 

  25. Anand SS, Xie CC, Mehta S, Franzosi MG, Joyner C, Chrolavicius S, Fox KA, Yusuf S. CURE Investigators. Differences in the management and prognosis of women and men who suffer from acute coronary syndromes. J Am Coll Cardiol 2005; 46(10):1845–51

    Article  PubMed  Google Scholar 

  26. Murphy TK, Calle E.E, Rodriguez C. Body mass index and colon cancer mortality in a large prospective study. Am J Epidemiol 2000; 152:847–54

    Article  PubMed  CAS  Google Scholar 

  27. Giovannucci E, Ascherio A, Rimm EB. Physical activity, obesity, and risk for colon cancer and adenoma in men. Ann Intern Med 1995; 122:327–334

    PubMed  CAS  Google Scholar 

  28. Meyerhardt JA, Catalano PJ, Haller DG, Mayer RJ, Benson AB III, Macdonald JS, Fuchs CS. Influence of body mass index on outcomes and treatment-related toxicity in patients with colon carcinoma. Cancer 2003; 98(3):484–95

    Article  PubMed  Google Scholar 

  29. Colorectal cancer screening. Recommendation statement from the Canadian Task Force on Preventive Health Care. CMAJ 2001; 165:206–8

    Google Scholar 

  30. Wallace MB, Kemp JA, Meyer F, et al. Screening for colorectal cancer with flexible sigmoidscopy by nonphysician endoscopists. Am J Med 1999; 107:214–8

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors would like to thank John Fris for his assistance in data management.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Alex D. Mitchell MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mitchell, A.D., Inglis, K.M., Murdoch, J.M. et al. Emergency Room Presentation of Colorectal Cancer: A Consecutive Cohort Study. Ann Surg Oncol 14, 1099–1104 (2007). https://doi.org/10.1245/s10434-006-9245-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-006-9245-z

Keywords

Navigation