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A Journal on Surgery
Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Chirurgia 2009 February;22(1):17-23
Assessment of surgical risk and emergency surgery in colorectal cancer
Ospedale “Santo Spirito” Casale Monferrato, Alessandria, Italia
Colorectal cancer (CRC) continues to have a strong social impact in the western world, occupying the top places among cancers in order of frequency and second place as a cause of cancer death after lung cancer in men, and breast cancer in women. In 30% of cases, CRC begins with a complication that is generally occlusion (about 80%) and in the remainder perforation of the site of the tumour (20%). Occlusion is associated with perforation (diastasic) in 5% of cases. Massive haemorrhage is rare. The evaluation of surgical risk is an important aspect of the decision to subject the patient to emergency surgery for CRC and in the type of operation to be carried out. This assessment includes an analysis of operative risk factors associated with greater post-operative morbidity and mortality and predictive models may be employed for the calculation of surgical risk. As current guidelines highlight, treatment that targets complication control and radical oncological treatment must be carried out if possible, with reference to codified oncological criteria in the case of uncomplicated forms. Curative surgery can be carried out in emergency conditions with acceptable levels of morbidity and mortality comparable with situations in which the patient is operated on by choice. While for right-hand locations the treatment of choice consists of a right or extended right hemicolectomy, for the left colon there are always various surgical options which have to be evaluated on the basis of the patient’s clinical conditions, intraoperative findings and type of complication, the technical preferences and capabilities of the surgeon and the resources of the structure.