Emergency presentation of colorectal cancer is associated with poor 5-year survival

Background: Previous studies have reported that emergency presentation of colorectal cancer is associated with poor outcome. Many of these studies were small and most were not adjusted for case mix. The aim of this study was to establish, after adjusting for case mix, the magnitude of the differences in postoperative mortality and survival between patients undergoing elective surgery and those presenting as an emergency. Methods: Three thousand two hundred patients who underwent surgery for colorectal cancer between 1991 and 1994 in Scotland were studied. Five-year survival rates and adjusted hazard ratios were calculated. Results: Some 1603 (72.4 per cent) of 2214 elective patients had a potentially curative resection compared with 632 (64.1 per cent) of 986 patients who presented as an emergency (P < 0.001). Following curative resection, the postoperative mortality rate was 2.8 per cent after elective and 8.2 per cent after emergency operation (P < 0.001). Overall survival at 5 years was 57.5 per cent after elective and 39.1 per cent after emergency curative surgery (P < 0.001); cancer-specific survival at 5 years was 70.9 and 52.9 per cent respectively (P < 0.001). The adjusted hazard ratio for overall survival after emergency relative to elective surgery was 1.68 (95 per cent confidence interval (c.i.) 1.49 to 1.90; P < 0.001) and that for cancer-specific survival was 1.90 (95 per cent c.i. 1.62 to 2.22; P < 0.001). Conclusion: Following apparently curative resection for colorectal cancer, there was an excess of both cancer-related and intercurrent deaths in patients who presented as an emergency.