PHYSICAL STATUS IS THE PRINCIPAL DETERMINANT OF OUTCOME AFTER EMERGENCY ADMISSION OF PATIENTS WITH COLORECTAL-CANCER

A prospective study of 825 consecutive patients with colorectal cancer presenting to three general surgeons in a district general hospital o ver a 10-year period are reported. In all, 735 patients had an operati on and are grouped according to whether their operation was within 24 h of admission (n = 63), more than 24 h after admission (n = 15 1), or elective (n = 521). Operative mortalities for these groups were 15.9% , 15.2% and 6.5%, respectively, significantly higher in both the emerg ency groups. Delayed surgery to allow complete resuscitation did not i mprove the operative mortality when compared with those patients havin g urgent surgery. Both groups of emergency patients, delayed (27%) urg ent (19%), showed poorer 5-year survival than the electively treated p atients (36%), many dying of non-cancer causes. Patients who undergo e mergency surgery for colorectal carcinoma are more likely to be in poo rer physical condition than patients undergoing elective surgery for t he same condition. It appears that the physical status is the principa l determinant of outcome after emergency colorectal surgery rather tha n any other factor.