Emergency surgery for gastrointestinal cancer: A nationwide study in Japan based on the National Clinical Database

Nobuaki Hoshino, Hideki Endo, Koya Hida, Nao Ichihara, Yoshimitsu Takahashi, Hiroshi Hasegawa, Toshimoto Kimura, Yuko Kitagawa, Yoshihiro Kakeji, Hiroaki Miyata, Takeo Nakayama, Yoshiharu Sakai

Research output: Contribution to journalArticle

Abstract

Background: Emergency gastrointestinal surgery, although rare, is known for its high mortality and morbidity. However, the risks of emergency surgery for gastrointestinal cancer have not been investigated in depth. This study aimed to investigate the impact of emergency surgery on mortality and morbidity in patients with gastrointestinal cancers and to identify associated risk factors. Methods: We extracted data from the National Clinical Database, a nationwide surgery registration system in Japan, for patients with gastrointestinal cancer who underwent esophageal resection, total gastrectomy, distal gastrectomy, right hemicolectomy, or low anterior resection between 2012 and 2017. The impacts of emergency surgery on 30-day mortality and incidence of overall postoperative complications were compared with those of non-emergency surgery. Risk factors for mortality and overall postoperative complications were then sought in patients who underwent emergency surgery. Results: Thirty-day mortality and incidence of overall postoperative complications were significantly higher in emergency surgeries for gastric, colon, and rectal cancers than in non-emergency surgeries (odds ratios 4.86-6.98 and 1.68-2.18, respectively; all P <.001). Various risk factors were identified in the group that underwent emergency surgery, including preoperative sepsis and lower body mass index. Some of the risk factors were common to all types of surgery and others were specific to a certain type of surgery. Conclusion: The actual risk of emergency surgery and the risk factors for overall postoperative complications in emergency cases are shown to serve as a reference for postoperative management. Emergency surgery had an additional burden on patients depending on the type of surgery.

Original languageEnglish
JournalAnnals of Gastroenterological Surgery
DOIs
Publication statusAccepted/In press - 2020
Externally publishedYes

Keywords

  • emergency surgery
  • gastrointestinal neoplasms
  • morbidity
  • mortality

ASJC Scopus subject areas

  • Gastroenterology
  • Surgery

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    Hoshino, N., Endo, H., Hida, K., Ichihara, N., Takahashi, Y., Hasegawa, H., Kimura, T., Kitagawa, Y., Kakeji, Y., Miyata, H., Nakayama, T., & Sakai, Y. (Accepted/In press). Emergency surgery for gastrointestinal cancer: A nationwide study in Japan based on the National Clinical Database. Annals of Gastroenterological Surgery. https://doi.org/10.1002/ags3.12353