Surgical treatment of left colon malignant emergencies. A new tool for operative risk evaluation

The surgical treatment of left colon and rectal cancer emergencies is still controversial. In our opinion the choice is to be based on the general health status of each patient.

We retrospectively analyzed our series of 57 patients who underwent immediate resection and anastomosis.

Factors significantly related to short-term results were chronic renal failure, heart disease, low albumin serum levels and colonic perforation. The presence of a diverting colostomy did not result in being a protective factor toward anastomotic dehiscence. We constructed a Colorectal Tumors Emergencies Score made of the identified four factors in which the score of each factor is the approximated odds ratio (chronic renal failure 7 points, low albumin serum levels 6 points, heart disease 5 points, colon perforation 4 points). Each patient was classified as Low Risk (CTES < 4), Moderate Risk (CTES 4-12) and High Risk (CTES > 12), mortality and morbidity being 4.3% and 21.7%, 24.0% and 60.0%, 88.9% and 88.9%, respectively.

High-risk patients may undergo a staged procedure. Moderate risk patient may be treated by immediate resection of the tumor, without anastomosis. Immediate resection and anastomosis may be reserved to low-risk patients.