Surgery for recurrent intra-abdominal cancer

A review of 185 patients who developed recurrent intra-abdominal cancer has been undertaken to compare the results after emergency (41 patients) and elective (144 patients) surgery. The overall postoperative mortality was 19% and morbidity 45%. The mean survival was 13 +/- 20 months, median 7 months and cumulative 5-year survival 5%. The postoperative relief of symptoms was 7 +/- 18 months. A statistically significantly poorer prognosis was observed in emergency patients when compared with those operated on electively. Postoperative mortality and morbidity rates after emergency operations were 41% and 68% and after elective surgery 13% and 39%. The mean survival in the emergency group, 5 +/- 10 months, was significantly shorter than in the elective group, 17 +/- 22 months. The postoperative relief of symptoms for emergency patients was 2 +/- 3 months and for elective patients 10 +/- 22 months. Postoperative sepsis was the most common complication in the emergency group and it caused death in 9 of the 10 cases. Formation of intestinal fistula and early obstruction were the most frequent complications in the elective group. Emergency resections and bypass procedures carried the lowest risk of mortality, 33% and 11%, when compared with enterostomy and laparotomy, which were accompanied by a mortality of 61% and 50%. It is concluded that resective surgery has the best chance to improve survival in emergency surgery for recurrent cancer, although it is associated with a high risk of morbidity and mortality and a disappointingly short relief of symptoms. If resection is not feasible, the possibility of creating a bypass should be considered.