Acute abdomen during chemotherapy: is surgery worthwhile? Insights from a single-center experience

Chemotherapy (CT) has improved cancer treatment, particularly for locally advanced or metastatic diseases. However, CT systemic effects complicate surgical management, especially in emergency scenarios like acute abdomen. This study evaluates outcomes of emergency abdominal surgery in patients undergoing CT. A retrospective analysis was conducted at the Surgical Department of Cardinal Massaia Hospital, Italy, from January 2019 to June 2024. Patients aged ≥ 18 years undergoing emergency surgery for acute abdomen within 30 days of CT were included. Data on demographics, CT regimens, surgical and postoperative outcomes, and survival were analyzed using statistical software. Ethical approval was obtained. Thirty patients (15 males, 15 females; mean age 64.2 ± 10.3 years) were included. Indications for surgery included intestinal obstruction (80%), gastrointestinal perforation (13.3%), and colovesical fistula (6.7%). Peritoneal carcinomatosis was present in 66.7%, and R0 resection was achieved in only one case. Derivative colostomies were performed in 30% of cases. Postoperative complications occurred in 20%, but no re-operations or ICU admissions were required. The 30-day mortality rate was 6.7%. CT was resumed in 46.7% of patients, with median survival of 249 days for obstruction cases. Emergency surgery during CT is rare but feasible, with acceptable morbidity and mortality rates. Prompt resolution of acute conditions allows for CT resumption, improving overall survival. Multicenter studies are needed to validate these findings and establish standardized protocols.