Emergency surgery for recurrent intraabdominal cancer

BACKGROUND: Recurrent abdominal cancer can manifest in many ways but there are certain situations that are a great challenge to clinicians. Emergency presentation is one such situation. Surgeons are faced with a therapeutic dilemma that on the one hand most of these patients have a limited life expectancy, and on the other surgical procedures are unavoidable. We reviewed our experience of recurrent abdominal cancers presenting with acute abdominal symptoms requiring emergency. PATIENTS AND METHODS: Over the last 10 years, 81 patients with recurrent abdominal cancer presented with an abdominal emergency. Case records, operative notes and histology were reviewed. Frequency distributions were prepared for clinical, hematological, biochemical parameters, treatment and complications. Surgical analysis was carried out by the Kaplan Meier method and groups were compared using a log-rank test. RESULTS: The mean age of the patients was 70.1 years with a female to male ratio of 1.25. An overall postoperative mortality of 11.1% and morbidity of 27.1% was observed. Postoperative infections and respiratory complications were the most common causes of morbidity and mortality. Emergency resections carried the same risk of mortality and morbidity as the other surgical procedures (p > 0.05). Patients who underwent radical or palliative resections had a better survival than patients undergoing other procedures (p < 0.05). Preoperative Apache II score was found to be single most important predictor of postoperative mortality and morbidity. CONCLUSIONS: We conclude that surgical resection offers the best chance for improvement in survival after emergency surgery for recurrent abdominal cancer. If resection is not feasible, the possibility of creating a bypass or enterostomies should be considered to improve the patients' quality of life.