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

机译：左结肠恶性紧急情况的外科治疗。一种用于手术风险评估的新工具。

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BACKGROUND/AIMS: 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. METHODOLOGY: We retrospectively analyzed our series of 57 patients who underwent immediate resection and anastomosis. RESULTS: 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. CONCLUSIONS: 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.
机译：背景/目的：左结肠癌和直肠癌紧急情况的手术治疗仍存在争议。我们认为，选择应基于每个患者的总体健康状况。方法：我们回顾性分析了我们的57例接受了立即切除和吻合的患者。结果：与短期结果显着相关的因素是慢性肾衰竭，心脏病，白蛋白血清水平低和结肠穿孔。转移性结肠造口术的存在并未导致成为吻合口裂的保护因素。我们根据确定的四个因素构建了结直肠肿瘤紧急情况评分，其中每个因素的得分都是近似的比值比（慢性肾衰竭7分，白蛋白低水平6分，心脏病5分，结肠穿孔4分）。每位患者分为低危（CTES <4），中危（CTES 4-12）和高危（CTES> 12），死亡率和发病率分别为4.3％和21.7％，24.0％和60.0％，88.9％和88.9。 ％， 分别。结论：高危患者可以接受分期手术。中度危险的患者可通过立即切除肿瘤而无吻合的方式进行治疗。低危患者应立即切除和吻合。

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