Quality of Colon Cancer Care in Patients Undergoing Emergency Surgery

Thirty percent of colon cancer diagnoses occur following emergency presentations, often with bowel obstruction or perforation requiring urgent surgery. We sought to compare cancer care quality between patients receiving emergency versus elective surgery. We conducted an institutional retrospective matched (46 elective:23 emergency; n = 69) case control study. Patients who underwent a colon cancer resection from January 2017 to February 2019 were matched by age, sex, and cancer stage. Data were collected through the National Surgical Quality Improvement Program and chart review. Process outcomes of interest included receipt of cross-sectional imaging, CEA testing, pre-operative cancer diagnosis, pre-operative colonoscopy, margin status, nodal yield, pathology reporting, and oncology referral. No differences were found between elective and emergency groups with respect to demographics, margin status, nodal yield, oncology referral times/rates, or time to pathology reporting. Patients undergoing emergency surgery were less likely to have CEA levels, CT staging, and colonoscopy (p = 0.004, p = 0.017, p < 0.001). Emergency cases were less likely to be approached laparoscopically (p = 0.03), and patients had a longer length of stay (p < 0.001) and 30-day readmission rate (p = 0.01). Patients undergoing emergency surgery receive high quality resections and timely post-operative referrals but receive inferior peri-operative workup. The adoption of a hybrid acute care surgery model including short-interval follow-up with a surgical oncologist or colorectal surgeon may improve the quality of care that patients with colon cancer receive after acute presentations. Surgeons treating patients with colon cancer emergently can improve their care quality by ensuring that appropriate and timely disease evaluation is completed.

114 VATS ESOPHAGECTOMY: DOES PATIENT OPERATIVE POSITION DURING THORACOSCOPIC MOBILISATION INFLUENCE OUTCOMES? A PROSPECTIVE COMPARATIVE STUDY

VATS esophagectomy can be done in lateral, prone and semiprone positions. Present evidence available comparing semiprone with lateral position is retrospective. We have conducted this study to provide prospective data on perioperative outcomes in patients undergoing Video Assissted Thoracoscopic (VATS) esophagectomy in Semiprone (SP) and Lateral decubitus position (LP) in a single centre. Methods 48 patients (SP =24 & LP =24) undergoing VATS esophagectomy (2017 to 2019) were analysed. Preoperative details (tumor characteristics, preoperative treatment and pulmonary function test), intraoperative details [operative time, blood loss, mean EtCO2, arterial blood gas analysis (ABG) at the end of one lung ventilation(OLV), number of ports used, need for lung reinflation and retraction] and postoperative details [duration of ICU stay, cardiovascular and respiratory complications, pain scores (VAS) and tidal volume improvement (spirometry reading) on first five postoperative days, circumferential resection margin (CRM) status, total and recurrent laryngeal nerve (RLN) nodal yield were noted. Results Preoperative data in both arms were comparable. Ports used (5 vs 3, p &lt; 0.0001), need for lung retraction (22 vs 4patients, p &lt; 0.0001), duration of ICU stay (2 days vs 1 day, p = 0.0327), spirometry readings for POD 1st-5th (p &lt; 0.05) and pain scores (p &lt; 0.05) for POD 1st-5th was significantly less in SP group. There were fewer respiratory complications in SP group (10 vs 4, p = 0.110). LP group had shorter duration of surgery (3.7 vs 4.2 hours, p = 0.0398). There were no differences in tumor characteristics, blood loss, ABG at the end of OLV, mean EtCO2, lung reinflation rate, cardiovascular complications, CRM involvement, total and RLN nodal yield. Conclusion Similar oncological clearance was achieved by both techniques of esophageal mobilization. Semiprone position is associated with lesser postoperative pain and better preservation of respiratory function.