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Oncology and Acute Care Surgery: Examining Outcomes in Cancer Patients Requiring Emergent Laparotomy

Year: 2025

Type: article

Abstract: INTRODUCTION: Patients presenting with abdominal emergencies requiring emergent laparotomy are at high risk of morbidity and mortality. The impact of an active cancer diagnosis on the short-term outcomes of emergent laparotomy is not well described. METHODS: A retrospective analysis was conducted using an institutional database comprised of patients admitted from 2015 to 2019 who underwent exploratory laparotomy within 6 h of surgical consultation. The postoperative outcomes of patients with and without an active cancer diagnosis were compared using univariate and multivariable analysis with adjustment for clinical and demographic variables. RESULTS: Among 409 patients who met inclusion criteria, 320 (78.2%) were without an active cancer diagnosis and 89 (21.8%) had an active cancer diagnosis. Patients with cancer were older (median [interquartile range], 63 [56, 70] y versus 59 y [49, 69], P = 0.0001) and presented with higher number of acute severity measures (17.9% versus 13.1%, P = 0.017). Patients with cancer had higher odds of 90-d mortality (adjusted odds ratio: 12.0, 95% confidence interval: [4.9, 29.3]) and 90-d systemic complications (adjusted odds ratio 2.4, 95% confidence interval: [1.26, 4.50]). Patients with cancer who died during index hospitalization received more inpatient palliative care consultations (53.3% versus 25.7%, P = 0.0336) and experienced more systemic complications postoperatively (45.2% versus 17.0%, P = 0.0038). CONCLUSIONS: An active cancer diagnosis is independently associated with worse postoperative outcomes following emergent laparotomy. These findings should inform individual and shared decision-making regarding the role of emergency surgery and are relevant for future patient-centered research in oncologic emergencies.

Source: Journal of Surgical Research

DOI: 10.1016/j.jss.2025.03.015