(cases) (%) Endoscopic obstruction (%) p-value All 329 120 (37) – Tumor site     < 0.01 Rectum 94 (29) 47 (50)   Colon 223 (68) 155 (70)   Tumor side     0.047 Left colon and rectum 224 (68) 135 (60)   Right colon 93 (28) 67 (72)   serum CEA     0.31 < 5 ng/ml 144 (59) 87 (60)   ≥ 5 ng/ml 102 (41) 68

(67)   Tumor size     < 0.01 < 5.5 cm 181 (57) 104 (57)   ≥ 5.5 cm 136 (43) 98 (72)   T     < 0.01 T0-2 47 (14) 18 (38)   T3-4 282 (86) 191 (68)   N     0.90 N0 171 (53) 108 (63)   N1-2 152 (47) 97 (64)   M     0.07 M0 281 (85) 173 (61)   M1 48 (15) 36 (75)   Tumor differentiation     0.63 Well/Moderate 279 (92) 181 (64)   Poor 25 (8) see more 15 (60)   Lymphovascular invasion     0.18 Absent 276 (84) 179 (64)   Present 51 (16) 28 (59)   CEA carcinoembryonic antigen. Significance of endoscopic obstruction on mode of operation and outcome Twenty-two cases (7%) required an GSK458 research buy emergency operation before their scheduled elective procedure. The emergency surgery requirement was significantly higher in eOB cases (10%), compared to those without obstruction (2%). Cases with an eOB had LY294002 a significantly higher chance of requiring an emergency operation at a Cox’s hazard ratio

of 6.9 (95% confidence interval 1.6-29.7). Among cases with eOB, the frequency of cases requiring emergency surgery was not significantly different between rectal cases (9%) and colonic cases (10%) (p-value 0.8). The median time from colonoscopy to operation in the emergency cases was 14 days. The cumulative incidences of emergency surgery in all cases at 15, 30 and 60 days of surgical waiting were 3%, 5% and 9%, respectively (Figure 1). The 60-day cumulative emergency operation rate was 14% in those with an obstructing tumor, compared to Thiamine-diphosphate kinase 3% in cases in which an endoscope could be passed beyond the tumor (p-value < 0.01). The reasons for the emergency surgery included complete colonic obstruction presenting as abdominal pain, vomiting and obstipation in 20 cases and 1 case each of gastrointestinal bleeding and tumor

perforation. The emergency procedure was a definitive colorectal resection in all 22 cases. Patients who underwent emergency surgery had a higher incidence of distant metastasis (32% compared to 13% in elective cases, p-value 0.02). Figure 1 Probability of requiring an emergency operation A: overall B: comparing between cases with and without endoscopic obstruction. Operative complications occurred in 48 cases (15%). Patients who underwent an emergency operation had a higher rate of post-operative complications (36%) than those who had surgery according to their elective schedule (13%, p-value < 0.01). (Table 3) On survival analysis, although eOB was not directly associated with overall survival, requiring emergency operation had a statistically significant impact on poorer overall survival (p-value < 0.01).