Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)
Authors: Coccolini Federico , Mazzoni Alessio , Cremonini Camilla , Cobuccio Luigi , Pucciarelli Marsia , Vetere Guglielmo , Borelli Beatrice , Strambi Silvia , Musetti Serena , Miccoli Mario , Cremolini Chiara ,   WIRES-T Study Group, Salvetti Francesco , Fugazzola Paola , Ceresoli Marco , Elisa Nita Gabriela , Litvin Andrey , Lostoridis Eftychios , Ahmed Ali Yasen Yasen Mohamed , Manatakis Dimitrios , Negoi Ionut , Ioannidis Orestis , Uzunoglu Mustafa Yener , Tochie Joel Noutakdie , Cillara Nicola , Tomadze Gia , Bala Miklosh , Isik Arda , Fonseca Vinicius Cordeiro , Bellanova Giovanni , Ghannam Wagih , Yalkin Omer , Garcia Fernando Hernandez , Altintoprak Fatih , Hadzhiev Dimitar , Chirica Mircea , Zese Monica , Balalis Dimitros , Cui Yunfeng , Luppi Davide , Romeo Luigi , Muratore Andrea , Lunghi Elia Giuseppe , Yovtchev Yovtcho , Nikolopoulos Ioannis , Omerovic Maid , Zizzo Maurizio , Ugoletti Lara , Costa Gianluca , Scalzone Rocco , Perrone Stefano , Occhionorelli Savino , Nardi Matteo , Gubbiotti Francesca , Catena Fausto , Muhtaroglu Ali , Scaramuzzo Rosa , Corte Helene , Yanez Carlos , Zakaria Andee Dzulkarnaen , Seretis Charalampos , Gelmini Roberta , Pappalardo Vincenzo , Paratore Filippo , Sydorchuk Ruslan , Mulita Francesk , Kara Yasin , Toma Elena Adelina , Vailas Michail , Sotiropoulou Maria , Benedetti Fabio , Elbahnasawy Mahamad , Sibilla Maria Grazia , Martines Gennaro , Goksoy Beslen , Hadzhiev Dimitar , Parini Dario , Zaghi Claudia , Podda Mauro , Osipov Aleksey , Brisinda Giuseppe , Gambino Giovanni , Akhmeteli Lali , Doklestic Krstina , Loncar Zlatibor , Micic Dusan , Lešević Ivana , D’Agostino Francesca , Garzali Ibrahim Umar , Caicedo Yaset , Marcela Lina , Marin Paola Andrea Gasca , Perivoliotis Konstantinos , Ntentas Ioannis , Kuptsov Arthur , Dimitrov Evgeni , Chowdhury Sharfuddin , Patel Tapan , Sartelli Massimo , Tartaglia Dario , Chiarugi Massimo 
Published: May 2023

Association of advanced age, neoplastic disease and immunocompromission (IC) may lead to surgical emergencies. Few data exist about this topic. Present study reports the preliminary data from the WIRES-T trial about patients managed for colorectal neoplastic emergencies in immunocompromised patients. The required data were taken from a prospective observational international register. The study was approved by the Ethical Committee with approval n. 17575; ClinicalTrials.gov Identifier: NCT03643718. 839 patients were collected; 753 (80.7%) with mild–moderate IC and 86 (10.3%) with severe. Median age was 71.9 years and 73 years, respectively, in the two groups. The causes of mild–moderate IC were reported such malignancy (753–100%), diabetes (103–13.7%), malnutrition (26–3.5%) and uremia (1–0.1%), while severe IC causes were steroids treatment (14–16.3%); neutropenia (7–8.1%), malignancy on chemotherapy (71–82.6%). Preoperative risk classification were reported as follow: mild–moderate: ASA 1–14 (1.9%); ASA 2–202 (26.8%); ASA 3–341 (45.3%); ASA 4–84 (11.2%); ASA 5–7 (0.9%); severe group: ASA 1-1 patient (1.2%); ASA 2–16 patients (18.6%); ASA 3–41 patients (47.7%); ASA 4–19 patients (22.1%); ASA 5–3 patients (3.5%); lastly, ASA score was unavailable for 105 cases (13.9%) in mild–moderate group and in 6 cases (6.9%) in severe group. All the patients enrolled underwent urgent/emergency surgery Damage control approach with open abdomen was adopted in 18 patients. Mortality was 5.1% and 12.8%, respectively, in mild–moderate and severe groups. Long-term survival data: in mild–moderate disease-free survival (median, IQR) is 28 (10–91) and in severe IC, it is 21 (10–94). Overall survival (median, IQR) is 44 (18–99) and 26 (20–90) in mild–moderate and severe, respectively; the same is for post-progression survival (median, IQR) 29 (16–81) and 28, respectively. Univariate and multivariate analyses showed as the only factor influencing mortality in mild–moderate and severe IC is the ASA score. Colorectal neoplastic emergencies in immunocompromised patients are more frequent in elderly. Sigmoid and right colon are the most involved. Emergency surgery is at higher risk of complication and mortality; however, management in dedicated emergency surgery units is necessary to reduce disease burden and to optimize results by combining oncological and acute care principles. This approach may improve outcomes to obtain clinical advantages for patients like those observed in elective scenario. Lastly, damage control approach seems feasible and safe in selected patients.