Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial) - Report - MDSpire
Advertisement
Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)
Emergent Colorectal Neoplasms in Immunosuppressed Patients: WIRES-T Initial Findings
Overview
This study presents preliminary data from the WIRES-T registry analyzing 839 immunocompromised patients with emergent colorectal neoplasms. It highlights differences in clinical characteristics, surgical outcomes, and survival between mild–moderate and severe immunosuppression groups, with ASA score identified as the main mortality predictor.
Background
The prevalence of immunocompromised (IC) patients is rising due to increased transplant recipients, chemotherapy use, and chronic illnesses. Colorectal cancer incidence increases with age, and emergencies related to colorectal neoplasms in IC patients represent a complex clinical challenge with limited existing data. The WIRES-T study aims to provide detailed international data on this under-investigated population to improve understanding and management.
Steroids 16.3%, Neutropenia 8.1%, Malignancy on chemotherapy 82.6%
ASA Score Distribution
ASA 3: 45.3%, ASA 4: 11.2%, ASA 5: 0.9%
ASA 3: 47.7%, ASA 4: 22.1%, ASA 5: 3.5%
WISS Median (IQR)
2 (2–5)
7 (2–10)
Post-op Complications (Clavien–Dindo Grade 5)
3.9%
12.8%
Median ICU Stay (days)
0.8
1
Median Hospital Stay (days)
12.5
12
In-hospital Mortality
5.1%
12.8%
Median Disease-Free Survival (months)
28 (10–91)
21 (10–94)
Median Overall Survival (months)
44 (18–99)
26 (20–90)
Key Findings
Among 839 patients, 80.7% had mild–moderate IC and 10.3% had severe IC.
Median age was approximately 72 years in both groups, with a predominance of male patients.
Sigmoid colon was the most common site of colorectal neoplastic emergencies (40% mild–moderate, 32.6% severe IC).
Intestinal occlusion was the leading complication (86.2% mild–moderate, 72.1% severe IC).
Postoperative mortality was significantly higher in severe IC (12.8%) compared to mild–moderate IC (5.1%).
ASA physical status score was the sole independent predictor of mortality in both IC groups.
Clinical Implications
Clinicians should recognize that immunosuppression severity impacts postoperative outcomes in colorectal neoplastic emergencies, with higher ASA scores indicating increased mortality risk. Early identification and optimization of patients’ physical status before emergency surgery may improve survival. Awareness of common presentation sites and complications can guide timely surgical intervention.
Conclusion
This large international cohort underscores the significant impact of immunosuppression on emergent colorectal neoplasm outcomes, highlighting ASA score as a key prognostic factor. These findings support tailored perioperative management strategies to improve patient prognosis.
References
WIRES-T Study Group 2024 -- Emergent Colorectal Neoplasms in Patients with Immunosuppression
Chen et al. -- Incidence of Right Colorectal Neoplastic Emergencies
