Colorectal neoplastic emergencies in immunocompromised patients: preliminary result from the Web-based International Register of Emergency Surgery and Trauma (WIRES-T trial)

Category	Detail
Condition	Colorectal neoplastic emergencies (CRNE) in immunocompromised (IC) patients
Key Mechanisms	Immunosuppression due to malignancy, chemotherapy, steroids, neutropenia, diabetes, malnutrition, uremia leading to increased risk and severity of colorectal emergencies
Target Population	Patients with colorectal neoplastic emergencies who are immunocompromised, including transplant recipients, chemotherapy patients, chronic renal failure on hemodialysis, and those with acquired or inherited immunodeficiency
Care Setting	Urgent/emergency surgical care in international multicenter settings

839 patients analyzed: 753 mild–moderate IC and 86 severe IC with median ages ~72 years
Most frequent site of CRNE is sigmoid colon (40% mild–moderate, 32.6% severe IC); intestinal occlusion is the most common complication
ASA score is the only factor significantly influencing mortality in both mild–moderate and severe IC groups

Classify immunosuppression severity as mild–moderate or severe based on recent guidelines
Assess preoperative risk using ASA Physical Status Classification
Evaluate disease site and complications (e.g., intestinal occlusion, perforation) via clinical and surgical findings

Urgent/emergency surgery is indicated for CRNE in IC patients
Damage control surgery with open abdomen may be considered in selected severe cases
Postoperative care includes intensive monitoring and management of complications classified by Clavien–Dindo system

Monitor postoperative complications using Clavien–Dindo classification
Track ICU and hospital length of stay
Follow long-term outcomes including disease-free survival, overall survival, and post-progression survival

Higher mortality associated with increased ASA score
Severe immunosuppression linked to increased postoperative complications and mortality
Older age and male gender associated with higher incidence of CRNE in IC patients

Immunocompromised patients undergoing emergency surgery for colorectal neoplastic complications

Urgent surgical intervention tailored to immunosuppression severity; ASA score guides risk stratification and prognosis

Use standardized classification (mild–moderate vs severe IC) to stratify patients
Employ ASA score for mortality risk prediction and surgical decision-making
Prioritize early surgical intervention for intestinal occlusion and other emergencies
Implement damage control surgery with open abdomen selectively in severe IC cases
Conduct thorough postoperative monitoring for complications and ICU needs
Collect and analyze long-term survival data to inform prognosis and follow-up care

Clinical Scorecard: Emergent Colorectal Neoplasms in Patients with Immunosuppression: Initial Findings from the Web-Based International Register of Emergency Surgery and Trauma (WIRES-T Study)