• Robert E Roses, Ching-Wei D Tzeng, Merrick I Ross, Keith F Fournier, Daniel E Abbott, and Y Nancy You.
• 1 Department of Surgery, University of Pennsylvania School of Medicine , Philadelphia, Pennsylvania.
• J Palliat Med. 2014 Jan 1;17(1):37-42.

BackgroundThe role of emergent palliative surgery in the setting of advanced malignancy remains a subject of controversy.ObjectiveThe purpose of this study was to identify clinical predictors of outcome in patients with cancer who undergo nonelective abdominal surgery.Setting/SubjectsIndividuals who underwent urgent and emergent abdominal operations between 2006 and 2010 at a tertiary cancer center were identified.MeasurementsAnalyses were performed to identify predictors of 30-day morbidity and mortality as well as overall survival (OS). A risk score was derived from predictors of OS.ResultsOf 143 patients, 93 (65%) had active disease (AD; defined as evidence of malignancy at time of surgery). Thirty-day morbidity and mortality were 36.4% and 9.8%, respectively. Independent predictors of 30-day mortality included ASA score >3 (p=0.009) and albumin <2.8 (p=0.040). Median OS was 5.4 months in patients with AD and was not reached in patients without AD (p<0.001). Independent predictors of decreased OS included AD; ASA >3; creatinine >1.3; and a tumor-related indication (i.e., bleeding, obstructing, or perforating tumor). A risk or palliative index (PI) score stratified patients into groups with discreet outcomes.ConclusionsAlthough AD did not predict 30-day morbidity, it was the dominant independent predictor of postoperative OS. In cancer patients undergoing emergency abdominal surgery, outcome is anticipated by disease status and other independent predictors of OS.

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