Data from: Current management of surgical oncologic emergencies

Objectives: For some oncologic emergencies, surgical interventions are necessary for dissolution or temporary relieve. In the absence of guidelines, the most optimal method for decision making would be in a multidisciplinary cancer conference (MCC). In an acute setting, the opportunity for multidisciplinary discussion is often not available. In this study, the management and short term outcome of patients after surgical oncologic emergency consultation was analyzed. Method: A prospective registration and follow up of adult patients with surgical oncologic emergencies between 01-11-2013 and 30-04-2014. The follow up period was 30 days. Results: In total, 207 patients with surgical oncologic emergencies were included. Postoperative wound infections, malignant obstruction, and clinical deterioration due to progressive disease were the most frequent conditions for surgical oncologic emergency consultation. During the follow up period, 40% of patients underwent surgery. The median number of involved medical specialties was two. Only 30% of all patients were discussed in a MCC within 30 days after emergency consultation, and only 41% of the patients who underwent surgery were discussed in a MCC. For 79% of these patients, the surgical procedure was performed before the MCC. Mortality within 30 days was 13%. Conclusion: In most cases, surgery occurred without discussing the patient in a MCC, regardless of the fact that multiple medical specialties were involved in the treatment process. There is a need for prognostic aids and acute oncology pathways with structural multidisciplinary management. These will provide in faster institution of the most appropriate personalized cancer care, and prevent unnecessary investigations or invasive therapy.

研究目标：针对部分肿瘤急症，需通过外科干预实现病灶清除或暂时缓解病情。在尚无相关指南的情况下，制定最优诊疗决策的理想途径为开展多学科肿瘤会诊（Multidisciplinary Cancer Conference, MCC）。但在急诊诊疗场景中，往往难以实现多学科讨论。本研究旨在分析接受外科肿瘤急诊会诊患者的诊疗经过与短期预后情况。
研究方法：对2013年11月1日至2014年4月30日期间收治的成年外科肿瘤急症患者开展前瞻性登记与随访，随访周期为30天。
研究结果：本研究共纳入207例外科肿瘤急症患者。术后切口感染、恶性梗阻以及因疾病进展引发的临床恶化，是外科肿瘤急诊会诊的最常见指征。随访期间，40%的患者接受了外科手术治疗。患者所涉及的医学专科数量中位数为2个。仅30%的患者在急诊会诊后30天内接受了多学科肿瘤会诊，接受手术治疗的患者中也仅有41%完成了多学科肿瘤会诊。其中79%的患者在多学科肿瘤会诊前即已接受外科手术。患者30天死亡率为13%。
研究结论：尽管治疗过程涉及多个医学专科，但多数患者在未接受多学科肿瘤会诊的情况下即实施了外科手术。当前亟需构建具备结构化多学科管理模式的预后辅助工具与急性肿瘤诊疗路径，此类工具与路径可加快为患者落实最适宜的个性化肿瘤诊疗服务，并避免不必要的检查或侵入性治疗。