Histotype influences emergency presentation and prognosis in colon cancer surgery
To investigate whether differences in histotype in colon cancer correlate with clinical presentation and if they might influence oncological outcomes and survival.
Data regarding colon cancer patients operated both electively or in emergency between 2009 and 2014 were retrospectively collected from a prospectively maintained database and analyzed for the purpose of this study. Rectal cancer was excluded from this analysis. Statistical univariate and multivariate analyses were performed to investigate possible significant variables influencing clinical presentation, as well as oncological outcomes and survival.
Data from 219 patients undergoing colorectal resection for cancer of the colon only were retrieved. One hundred seventy-four patients had an elective procedure and forty-five had an emergency colectomy. Emergency presentation was more likely to occur in mucinous (p < 0.05) and signet ring cell (p < 0.01) tumors. No definitive differences in 5-year overall (44.7% vs. 60.6%, p = 0.078) and disease-free (51.2% vs. 64.4%, p = 0.09) survival were found between the two groups as a whole, but the T3 emergency patients showed worse prognosis than the elective (p < 0.03). Lymph node invasion, laparoscopy, histology, and blood transfusions were independent variables found to influence survival. Distribution assessed for pTNM stage showed T3 cancers were more common in emergency (p < 0.01).
Conclusions and discussion
Mucinous and signet ring cell tumors are related to emergency presentation, pT3 stage, poorest outcomes, and survival. Disease-free survival in patients who had emergency surgery for T3 colon cancer seems related to the histotype.
KeywordsColon cancer Emergency Elective Surgery Mucinous cancer
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 4.Oliphant R, Mansouri D, Nicholson GA, McMillan D, Horgan PG, Morrison DS, West of Scotland Colorectal Cancer Managed Clinical Network (2014) Emergency presentation of node negative colorectal cancer treated with curative surgery is associated with poorer short and longer term survival. Int J Color Dis 29(5):591–598CrossRefGoogle Scholar
- 16.Tsai HL, Cheng KI, Lu CY, Kuo CH, Ma CJ, Wu JY, Chai CY, Hsieh JS, Wang JY (2008) Prognostic significance of depth of invasion, vascular invasion and numbers of lymph node retrievals in combination for patients with stage II colorectal cancer undergoing radical resection. J Surg Oncol 97:383–387PubMedCrossRefGoogle Scholar
- 17.Compton CC, Fielding LP, Burgart LJ, et al (2000) Prognostic factors in colo-rectal cancer. College of American Pathologists Consensus Statement 1999. Arch Pathol Lab; ed; 124: 979-994.Google Scholar
- 25.Xu Z, Becerra AZ, Aquina CT, Hensley BJ, Justiniano CF, Boodry C, Swanger AA, Arsalanizadeh R, Noyes K, Monson JR, Fleming FJ (2017) Emergent colectomy is independently associated with decreased long-term overall survival in colon cancer patients. J Gastrointest Surg 21:543–553PubMedCrossRefGoogle Scholar
- 37.Lara-Romero C, Vilches Á, Caunedo-Álvarez Á, Hergueta-Delgado P, Lavín-Castejón I, Andrade-Bellido R, Alcaín-Martínez G (2019) Better recurrence-free survival after stent bridge to surgery compared to emergency surgery for obstructive left-sided colonic cancer in patients with stage III status of the American Joint Committee on Cancer (AJCC): a bicentric retrospective study. Int J Color Dis 34(7):1241–1250CrossRefGoogle Scholar
- 38.Amelung FJ, Borstlap WAA (2019) Consten ECJet al.: Dutch Snapshot Research Group. Propensity score-matched analysis of oncological outcome between stent as bridge to surgery and emergency resection in patients with malignant left-sided colonic obstruction. Br J Surg 106(8):1075–1086PubMedCrossRefGoogle Scholar
- 44.Sica GS, Fiorani C, Stolfi C, Monteleone G, Candi E, Amelio I, Catani V, Sibio S, Divizia A, Tema G, Iaculli E, Gaspari AL (2015 May 30) Peritoneal expression of matrilysin helps identify early post-operative recurrence of colorectal cancer. Oncotarget. 6(15):13402–13415PubMedPubMedCentralCrossRefGoogle Scholar
- 45.Sibio S, Fiorani C, Stolfi C, Divizia A, Pezzuto R, Montagnese F, Bagaglini G, Sammartino P, Sica GS (2015) Detection methods and clinical significance of free peritoneal tumor cells found during colorectal cancer surgery. World J Gastrointest Surg 7(9):178–184PubMedPubMedCentralCrossRefGoogle Scholar
- 50.Benz S, Stricker I, Tam Y et al (2017) CME or traditional surgery for right-sided colon cancer? Protocol of a registry-based multicenter prospective non-randomized trial (RESECTAT trial). Coloproctology (39):184–189Google Scholar
- 53.Bertelsen CA, Neuenschwander AU, Jansen JE, Wilhelmsen M, Kirkegaard-Klitbo A, Tenma JR, Bols B, Ingeholm P, Rasmussen LA, Jepsen LV, Iversen ER, Kristensen B, Gögenur I, Danish Colorectal Cancer Group (2015) Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 16:161–168PubMedCrossRefGoogle Scholar