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Histotype influences emergency presentation and prognosis in colon cancer surgery

  • Simone SibioEmail author
  • A. Di Giorgio
  • S. D’Ugo
  • G. Palmieri
  • L. Cinelli
  • V. Formica
  • B. Sensi
  • G. Bagaglini
  • S. Di Carlo
  • V. Bellato
  • G. S. Sica
Original Article

Abstract

Aim

To investigate whether differences in histotype in colon cancer correlate with clinical presentation and if they might influence oncological outcomes and survival.

Methods

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.

Results

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.

Keywords

Colon cancer Emergency Elective Surgery Mucinous cancer 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    Gunderson LL, Jessup JM, Sargent DJ, Greene FL, Stewart AK (2010) Categorization for colon cancer based on national survival outcomes data. J Clin Oncol 28(2):264–271PubMedCrossRefPubMedCentralGoogle Scholar
  2. 2.
    Brenner H, Bouvier AM (2012) Foshi R et al and the EUROCARE GROUP: Progress in colorectal cancer survival in Europe from the late 1980’s and the early 21st century: the EUROCARE study. Int J Cancer 13(7):1649–1658CrossRefGoogle Scholar
  3. 3.
    Aquina CT, Becerra AZ, Xu Z et al (2017) Nonelective colon cancer resection: a continued public health concern. Surg. 161(6):1609–1618CrossRefGoogle Scholar
  4. 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
  5. 5.
    Brannstrom F, Gunnarson U (2016) Risk factors for local recurrence after emergency resection for colon cancer: scenario in Sweden. Dig Surg 33(6):503–508PubMedCrossRefPubMedCentralGoogle Scholar
  6. 6.
    Wanis KN, Ott M, Van Koughnett JAM et al (2018) Long term oncological outcomes following emergency resection of colon cancer. Int J Color Dis 33(11):1525–1532CrossRefGoogle Scholar
  7. 7.
    Siegel R, Ma J, Zou Z, Jemal A (2014) Cancer statistics, 2014. CA Cancer J Clin 64:9–29PubMedCrossRefPubMedCentralGoogle Scholar
  8. 8.
    Ansaloni L, Andersson RE, Bazzoli F et al (2010) Guidelines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg 5:29PubMedPubMedCentralCrossRefGoogle Scholar
  9. 9.
    Dukes CE (1932) The classification of cancer of the rectum. J Pathol Bacteriol 35:323–332CrossRefGoogle Scholar
  10. 10.
    Astler VB, Coller FA (1954) The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 139:846–852PubMedPubMedCentralCrossRefGoogle Scholar
  11. 11.
    Hutter RV (1987) At last--worldwide agreement on the staging of cancer. Arch Surg 122:1235–1239PubMedCrossRefGoogle Scholar
  12. 12.
    Merkel S, Mansmann U, Papadopoulos T, Wittekind C, Hohenberger W, Hermanek P (2001) The prognostic inhomogeneity of colorectal carcinoma stage III. A proposal for subdivision of stage III. Cancer 92:2754–2759PubMedCrossRefGoogle Scholar
  13. 13.
    Miyoshi M, Ueno H, Hashiguchi Y, Mochizuki H, Talbot IC (2006) Extent of mesorectal tumor invasion as a prognostic factor after curative surgery for T3 rectal cancer patients. Ann Surg 243:492–498PubMedPubMedCentralCrossRefGoogle Scholar
  14. 14.
    Willett CG, Badizadegan K, Ancukiewicz M, Shellito PC (1999) Prognostic factors in T3 N0 rectal cancer: do all patients require postoperative pelvic irradiation and chemotherapy? Dis Colon Rectum 42:167–173PubMedCrossRefGoogle Scholar
  15. 15.
    Burdy G, Panis Y, Alves A, Nemeth J, Lavergne-Slove A, Valleur P (2001) Identifying patients with T3-T4 node-negative colon cancer at high risk of recurrence. Dis Colon Rectum 44:1682–1688PubMedCrossRefGoogle Scholar
  16. 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. 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
  18. 18.
    Tarantino I, Huttner F, Warshkow R et al (2016) Prognostic relevance of mucinous subtype in a population-based propensity score analysis of 40.083 rectal cancer patients. Ann Surg Oncol 23:1576–1586PubMedCrossRefGoogle Scholar
  19. 19.
    Warschkow R, Tarantino I, Huttner F, Schmied BM, Guller U, Diener MK, Ulrich A (2016) Predictive value of mucinous histology in colon cancer: a population-based, propensity score matched analysis. Br J Cancer 114:1027–1032PubMedPubMedCentralCrossRefGoogle Scholar
  20. 20.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedPubMedCentralCrossRefGoogle Scholar
  21. 21.
    Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Amer Statist Assn 53:457–481CrossRefGoogle Scholar
  22. 22.
    Scott NA, Jeacock J, Kingston RD (1995) Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg 82:321–323PubMedCrossRefGoogle Scholar
  23. 23.
    Porta M, Fernandez E, Belloc J, Malats N, Gallén M, Alonso J (1998) Emergency admission for cancer: a matter of survival? Br J Cancer 77:477–484PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Biondo S, Marti-Rague J, Kreisler E, Pares D, Martin A, Navarro M et al (2005) Am J Surg 189:377–383PubMedCrossRefGoogle Scholar
  25. 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
  26. 26.
    Ng HJ, Yule M, Twoon M, Binnie NR, Aly EH (2015) Current outcomes of emergency large bowel surgery. Ann R Coll Surg Engl 97(2):151–156PubMedPubMedCentralCrossRefGoogle Scholar
  27. 27.
    Amri R, Sc. M, Bordeianou LG, Sylla P, Berger DL (2015) Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes. Am J Surg 209:246–253PubMedCrossRefGoogle Scholar
  28. 28.
    Siegel R, Ward E, Brawley O, Jemal H (2011) Cancer statistics 2011: the impact of eliminating socioeconomic and radical disparities on premature cancer deaths. CA Cancer J Clin 61:212–236PubMedCrossRefGoogle Scholar
  29. 29.
    Ward EE, Jemal AA, Cokkinides VV et al (2004) Cancer disparities by race/ethnicity and socioeconomic status. CA Cancer J Clin 54:78–93PubMedCrossRefGoogle Scholar
  30. 30.
    Amri R, Stronks K, Bordeianou LG et al (2014) Gender and ethnic disparities in colon cancer presentation and outcomes in a US universal healthcare setting. J Surg Oncol 109:645–651PubMedCrossRefPubMedCentralGoogle Scholar
  31. 31.
    Weixler B, Warschkow R, Ramser M et al (2016) Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease free survival: a propensity score analysis. BMC Cancer 16:208PubMedPubMedCentralCrossRefGoogle Scholar
  32. 32.
    Merkel S, Meyer C, Papadopoulos T, Meyer T, Hohenberger W (2007) Urgent surgery in colon carcinoma. Zentralbl Chir 132(1):16–25PubMedCrossRefPubMedCentralGoogle Scholar
  33. 33.
    Cuffy M, Abir F, Audisio RA (2004) Colorectal cancer presenting as surgical emergencies. Surg Oncol 13:149–157PubMedCrossRefPubMedCentralGoogle Scholar
  34. 34.
    Anderson JH, Hole D, McArdle CS (1992) Elective VS emergency surgery for patients with colorectal cancer. Br J Surg 79(7):706–709PubMedCrossRefPubMedCentralGoogle Scholar
  35. 35.
    Smothers L, Hynan L, Fleming J et al (2003) Emergency surgery for colon carcinoma. Dis Colon Rectum 46:24–30PubMedCrossRefPubMedCentralGoogle Scholar
  36. 36.
    Amelung FJ, Consten ECJ, Siersema PD, Tanis PJ (2016) A population-based analysis of three treatment modalities for malignant obstruction of the proximal colon: acute resection versus stent or stoma as a bridge to surgery. Ann Surg Oncol 23(11):3660–3668PubMedPubMedCentralCrossRefGoogle Scholar
  37. 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. 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
  39. 39.
    Mrak K, Jagoditsch M (2011) Leibl Set al.: Influence of pT3 subgroups on outcome of R0-resected colorectal tumors. South Med J 104:722–730PubMedCrossRefGoogle Scholar
  40. 40.
    Kang H, O’Connell JB (2005) Maggard Ma, et al.: A 10-year outcomes evaluation of mucinous and signet-ring cell carcinoma of the colon and rectum. Dis Colon Rectum 48:1161–1168PubMedCrossRefGoogle Scholar
  41. 41.
    Sasaki S, Masaki T, Umetani N, Futakawa N, Ando H, Muto T (1998) Characteristics in primary signet-ring cell carcinoma of the colorectum, from clinicopathological observations. Jpn J Clin Oncol 28:202–206PubMedCrossRefGoogle Scholar
  42. 42.
    Thota R, Fang X, Subbiah S (2014) Clinicopathological features and survival outcomes of primary signet-ring cell and mucinous adenocarcinoma of the colon: retrospective analysis of VACCR database. J Gastrointest Oncol 5:18–24PubMedPubMedCentralGoogle Scholar
  43. 43.
    Imperiale TF, Ransohoff DF, Itzkowitz SH, Turnbull BA, Ross ME, Colorectal Cancer Study Group (2004) Fecal DNA versus fecal occult blood for colorectal-cancer screening in an average-risk population. N Engl J Med 351:2704–2714PubMedCrossRefGoogle Scholar
  44. 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. 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
  46. 46.
    Baer C, Menon R, Bastawrous S (2017) Bastawrous A: emergency presentation of colorectal cancer. Surg Clin North Am 97(3):529–545PubMedCrossRefGoogle Scholar
  47. 47.
    Teixeira F, Hiroshi EH, Ushinohama AZ et al (2015) Can we respect the principles of oncologic resection in an emergency surgery to treat colon cancer? World J Emerg Surg 10:5PubMedPubMedCentralCrossRefGoogle Scholar
  48. 48.
    Wang C, Gao Z, Shen K, Shen Z, Jiang K, Liang B, Yin M, Yang X, Wang S, Ye Y (2017) Safety, quality and effect of complete mesocolic excision vs non-complete mesocolic excision in patients with colon cancer: a systemic review and meta-analysis. Color Dis 19(11):962–972CrossRefGoogle Scholar
  49. 49.
    Benz S, Tam Y, Tannapfel A et al (2016) The uncinate process first approach: a novel technique for laparoscopic right hemicolectomy with complete mesocolic excision. Eurg Endosc 30:1930–1937CrossRefGoogle Scholar
  50. 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
  51. 51.
    Benz S, Tannapfel A, Tam Y, Grünenwald A, Vollmer S, Stricker I (2019) Proposal of a new classification system for complete mesocolic excision in right-sided colon cancer. Tech Coloproctology (23):251–257PubMedCrossRefGoogle Scholar
  52. 52.
    Kim NK, Kim YW, Han YD, Cho MS, Hur H, Min BS, Lee KY (2016) Complete mesocolic excision and central vascular ligation for colon cancer: principle, anatomy, surgical technique, and outcomes. Surg Oncol 25(3):252–262PubMedCrossRefGoogle Scholar
  53. 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
  54. 54.
    Negoi I, Beuran M, Hostiuc S et al (2018) Complete mesocolic excision for colon cancer is technically challenging but the most oncological appealing. Transl Gastroenterol Hepatol 3:79PubMedPubMedCentralCrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Surgery “Pietro Valdoni”Sapienza University of RomeRomeItaly
  2. 2.Department of Surgery “Pietro Valdoni”Sapienza University of RomeRomeItaly
  3. 3.Department of Surgery, Tor Vergata HospitalTor Vergata University of RomeRomeItaly
  4. 4.Department of Surgical SciencesSapienza University of RomeRomeItaly

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