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Preoperative prognostic factors for obstructive colorectal cancer

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Aim

The aim of the study was to determine the preoperative predictive factors of overall survival, relapse-free survival, and peritoneal carcinomatosis in obstructive colorectal cancer.

Methods

Data from patients undergoing emergency surgery for obstructive colorectal cancer at our center between 2004 and 2016 were extracted retrospectively from our health records. Several preoperative parameters were used to predict survival and peritoneal carcinomatosis using univariate and multivariate analysis, and ROC curves.

Results

A total of 107 patients with obstructive colorectal cancer were included. Five-year relapse-free and overall survival rates were 14% and 28%, respectively, with 15% peritoneal carcinomatosis. Univariate analysis showed that age ≥ 83 years old, preoperative ASA score ≥ 3, initial hemodynamic instability, and CRP > 18.3 mg/L was significantly associated with worse relapse-free and overall survival. In a multivariate analysis, only age > 83 years (HR = 1.75; HR = 2.16, for relapse-free and overall survival status, respectively) and hemodynamic instability (HR = 7.29; HR = 6.55) were confirmed in the multivariate model. Global peritoneal carcinomatosis was significantly associated with synchronous liver metastases in the multivariate model (OR = 4.56), and synchronous peritoneal carcinomatosis only was significantly associated with platelet to lymphocyte ratio (PLR) > 269 and synchronous liver metastases in the multivariate model (OR = 0.003; OR = 7.26).

Conclusion

Synchronous liver metastases are prognostic risk factor for global and synchronous peritoneal carcinomatosis whereas PLR > 269 was a significant protective factor for synchronous peritoneal carcinomatosis only for obstructive colorectal cancer. Age > 83 years and initial hemodynamic instability were key preoperative prognostic risk factors for worse relapse-free and overall survival. Prognostic usefulness of blood cell ratios for mortality and peritoneal carcinomatosis warrants further investigation.

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Authors and Affiliations

  1. Acute Care Surgery Unit, University Hospital of Nice, Pasteur 2 Hospital, Nice Sophia-Antipolis University, Nice, France

    Jean-Hubert Etienne, Damien Massalou & Patrick Baqué

  2. Digestive Surgery Unit, Antibes - Juan Les Pins Hospital, Antibes, France

    Benjamin Salucki

  3. University Hospital of Nice, L’Archet 2 Hospital, Nice Sophia-Antipolis University, Nice, France

    Jean-Marc Bereder

  4. Nice-Sophia-Antipolis University, Pasteur 2 Hospital, Nice UMC, France

    Damien Massalou

  5. Urology Unit, University Hospital of Nice, Pasteur 2 Hospital, Nice Sophia-Antipolis University, Nice, France

    Imad Bentellis

  6. Demography Institute, Strasbourg University, Strasbourg, France

    Maïlys Goetschy

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  1. Jean-Hubert Etienne
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  2. Benjamin Salucki
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Correspondence to Jean-Hubert Etienne.

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Etienne, JH., Salucki, B., Bereder, JM. et al. Preoperative prognostic factors for obstructive colorectal cancer. Int J Colorectal Dis 37, 1257–1272 (2022). https://doi.org/10.1007/s00384-022-04163-1

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  • DOI: https://doi.org/10.1007/s00384-022-04163-1

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