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Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors

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Abstract

Background

The aim of this study was to analyze the incidence, patterns and prognostic factors of recurrence in patients with complicated colon cancer who had emergency surgery within 24 h of admission.

Methods

A retrospective observational study was performed on patients with obstructing or perforated colon cancer having resection with curative intent between 1996 and 2014 at a single center. Data were obtained from a prospectively maintained database. Patients who had rectal cancer, iatrogenic endoscopic perforation, stage IV disease, palliative surgery, a colonic stent or decompressive colostomy were excluded.

Results

The study included 393 patients. Obstruction was observed in 320 patients (81.4%) and perforation in 73 (18.6%). Hartmann’s procedure was more frequently performed by general surgeons (7.5% vs 23.3%; p = 0.023). 30-day postoperative mortality was 13.5% (53/393), including 47 (14.7%) obstructed and 6 (8.2%) perforated patients. Postoperative complications (Clavien–Dindo III–IV) occurred in 87 patients (22.1%), including 68 (21.2%) of obstructed and 19 (26.0%) of perforated patients. Anastomotic dehiscence was diagnosed in 52 of 329 (15.8%) patients with primary anastomosis and was higher in the obstructing group than in the perforated group (17.4% vs 7.6%). There was a significantly higher anastomotic dehiscence rate after procedures performed by general surgeons when compared with those performed by colorectal surgeons (10.3% vs 21.3%; p = 0.005; OR 2.81, 95% CI 1.4–5.9). With a median follow-up of 6 years, the recurrence rate was 30.1% (67.4% distant, 22.8% local, 9.8% both). Overall and cancer-related survivals were 68.7% and 77.8%, respectively. The presence of positive nodes, male gender, anastomotic dehiscence and diffuse peritonitis were independent predictors for local recurrence while type of surgeon (general) was an independent factor for distant recurrence.

Conclusions

Male gender, diffuse peritonitis, positive lymph nodes, type of surgeon and postoperative anastomotic dehiscence significantly influence recurrence of colorectal cancer in this series.

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References

  1. Chen TM, Huang YT, Wang GC (2017) Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Oncol 15:164

    Article  Google Scholar 

  2. Biondo S, Kreisler E, Millan M et al (2008) Differences in patient postoperative and long-term outcomes between obstructive and perforated colonic cancer. Am J Surg 195:427–432

    Article  Google Scholar 

  3. Frago R, Biondo S, Millan M et al (2011) Differences between proximal and distal obstructing colonic cancer after curative surgery. Colorectal Dis 13:e116–e122

    Article  CAS  Google Scholar 

  4. Yang XF, Pan K (2014) Diagnosis and management of acute complications in patients with colon cancer: bleeding, obstruction, and perforation. Chin J Cancer Res 26:331–340

    PubMed  PubMed Central  Google Scholar 

  5. Ho YH, Siu SK, Buttner P, Stevenson A, Lumley J, Stitz R (2010) The effect of obstruction and perforation on colorectal cancer disease-free survival. World J Surg 34:1091–1101

    Article  Google Scholar 

  6. McArdle CS, Hole DJ (2004) Influence of volume and specialization on survival following surgery for colorectal cancer. Br J Surg 91:610–617

    Article  CAS  Google Scholar 

  7. Biondo S, Martí-Ragué J, Kreisler E et al (2005) A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg 189:377–383

    Article  Google Scholar 

  8. Baer C, Menon R, Bastawrous S, Bastawrous A (2017) Emergency presentations of colorectal cancer. Surg Clin North Am 97:529–545

    Article  Google Scholar 

  9. Hogan J, Samaha G, Burke J et al (2015) Emergency presenting colon cancer is an independent predictor of adverse disease-free survival. Int Surg 100:77–86

    Article  Google Scholar 

  10. Biondo S, Kreisler E, Millan M et al (2010) Impact of surgical specialization on emergency colorectal surgery outcomes. Arch Surg 145:79–86

    Article  Google Scholar 

  11. 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 240:205–213

    Article  Google Scholar 

  12. Biondo S, Kreisler E, Millan M et al (2007) Long-term results of emergency surgery for colon cancer compared with elective surgery. Cir Esp 82:89–98

    Article  Google Scholar 

  13. Iversen LH, Bülow S, Christensen IJ, Laurberg S, Harling H, Danish Colorectal Cancer Group (2008) Postoperative medical complications are the main cause of early death after emergency surgery for colonic cancer. Br J Surg 95:1012–1019

    Article  CAS  Google Scholar 

  14. 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 16:208

    Article  Google Scholar 

  15. Smith JA, King PM, Lane RH, Thompson MR (2003) Evidence of the effect of specialization’ on the management, surgical outcome and survival from colorectal cancer in Wessex. Br J Surg 90:583–592

    Article  CAS  Google Scholar 

  16. Degett TH, Dalton SO, Christensen J, Søgaard J, Iversen LH, Gögenur I (2019) Mortality after emergency treatment of colorectal cancer and associated risk factors-a nationwide cohort study. Int J Colorectal Dis 34(1):85–95

    Article  Google Scholar 

  17. Cortet M, Grimault A, Cheynel N, Lepage C, Bouvier AM, Faivre J (2013) Patterns of recurrence of obstructing colon cancers after surgery for cure: a population-based study. Colorectal Dis 15:1100–1106

    CAS  PubMed  Google Scholar 

  18. Asano H, Kojima K, Ogino N, Fukano H, Ohara Y, Shinozuka N (2017) Postoperative recurrence and risk factors of colorectal cancer perforation. Int J Colorectal Dis 32:419–424

    Article  Google Scholar 

  19. Crozier JE, Leitch EF, McKee RF, Anderson JH, Horgan PG, McMillan DC (2009) Relationship between emergency presentation, systemic inflammatory response, and cancer-specific survival in patients undergoing potentially curative surgery for colon cancer. Am J Surg 197(4):544–549

    Article  Google Scholar 

  20. Manfredi S, Bouvier AM, Lepage C, Hatem C, Dancourt V, Faivre J (2006) Incidence and patterns of recurrence after resection for cure of colonic cancer in a well defined population. Br J Surg 93:1115–1122

    Article  CAS  Google Scholar 

  21. Read TE, Mutch MG, Chang BW et al (2002) Locoregional recurrence and survival after curative resection of adenocarcinoma of the colon. J Am Coll Surg 195:33–40

    Article  Google Scholar 

  22. Harris GJ, Church JM, Senagore AJ et al (2002) Factors affecting local recurrence of colonic adenocarcinoma. Dis Colon Rectum 45:1029–1034

    Article  CAS  Google Scholar 

  23. Chen HS, Sheen-Chen SM (2000) Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery 127:370–376

    Article  CAS  Google Scholar 

  24. Sjövall A, Granath F, Cedermark B, Glimelius B, Holm T (2007) Loco-regional recurrence from colon cancer: a population-based study. Ann Surg Oncol 14:432–440

    Article  Google Scholar 

  25. Sugawara K, Kawaguchi Y, Nomura Y, Koike D, Nagai M, Tanaka N (2017) Insufficient lymph node sampling in patients with colorectal cancer perforation is associated with an adverse oncological outcome. World J Surg 41:295–305

    Article  Google Scholar 

  26. Runkel NS, Hinz U, Lehnert T, Buhr HJ, Herfarth Ch (1998) Improved outcome after emergency surgery for cancer of the large intestine. Br J Surg 85:1260–1265

    Article  CAS  Google Scholar 

  27. Jessup JM, Stewart A, Greene FL, Minsky BD (2005) Adjuvant chemotherapy for stage III colon cancer: implications of race/ethnicity, age, and differentiation. JAMA 294:2703–2711

    Article  CAS  Google Scholar 

  28. O’Connor ES, Greenblatt DY, Lo Conte NK et al (2011) Adjuvant chemotherapy for stage II colon cancer with poor prognostic features. J Clin Oncol 29:3381–3388

    Article  Google Scholar 

  29. Quasar Collaborative Group, Gray R, Barnwell J, McConkey C et al (2007) Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study. Lancet 370:2020–2029

  30. Barbas AS, Turley RS, Mantyh CR, Migaly J (2012) Effect of surgeon specialization on long-term survival following colon cancer resection at an NCI-designated cancer center. J Surg Oncol 106:219–223

    Article  Google Scholar 

  31. Oliphant R, Nicholson GA, Horgan PG, Molloy RG, McMillan DC, Morrison DS, West of Scotland Colorectal Cancer Managed Clinical Network (2013) Contribution of surgical specialization to improved colorectal cancer survival. Br J Surg 100:1388–1395

    Article  CAS  Google Scholar 

  32. Hall GM, Shanmugan S, Bleier JI, Jeganathan AN, Epstein AJ, Paulson EC (2016) Colorectal specialization and survival in colorectal cancer. Colorectal Dis 18:O51–O60

    Article  CAS  Google Scholar 

  33. Alonso S, Pascual M, Salvans S, Mayol X, Mojal S, Gil MJ, Grande L, Pera M (2015) Postoperative intra-abdominal infection and colorectal cancer recurrence: a prospective matched cohort study of inflammatory and angiogenic responses as mechanisms involved in this association. Eur J Surg Oncol 41(2):208–214

    Article  CAS  Google Scholar 

  34. Sánchez-Velázquez P, Pera M, Jiménez-Toscano M, Mayol X, Rogés X, Lorente L, Iglesias M, Gallén M (2018) Postoperative intra-abdominal infection is an independent prognostic factor of disease-free survival and disease-specific survival in patients with stage II colon cancer. Clin Transl Oncol 20(10):1321–1328

    Article  Google Scholar 

  35. Goto S, Hasegawa S, Hida K et al (2017) Study Group for Nomogram of the Japanese Society for Cancer of the Colon and Rectum. Multicenter analysis of impact of anastomotic leakage on long-term oncologic outcomes after curative resection of colon cancer. Surgery 162:317–324

    Article  Google Scholar 

  36. Krarup PM, Nordholm-Carstensen A, Jorgensen LN, Harling H (2014) Anastomotic leak increases distant recurrence and long-term mortality after curative resection for colonic cancer: a nationwide cohort study. Ann Surg 259:930–938

    Article  Google Scholar 

Download references

Acknowledgements

The authors thank Mr. Bernat Miguel, Statistician and Data Manager of the Colorectal Unit, University Hospital of Bellvitge and IDIBELL, for the statistical analysis.

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There are no funding sources for the present observational study.

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Correspondence to Sebastiano Biondo.

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Biondo, S., Gálvez, A., Ramírez, E. et al. Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors. Tech Coloproctol 23, 1141–1161 (2019). https://doi.org/10.1007/s10151-019-02110-x

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