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The Effect of Obstruction and Perforation on Colorectal Cancer Disease-Free Survival

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Abstract

Background

Obstruction (OBSTR) and perforation (PERF) in colorectal cancer impact adversely upon outcomes, and cancer-related survival may also be affected. However, data are sparse, particularly on disease-free survival (DFS) where the cancer is both obstructed and perforated (OBS-PERF).

Methods

Data were extracted from a prospectively collected database of 1876 colorectal cancer patients managed and followed up at the Royal Brisbane Hospital from 1984 to 2004. The patients who had curative surgery (n = 1426) were classified as OBSTR (n = 153), PERF (n = 53), OBS-PERF (n = 19), and uncomplicated (UNCOM; n = 1201). Kaplan-Meier survival and Cox proportional hazard analyses were performed.

Results

Postoperative mortality within 30 days of surgery was 1.5% (n = 22) and the overall complication rate was 40.8% (n = 582). However, only 7.2% (n = 102) required reoperations. The median survival time was 71 (IQR = 64.9–77.1) months and the median follow-up for DFS was 37.5 (IQR 14–68) months. The overall recurrence rate was 32.7% (n = 466), the local recurrence rate was 9.4% (n = 135), and local and distant recurrences occurred in the same patient in 4.7% (n = 67). Male gender, OBSTR, PERF, OBS-PERF, emergency operation, major medical and surgical complications, reoperation, TNM staging, tumor grading, and tumor venous invasion adversely affected DFS (p < 0.05). Multivariate analysis showed that OBS-PERF (p = 0.008), major medical complications (p = 0.011), reoperation (p = 0.018), TNM staging (p < 0.001), grading (p = 0.018), and venous invasion (p = 0.002) were independently associated with a poorer DFS.

Conclusions

OBS-PERF colorectal cancer is associated with a poorer DFS, which may be worse than either OBSTR or PERF alone.

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References

  1. Australian Institute of Health and Welfare (2006) Cancer in Australia: an overview, 2006. Cat. No. Can 32, Canberra, AIHW

  2. McArdle CS, McMillan DC, Hole DJ (2006) The impact of blood loss, obstruction and perforation on survival in patients undergoing curative resection for colon cancer. Br J Surg 93:483–488

    Article  CAS  PubMed  Google Scholar 

  3. Phillips RK, Hittinger R, Fry JS et al (1985) Malignant large bowel obstruction. Br J Surg 72:296–302

    Article  CAS  PubMed  Google Scholar 

  4. Scott NA, Jeacock J, Kingston RD (1995) Risk factors in patients presenting as an emergency with colorectal cancer. Br J Surg 82:321–323

    Article  CAS  PubMed  Google Scholar 

  5. Carraro PG, Segala M, Cesana BM et al (2001) Obstructing colonic cancer: failure and survival patterns over a ten-year follow-up after one-stage curative surgery. Dis Colon Rectum 44:243–250

    Article  CAS  PubMed  Google Scholar 

  6. Carraro PG, Segala M, Orlotti C et al (1998) Outcome of large-bowel perforation in patients with colorectal cancer. Dis Colon Rectum 41:1421–1426

    Article  CAS  PubMed  Google Scholar 

  7. 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  PubMed  Google Scholar 

  8. McArdle CS, Hole DJ (2004) Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 91:605–609

    Article  CAS  PubMed  Google Scholar 

  9. Jestin P, Nilsson J, Huergren M et al (2005) Emergency surgery for colorectal cancer in a defined population. Br J Surg 92:94–100

    Article  CAS  PubMed  Google Scholar 

  10. Welch J, Donaldson GA (1974) Management of severe obstruction of large bowel due to malignant disease. Am J Surg 127:492–499

    Article  CAS  PubMed  Google Scholar 

  11. Ohman U (1982) Prognosis in patients with obstructing colorectal carcinoma. Am J Surg 143:742–747

    Article  CAS  PubMed  Google Scholar 

  12. Hughes ES (1966) Mortality of large bowel obstruction. Br J Surg 53:593–594

    Article  Google Scholar 

  13. Irvin TT, Greaney MG (1977) Treatment of colonic cancer presenting with intestinal obstruction. Br J Surg 64:741–744

    Article  CAS  PubMed  Google Scholar 

  14. Chapuis PH, Dent OF, Fisher R et al (1985) A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer. Br J Surg 72:698–702

    Article  CAS  PubMed  Google Scholar 

  15. Crowder VH Jr, Cohn I Jr (1967) Perforation in cancer of the colon and rectum 10:415–420

    Google Scholar 

  16. Staib L, Link KH, Blatx A et al (2002) Surgery of colorectal cancer: surgical morbidity and five- and ten-year results in 2400 patients–monoinstitutional experience. World J Surg 26:59–66

    Article  PubMed  Google Scholar 

  17. Lee IK, Sung NY, Lee SC et al (2007) The survival rate and prognostic factors in 26 perforated colorectal cancer patients. Int J Colorectal Dis 22:467–473

    Article  PubMed  Google Scholar 

  18. Wu ZY, Wan J, Zhao G et al (2008) Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection. World J Gastroenterol 14:4805–4809

    Article  PubMed  Google Scholar 

  19. Link KH, Saghan TA, Morschel M et al (2005) Colon cancer: survival after curative surgery. Langenbecks Arch Surg 390:83–93

    Article  CAS  PubMed  Google Scholar 

  20. Crozier JE, Leitch EF, McKee RF et al (2000) Relationship between emergency presentation, systemic response, and cancer specific survival in patients undergoing potentially curative surgery for colon cancer. Am J Surg 174:544–549

    Google Scholar 

  21. McMillan DC, Wotherspoon HA, Fearon KC et al (1995) Prospective study of tumour recurrence and the acute-phase response after apparently curative colorectal cancer surgery. Am J Surg 170:319–322

    Article  CAS  PubMed  Google Scholar 

  22. McMillan DC, Canna K, McArdle CS (2003) Systemic inflammatory response predicts survival following curative resection of colorectal cancer. Br J Surg 90:215–219

    Article  CAS  PubMed  Google Scholar 

  23. Canna K, McMillan DC, McKee RF et al (2004) Evaluation of a cumulative prognostic score based on systemic inflammatory response based on the systemic inflammatory surgery for colorectal cancer. Br J Cancer 90:1707–1709

    CAS  PubMed  Google Scholar 

  24. Kraemer M, Wiratkapun MD, Seow-Choen F et al (2001) Stratifying risk factors for follow-up: a comparison of recurrent and nonrecurrent colorectal cancer. Dis Colon Rectum 44:815–821

    Article  CAS  PubMed  Google Scholar 

  25. Thomson WH, Foy CJ, Longman RJ (2008) The nature of local recurrence after colorectal cancer recurrence. Colorectal Dis 10:69–74

    CAS  PubMed  Google Scholar 

  26. Hall NR, Finan PJ, Brown S et al (2000) Comparison of prognosis in cancer of the colon and rectum. Colorectal Dis 2:159–164

    Article  Google Scholar 

  27. Mulcahy HE, Skelly MM, Husain A (1996) Long-term outcome following curative surgery for malignant large bowel obstruction. Br J Surg 83:46–50

    Article  CAS  PubMed  Google Scholar 

  28. Diggs JC, Xu F, Diaz M et al (2007) Failure to screen: predictors and burden of emergency colorectal cancer resection. Am J Manag Care 13:157–164

    PubMed  Google Scholar 

  29. Rabeneck L, Paszzt LF, Li C (2006) Risk factors for obstruction, perforation, or emergency admission at presentation in patients with colorectal cancer: a population-based study. Am J Gastroenterol 101:1098–1103

    Article  PubMed  Google Scholar 

  30. Kingston RD, Walsh SH, Jeacock J (1993) Physical status is the principal determinant of outcome after emergency admission of patients with colorectal cancer. Ann R Coll Surg Engl 75:335–338

    CAS  PubMed  Google Scholar 

  31. Yancik R, Wesley MN, Ries LA et al (1998) Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study. Cancer 82:2123–2134

    Article  CAS  PubMed  Google Scholar 

  32. Bass G, Fleming C, Conneely J et al (2009) Emergency first presentation of colorectal cancer predicts significantly poorer outcomes: review of 365 consecutive Irish patients. Dis Colon Rectum 52:678–684

    PubMed  Google Scholar 

  33. Alvarez JA, Baldnedo RF, Bear IG (2005) Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 190:376–382

    Article  PubMed  Google Scholar 

  34. Bokey EL, Chapuis PH, Fung C et al (1995) Postoperative morbidity and mortality following resection of the colon and rectum for cancer. Dis Colon Rectum 38:480–486

    Article  CAS  PubMed  Google Scholar 

  35. Tentes AA, Mirelis CG, Kakoliris S et al (2009) Results of surgery for colorectal carcinoma with obstruction. Langenbecks Arch Surg 394:46–53

    Article  Google Scholar 

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

    Article  PubMed  Google Scholar 

  37. Kagda FH, Nyam DC, Ho Y-H et al (1999) Surgery may be curative for patients with a localized perforation of rectal carcinoma. Br J Surg 86:1448–1450

    Article  CAS  PubMed  Google Scholar 

  38. Cheynel N, Coetet M, Lepage C (2009) Incidence, patterns of failure, and prognosis of perforated colorectal cancers in a well-defined population. Dis Colon Rectum 52:406–411

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, School of Medicine and Dentistry, North Queensland Centre for Cancer Research, James Cook University, Townsville, QLD, Australia

    Yik-Hong Ho

  2. Division of Colorectal Surgery, Department of Surgery, Royal Brisbane Hospital, Brisbane, QLD, 4000, Australia

    Simon K. K. Siu, Andrew Stevenson, John Lumley & Russel Stitz

  3. School of Public Health and Tropical Medicine, North Queensland Centre for Cancer Research, James Cook University, Townsville, QLD, Australia

    Petra Buttner

  4. Discipline of Surgery, School of Medicine, University of Queensland, Herston, QL, Australia

    Russel Stitz

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  1. Yik-Hong Ho
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  2. Simon K. K. Siu
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  3. Petra Buttner
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  4. Andrew Stevenson
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  5. John Lumley
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  6. Russel Stitz
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Correspondence to Simon K. K. Siu.

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Ho, YH., Siu, S.K.K., Buttner, P. et al. The Effect of Obstruction and Perforation on Colorectal Cancer Disease-Free Survival. World J Surg 34, 1091–1101 (2010). https://doi.org/10.1007/s00268-010-0443-2

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