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Peri-Operative Bowel Perforation in Early Stage Colon Cancer is Associated with an Adverse Oncological Outcome

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background

The presence of an inflammatory response resulting from bowel perforation or anastomotic leakage has been suggested to enhance recurrence rates in colorectal cancer patients. Currently, it is unknown if bowel perforation or anastomotic leakage has prognostic significance in early stage colon cancer patients. In this study, the impact of peri-operative bowel perforation including anastomotic leakage on disease-free survival of stage I/II colon cancer patients was investigated.

Methods

Prospective follow up data of 448 patients with stages I/II colon cancer that underwent resection were included. Patients who died within 3 months after initial surgery were excluded.

Results

Median follow up was 56.0 months. Patients with peri-operative bowel perforation (n = 25) had a higher recurrence rate compared to patients without perforation (n = 423), 36.0 % vs. 16.1 % (p = 0.01). Disease-free survival was significantly worse for the perforation group compared to patients without perforation (p = 0.004). Multivariate analysis including T-stage, histological grade, and adjuvant chemotherapy showed peri-operative bowel perforation to be an independent factor significantly associated with disease recurrence (odds ratio, 2.7; 95 % CI, 1.1–6.7).

Conclusion

Peri-operative bowel perforation is associated with increased recurrence rates and impaired disease-free survival in early-stage colon cancer patients.

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References

  1. Gill S, Loprinzi CL, Sargent DJ et al. Pooled analysis of fluorouracil-based adjuvant therapy for stage II and III colon cancer: who benefits and by how much? J Clin Oncol 2004; 22:1797–1806.

    Article  PubMed  CAS  Google Scholar 

  2. Figueredo A, Coombes ME, Mukherjee S. Adjuvant therapy for completely resected stage II colon cancer. Cochrane Database Syst Rev 2008;CD005390.

  3. Walker KG, Bell SW, Rickard MJ et al. Anastomotic leakage is predictive of diminished survival after potentially curative resection for colorectal cancer. Ann Surg 2004; 240:255–259.

    Article  PubMed  Google Scholar 

  4. McArdle CS, McMillan DC, Hole DJ. Impact of anastomotic leakage on long-term survival of patients undergoing curative resection for colorectal cancer. Br J Surg 2005; 92:1150–1154.

    Article  PubMed  CAS  Google Scholar 

  5. Law WL, Choi HK, Lee YM et al. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg 2007; 11:8–15.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  7. Ptok H, Marusch F, Meyer F et al. Impact of anastomotic leakage on oncological outcome after rectal cancer resection. Br J Surg 2007; 94:1548–1554.

    Article  PubMed  CAS  Google Scholar 

  8. Eriksen MT, Wibe A, Norstein J et al. Anastomotic leakage following routine mesorectal excision for rectal cancer in a national cohort of patients. Colorectal Dis 2005; 7:51–57.

    Article  PubMed  CAS  Google Scholar 

  9. den Dulk M., Marijnen CA, Collette L et al. Multicentre analysis of oncological and survival outcomes following anastomotic leakage after rectal cancer surgery. Br J Surg 2009; 96:1066–1075.

    Article  Google Scholar 

  10. Sobin LH, Wittekind CH. International Union Against Cancer (UICC): TNM classification of malignant tumours, 5th ed. Wiley, New York. 1997.

    Google Scholar 

  11. Bohle B, Pera M, Pascual M et al. Postoperative intra-abdominal infection increases angiogenesis and tumor recurrence after surgical excision of colon cancer in mice. Surgery 2010; 147:120–126.

    Article  PubMed  Google Scholar 

  12. Raa ST, Oosterling SJ, van der Kaaij NP et al. Surgery promotes implantation of disseminated tumor cells, but does not increase growth of tumor cell clusters. J Surg Oncol 2005; 92:124–129.

    Article  PubMed  Google Scholar 

  13. Oosterling SJ, van der Bij GJ, Bogels M et al. Anti-beta1 integrin antibody reduces surgery-induced adhesion of colon carcinoma cells to traumatized peritoneal surfaces. Ann Surg 2008; 247:85–94.

    Article  PubMed  Google Scholar 

  14. van den Tol MP, Haverlag R, van Rossen ME et al. Glove powder promotes adhesion formation and facilitates tumour cell adhesion and growth. Br J Surg 2001; 88:1258–1263.

    Article  PubMed  Google Scholar 

  15. van der Bij GJ, Oosterling SJ, Bogels M et al. Blocking alpha2 integrins on rat CC531s colon carcinoma cells prevents operation-induced augmentation of liver metastases outgrowth. Hepatology 2008; 47:532–543.

    PubMed  Google Scholar 

  16. Katsuno H, Zacharakis E, Aziz O et al. Does the presence of circulating tumor cells in the venous drainage of curative colorectal cancer resections determine prognosis? A meta-analysis. Ann Surg Oncol 2008; 15:3083–3091.

    Article  PubMed  Google Scholar 

  17. Wind J, Tuynman JB, Tibbe AG et al. Circulating tumour cells during laparoscopic and open surgery for primary colonic cancer in portal and peripheral blood. Eur J Surg Oncol 2009; 35:942–950.

    Article  PubMed  CAS  Google Scholar 

  18. Sadahiro S, Suzuki T, Maeda Y et al. Detection of carcinoembryonic antigen messenger RNA-expressing cells in peripheral blood 7 days after curative surgery is a novel prognostic factor in colorectal cancer. Ann Surg Oncol 2007; 14:1092–1098.

    Article  PubMed  Google Scholar 

  19. Baskaranathan S, Philips J, McCredden P et al. Free colorectal cancer cells on the peritoneal surface: correlation with pathologic variables and survival. Dis Colon Rectum 2004; 47:2076–2079.

    Article  PubMed  Google Scholar 

  20. Biswas SK, Lopez-Collazo E. Endotoxin tolerance: new mechanisms, molecules and clinical significance. Trends Immunol 2009; 30:475–487.

    Article  PubMed  CAS  Google Scholar 

  21. Heuff G, Oldenburg HS, Boutkan H et al. Enhanced tumour growth in the rat liver after selective elimination of Kupffer cells. Cancer Immunol Immunother 1993; 37:125–130.

    Article  PubMed  CAS  Google Scholar 

  22. Eberhardt JM, Kiran RP, Lavery IC. The impact of anastomotic leak and intra-abdominal abscess on cancer-related outcomes after resection for colorectal cancer: a case control study. Dis Colon Rectum 2009; 52:380–386.

    Article  PubMed  Google Scholar 

  23. Bell SW, Walker KG, Rickard MJ et al. Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg 2003; 90:1261–1266.

    Article  PubMed  CAS  Google Scholar 

  24. Petersen S, Freitag M, Hellmich G et al. Anastomotic leakage: impact on local recurrence and survival in surgery of colorectal cancer. Int J Colorectal Dis 1998; 13:160–163.

    Article  PubMed  CAS  Google Scholar 

  25. Branagan G, Finnis D. Prognosis after anastomotic leakage in colorectal surgery. Dis Colon Rectum 2005; 48:1021–1026.

    Article  PubMed  Google Scholar 

  26. Mirnezami A, Mirnezami R, Chandrakumaran K et al. Increased local recurrence and reduced survival from colorectal cancer following anastomotic leak: systematic review and meta-analysis. Ann Surg 2011; 253:890–899.

    Article  PubMed  Google Scholar 

  27. Katoh H, Yamashita K, Wang G et al. (2011) Anastomotic leakage contributes to the risk for systemic recurrence in stage II colorectal cancer. J Gastrointest Surg 15(1):120–129.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands

    E. J. T. Belt & M. van Egmond

  2. Department Surgery, Kennemer Gasthuis, P.O. Box 417, 2000, Haarlem, The Netherlands

    H. B. A. C. Stockmann, G. S. A. Abis, J. M. de Boer & S. J. Oosterling

  3. Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands

    E. S. M. de Lange-de Klerk

  4. Department of Pathology, VU University Medical Center, Amsterdam, The Netherlands

    G. A. Meijer

Authors
  1. E. J. T. Belt
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  2. H. B. A. C. Stockmann
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  3. G. S. A. Abis
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  4. J. M. de Boer
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  5. E. S. M. de Lange-de Klerk
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  6. M. van Egmond
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  7. G. A. Meijer
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  8. S. J. Oosterling
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Corresponding author

Correspondence to S. J. Oosterling.

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Belt, E.J.T., Stockmann, H.B.A.C., Abis, G.S.A. et al. Peri-Operative Bowel Perforation in Early Stage Colon Cancer is Associated with an Adverse Oncological Outcome. J Gastrointest Surg 16, 2260–2266 (2012). https://doi.org/10.1007/s11605-012-2053-9

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  • DOI: https://doi.org/10.1007/s11605-012-2053-9

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