Colorectal cancer with intestinal perforation – a retrospective analysis of treatment outcomes

Banaszkiewicz, Zbigniew; Woda, Łukasz; Tojek, Krzysztof; Jarmocik, Paweł; Jawień, Arkadiusz

doi:10.5114/wo.2014.46362

Cited by 18 publications

(11 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Chen et al demonstrated that neoplastic bowel obstruction, but not bowel perforation at the tumor site, was associated with poor survival [ 9 ]. Banaszkiewicz et al reported increased rates of complications and mortality in these patient groups [ 15 ]. Ho et al reported that bowel obstruction and perforation were associated with poor disease survival in colorectal cancer [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

Outcome of colon cancer initially presenting as colon perforation and obstruction

2017

View full text Add to dashboard Cite

BackgroundEmergency complications of colon cancer include perforation and obstruction which were recognized as poor prognostic factors. Few studies have directly compared the outcomes of these two groups. In this study, we evaluated mortality and morbidity in patients with colon cancer initially presenting as perforation and obstruction.MethodsNewly diagnosed colon cancer cases initially presenting with perforation or obstruction at Tzu Chi General Hospital, Hualien, Taiwan, between 2009 and 2015 were included. Cases of iatrogenic perforation or perforation sites far away from the tumor sites and rectal (< 15 cm from the anal verge) cancer were excluded. Progression-free survival, local recurrence rate, distant metastasis rate, and overall survival were the evaluated outcomes.ResultsEighty-one patients met the selection criteria; 23 and 58 patients had perforation and obstruction, respectively, as the initial symptom. The median age was 72 years. The median tumor stage was stage IIIB. The 1-year and 3-year survival rates were 83.7 and 59.7%, respectively. The perforation group (PRG) and obstruction group (OBG) did not differ significantly in intensive care unit (ICU) stay rate (p = 0.147), sex (p = 0.45), comorbidities (heart, liver, and renal diseases and diabetes mellitus), median stage (p = 0.198), and overall survival (p = 0.328). However, PRG had a higher age at diagnosis (74 vs. 64 years, p = 0.037), a higher APACHE II score (12 vs. 7, p = 0.002), lower disease-free survival (p = 0.001), a higher recurrence rate (56.5 vs. 19%, p = 0.002), a higher distant metastasis rate (39.1 vs. 13.8%, p = 0.015), and a higher local recurrence rate (43.5 vs. 5.2%, p < 0.001) than did OBG. OBG had a higher two-stage operation rate (46.6 vs. 17.4%, p = 0.022). After adjustment for the tumor stage, comorbidity (chronic renal disease), body mass index (BMI), and adjuvant chemotherapy or radiotherapy in multivariate statistics, PRG had lower disease-free survival (p = 0.005) than OBG but overall survival was identical.ConclusionFor colon cancer initially presenting as perforation or obstruction, the PRG had poorer progression-free survival, a higher local recurrence rate, and a higher distant metastasis rate than did OBG. Overall survival did not differ between these two groups.

show abstract

Section: Discussionmentioning

confidence: 99%

Outcome of colon cancer initially presenting as colon perforation and obstruction

2017

View full text Add to dashboard Cite

show abstract

“…Another complication found in our study as an independent predictor of mortality was gastrointestinal involvement by tumor. Although the mortality in gastric/intestinal perforation and severe bleeding by tumor has been reported in different studies [ 43 – 46 ], data regarding the prognostic factors of this complication in the setting of critical care are scarce. The substantial mortality rate of 73% observed in our cohort emphasizes the importance of discussing the appropriateness of ICU admission in this specific subgroup of patients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes in Critically Ill Patients with Cancer-Related Complications

et al. 2016

View full text Add to dashboard Cite

IntroductionCancer patients are at risk for severe complications related to the underlying malignancy or its treatment and, therefore, usually require admission to intensive care units (ICU). Here, we evaluated the clinical characteristics and outcomes in this subgroup of patients.Materials and MethodsSecondary analysis of two prospective cohorts of cancer patients admitted to ICUs. We used multivariable logistic regression to identify variables associated with hospital mortality.ResultsOut of 2,028 patients, 456 (23%) had cancer-related complications. Compared to those without cancer-related complications, they more frequently had worse performance status (PS) (57% vs 36% with PS≥2), active malignancy (95% vs 58%), need for vasopressors (45% vs 34%), mechanical ventilation (70% vs 51%) and dialysis (12% vs 8%) (P<0.001 for all analyses). ICU (47% vs. 27%) and hospital (63% vs. 38%) mortality rates were also higher in patients with cancer-related complications (P<0.001). Chemo/radiation therapy-induced toxicity (6%), venous thromboembolism (5%), respiratory failure (4%), gastrointestinal involvement (3%) and vena cava syndrome (VCS) (2%) were the most frequent cancer-related complications. In multivariable analysis, the presence of cancer-related complications per se was not associated with mortality [odds ratio (OR) = 1.25 (95% confidence interval, 0.94–1.66), P = 0.131]. However, among the individual cancer-related complications, VCS [OR = 3.79 (1.11–12.92), P = 0.033], gastrointestinal involvement [OR = 3.05 (1.57–5.91), P = <0.001] and respiratory failure [OR = 1.96(1.04–3.71), P = 0.038] were independently associated with in-hospital mortality.ConclusionsThe prognostic impact of cancer-related complications was variable. Although some complications were associated with worse outcomes, the presence of an acute cancer-related complication per se should not guide decisions to admit a patient to ICU.

show abstract

“…Diastatic perforation is defined as a blowout of the wall of the cecum caused by an overdistention which results from remote obstruction of the distal colon. These two types of perforation are more common in patients after radiotherapy or while receiving chemotherapy [4]. To the best of our knowledge, this is the first case report of a patient who presented with a retroperitoneal abscess caused by a diastatic cecal perforation, while the tumor itself was located in the ascending colon.…”

Section: Introductionmentioning

confidence: 75%

Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma

Paramythiotis

Karakatsanis

Moysidis

et al. 2020

Case Reports in Surgery

View full text Add to dashboard Cite

Most colorectal cancer patients in the early stages of the disease do not display any alarming symptoms. A total percentage of 9-27% of colorectal cancer patients present with acute abdomen, bowel obstruction, perforation, or bleeding. Perforation as the first presentation of the disease is seen in no more than 2.6-10% of patients. Intestinal perforation may be found on either the site of the tumor or on a more proximal site, caused by distention of the bowel due to peripheral obstruction. This is a case of a 75-year-old female patient who presents in the emergency department with retroperitoneal cecal perforation due to an obstructing tumor of the ascending colon. She underwent an emergency right hemicolectomy and washout of the retroperitoneal space. The cecum is not an unusual site of distention and subsequent perforation in the case of colonic obstruction, especially in the presence of a competent ileocecal valve. While the mechanism of diastatic cecal perforation is well described, it is the first time in the literature that this does not occur on the anterior surface of the organ. In our case, cecal perforation presents as a retroperitoneal abscess without peritoneal spillage. Nonetheless, it still carries a grim prognosis and urgent surgical intervention is needed.

show abstract

Colorectal cancer with intestinal perforation – a retrospective analysis of treatment outcomes

Cited by 18 publications

References 24 publications

Outcome of colon cancer initially presenting as colon perforation and obstruction

Outcome of colon cancer initially presenting as colon perforation and obstruction

Outcomes in Critically Ill Patients with Cancer-Related Complications

Retroperitoneal Cecal Perforation Resulting from Obstructive Ascending Colon Adenocarcinoma

Contact Info

Product

Resources

About