Outcome of colon cancer initially presenting as colon perforation and obstruction

Abstract

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.

Evaluation of Prognostic Factors for Survival in Transverse Colon Cancer

“…According to other studies [36,37], our patients whose tumor occurred with obstruction or perforation showed a worse DFS compared with the other tumor manifestations, although with a trend towards significance (HR = 2.65, 95% CI 1.00-7.01, p = 0.050).…”

Prognostic significance of sealed-off perforation in colon cancer: a prospective cohort study

“…The prevalence of perforation in colon cancer patients is reported to be 3–10% [ 1 – 3 ]. More specifically, colon cancer patients with perforation exhibit a greater frequency of recurrence and poorer overall survival (OS) compared with those without perforation [ 4 , 5 ]. In the National Comprehensive Cancer Network guidelines, colon cancer with perforation is categorized a high-risk feature [ 6 ].…”

Long-term outcomes of colorectal cancer patients with and without malignant large-bowel obstruction

“…In addition, if a SEMS or TDT is not technically feasible, a decompressing stoma may be necessary to achieve a symptom-free condition for the patient. Although the mortality rate of these patients in the short term is high, little is known about the long-term outcomes of recurrence and prognosis [6,7]. In the present study, we analyzed the specific prognosis (except for short-term mortality such as progression of disease and postoperative complications) in colon cancer patients with and without an MLBO.…”