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

Abstract

BackgroundPerforated colon cancer is a rare complication, but has a high risk of recurrence. However, most studies have not distinguished sealed-off perforation from free perforation, and the prognosis is unclear. The aim of this study was to evaluate the oncologic outcome of colon cancer with sealed-off perforation.MethodsEighty-six consecutive patients who underwent resection for colon cancer with sealed-off or free perforation were included. We defined sealed-off perforation as a colon perforation with localized abscess identified on operative, computed tomography, or pathologic findings, with no evidence of free perforation, including fecal contamination and dirty fluid collection in the peritoneal cavity. Oncologic outcomes were compared between patients with colon cancer with sealed-off perforation and free perforation using a log-rank test and Cox regression analysis.ResultsThe sealed-off perforation group included 62 patients, and 24 patients were in the free perforation group. TNM stage and lymphatic, venous, and perineural invasion were similar between the groups. The median follow-up period was 28.9 months (range 0–159). The sealed-off perforation group had better prognosis compared with the free perforation group in terms of progression-free survival (PFS) and overall survival (OS), although there were no statistically significant differences in PFS (5-year PFS 53.7% vs. 40.5%, p = 0.148; 5-year OS 53.6% vs. 22.9%, p = 0.001). However, in multivariable analysis using the Cox progression test, sealed-off perforation did not show a significant effect on cancer progression (p = 0.138) and OS (p = 0.727).ConclusionsColon cancer with sealed-off perforation showed no difference in prognosis compared with free perforation.Electronic supplementary materialThe online version of this article (10.1186/s12957-018-1530-3) contains supplementary material, which is available to authorized users.

Clinical characteristics and oncologic outcomes in patients with preoperative clinical T3 and T4 colon cancer who were staged as pathologic T3

“…In our study, postoperative local recurrence of cT4 patients was similar to those of other studies [17][18][19][20][21][22]. If the tumor invades the serosa, seeding tumor cells may remain in the peritoneal cavity.…”

Perforasi Kolon pada Kanker Kolon

“…Tempat perforasi kolon yang paling sering terjadi adalah kolon sigmoid. Perforasi pada kanker kolon diketahui memiliki prognosis yang buruk selain karena sering terjadi pada kanker stadium lanjut tetapi juga disebabkan oleh perforasi itu sendiri (Lee et al, 2018).…”

“…Prevalensi perforasi pada pasien kanker kolon dapat mencapai 3-10% (Ozogul et al, 2014). Pasien kanker kolon dengan perforasi memiliki tingkat frekuensi kekambuhan yang lebih besar daripada pasien yang tidak mengalami perforasi karena diketahui bahwa kanker kolon dengan perforasi sangat berisiko tinggi (Lee et al, 2018). Bagian kolon yang paling umum terjadi obstruksi kanker kolon adalah kolon sigmoid, dengan persentase sebesar 75% dari tumor berlokasi di distal fleksura splenica.…”

“…Gambaran onkologis dari perforasi tertutup berbeda dengan perforasi bebas, hal ini dikarenakan adanya peradangan lokal akibat dari pembentukan abses lokal yang dapat dilihat pada tomografi komputer operasi atau pemeriksaan patologis. Pembentukan rongga abses inilah yang membuat risiko penyebaran tumor (sel-sel ganas) lebih rendah dibandingkan dengan perforasi bebas (Lee et al, 2018). Pasien kanker kolon usia tua cenderung mengalami komplikasi perforasi kolon.…”

Resultados de la Cirugía de Urgencia en Pacientes con Cáncer de Colon Perforado

“…Del mismo modo, la presencia de linfonodos positivos, dehiscencia anastomótica y peritonitis difusa se consideran predictores independientes de recidiva local (Biondo et al, 2019). No así que la perforación sea cubierta o libre a peritoneo, situaciones en que la SVG no difiere de forma significativa (Lee et al, 2018).…”