Clinical surgery—International
Differences in patient postoperative and long-term outcomes between obstructive and perforated colonic cancer

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Abstract

Background

The aim of this observational study was to analyze the differences between patients with obstructive and perforated colonic cancer who managed with emergency curative surgery.

Methods

Between January 1994 and December 2000, patients deemed to have undergone curative resection for complicated colonic cancer were considered for inclusion in the study. They were classified into 2 groups: patients with obstructive cancer (OC) and patients with perforated cancer (PC). The main end points were postsurgical outcomes and long-term overall survival, cancer-related survival, and tumor recurrence.

Results

Of the 236 patients, surgery was deemed to be radical and performed with intent to cure in 155 patients (65.7%): 117 patients in the OC group and 38 patients in the PC group. No statistical differences were observed between the percentage of radical surgery between the 2 groups (P = .63). The overall postsurgical mortality rate was 12.2%: 14 patients in the OC group and 5 patients in the PC group (P = .839). Overall survival, probability of being free of recurrence, and cancer-related survival of the entire series were 64.57%, 67.72% and 73.03%, respectively. There were no differences between the 2 groups with respect to tumor recurrence, type of recurrence, overall survival, probability of being free of recurrence, and cancer-related survival at 5 years.

Conclusions

In our experience, patients with perforated colonic cancer do not seem to show worse long-term outcomes than those with OC. Studies with larger series are needed for further investigations.

Section snippets

Methods

Between January 1994 and December 2000, 236 patients with obstructive and perforated colonic cancer underwent surgery in an emergency setting at the same institution. The present series is a significant extension of our previously published study in which the primary aim was to analyze the efficacy of curative emergency surgery in terms of tumor recurrence and cancer-related survival compared with elective colonic surgery [1].

All patients with rectal cancer <15 cm from the anal verge and

Results

Of the 236 patients included in the study, 187 (79.2%) were in the OC group, and 49 patients (20.8%) were in the PC group. Eighty-one patients (34.3%) were excluded because of palliative surgery: 70 (37.4%) in the OC group and 11 (22.4%) in the PC group. Surgery was deemed to be radical with curative intent in 155 patients (65.7%): 117 patients (62.6%) in the OC group and 38 patients (77.6%) in the PC group (P = .63). Localization of perforation in the PC group was at the site of cancer in 18

Comments

Despite cancer screening programs and endoscopy, >15% of colonic neoplasia will present as an emergency [2], [10]. Perforation as the initial presentation of colorectal cancer is less frequent than obstruction [1], [11], [15], and emergency surgery is often required [18]. It has been observed that patients with emergency colorectal cancer are less likely to have their tumors resected than patients undergoing elective surgery [9], [19]. However, recent studies show similar curative resection

Acknowledgments

The authors thank Lidia Millan, Colorectal Unit, University Hospital of Bellvitge, University of Barcelona, for statistical analysis.

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