Outcome of colon cancer initially presenting as colon perforation and obstruction

Abstract

Background: Emergency 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.

Methods: Newly 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.

Results: Eighty-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.

Conclusion: For 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.

Keywords: Colon cancer; Obstruction; Perforation.

Fig. 1

The image on the left depicts colon perforation because of sigmoid colon cancer. The image on the right depicts bowel distension caused by complete obstruction of the transverse colon

Fig. 2

Comparison of overall survival between PRG and OBG. PRG colon cancer initially presenting as perforation, OBG colon cancer initially presenting as obstruction

Fig. 3

Comparison of disease-free survival between PRG and OBG. PRG colon cancer initially presenting as perforation, OBG colon cancer initially presenting as obstruction

Fig. 4

The survival curves of stage IIIB colon cancer and complicated (with perforation or obstruction) colon cancer are extremely similar. The overall 1-year survival rate was 83.7% and 3-year survival rate was 59.7% in colon cancer with perforation and obstruction. In comparison, the overall 1-year and 3-year survival rates were 83.4 and 59.3%, respectively, in stage IIIB colon cancer. The survival curve of stage IIIB colon cancer was plotted on the basis of the seventh edition of the American Joint committee on Cancer cancer staging manual and the future of TNM