TY - JOUR
T1 - Emergency Management of Perforated Colon Cancers
T2 - How Aggressive Should We Be?
AU - Zielinski, Martin D.
AU - Merchea, Amit
AU - Heller, Stephanie F.
AU - You, Y. Nancy
PY - 2011/12
Y1 - 2011/12
N2 - Background: Emergency treatment of perforated colon cancer has traditionally been linked with dismal outcomes due to the double jeopardy of a septic insult combined with a malignant disease, leaving unclear how aggressive emergency surgical procedures should be. We aimed to define short- and long-term outcomes in the current era of critical care support and oncologic advances, to provide updated data for decision making. Study Design: Patients with perforations associated with a primary colon cancer were identified. Peri-operative and long-term survival were compared among free (FP; n = 41) and contained perforations (CP; n = 45) and to age-, stage-, and resection status case-matched, non-perforated (NP; n = 85), controls. Results: Tumors were completely resected in 67% of FP but fewer lymph nodes were harvested (median, 11 vs. 11 and 16 in CP and NP; p = 0. 21 and p < 0. 001). Peri-operative mortality was highest in FP: 19% vs. 0% and 5% in CP and NP (p = 0. 038), respectively. After adjusting for peri-operative mortality, 5-year overall survival was comparable: 55%, 59%, and 54% for FP, CP, and NP, respectively. Advanced age, higher ASA class, presence of residual disease, and advanced stage, but not perforation, were independent predictors of poorer long-term overall survival. Conclusions: Patients with malignant colonic perforation face high risk of peri-operative death, making septic source control the priority in the acute setting. Pursuit of an oncologically oriented resection and long-term cancer-directed treatments, however, may lead to improved long-term outcomes.
AB - Background: Emergency treatment of perforated colon cancer has traditionally been linked with dismal outcomes due to the double jeopardy of a septic insult combined with a malignant disease, leaving unclear how aggressive emergency surgical procedures should be. We aimed to define short- and long-term outcomes in the current era of critical care support and oncologic advances, to provide updated data for decision making. Study Design: Patients with perforations associated with a primary colon cancer were identified. Peri-operative and long-term survival were compared among free (FP; n = 41) and contained perforations (CP; n = 45) and to age-, stage-, and resection status case-matched, non-perforated (NP; n = 85), controls. Results: Tumors were completely resected in 67% of FP but fewer lymph nodes were harvested (median, 11 vs. 11 and 16 in CP and NP; p = 0. 21 and p < 0. 001). Peri-operative mortality was highest in FP: 19% vs. 0% and 5% in CP and NP (p = 0. 038), respectively. After adjusting for peri-operative mortality, 5-year overall survival was comparable: 55%, 59%, and 54% for FP, CP, and NP, respectively. Advanced age, higher ASA class, presence of residual disease, and advanced stage, but not perforation, were independent predictors of poorer long-term overall survival. Conclusions: Patients with malignant colonic perforation face high risk of peri-operative death, making septic source control the priority in the acute setting. Pursuit of an oncologically oriented resection and long-term cancer-directed treatments, however, may lead to improved long-term outcomes.
KW - Complicated colon cancer
KW - Intensive care
KW - Long-term outcomes
KW - Peforated viscous
KW - Septic shock
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U2 - 10.1007/s11605-011-1674-8
DO - 10.1007/s11605-011-1674-8
M3 - Article
C2 - 21913040
AN - SCOPUS:81355160604
SN - 1091-255X
VL - 15
SP - 2232
EP - 2238
JO - Journal of Gastrointestinal Surgery
JF - Journal of Gastrointestinal Surgery
IS - 12
ER -