Emergency Management of Perforated Colon Cancers: How Aggressive Should We Be?

Martin D. Zielinski, Amit Merchea, Stephanie F. Heller, Y. Nancy You

Research output: Contribution to journalArticle

27 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2232-2238
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume15
Issue number12
DOIs
StatePublished - Dec 1 2011

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Keywords

  • Complicated colon cancer
  • Intensive care
  • Long-term outcomes
  • Peforated viscous
  • Septic shock

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

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