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Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends.
Surgery. 2000 Apr; 127(4):370-6.S

Abstract

BACKGROUND

In adenocarcinoma of the colon and rectum, obstruction and perforation may occur either alone or together at the site of the neoplasm or proximally. Both events carry a poor prognosis. This retrospective study sought to determine whether a correlation exists between perforation and obstruction, and between these conditions and different clinicopathological factors in colorectal adenocarcinoma.

METHODS

The medical records of 1950 patients with colorectal adenocarcinoma treated in our hospital during a 7-year period were retrospectively analyzed. One hundred patients (5%) were excluded from this study because of a loss of follow-up. Data on clinicopathological factors including age, sex, tumor location, surgical mortality, pathological type, stage, and long-time cancer-free rate were simultaneously analyzed. Patients were grouped as follows: Group 1, complete colonic obstruction without perforation (n = 120). Group 2, complete obstruction with perforation at the site of the cancer (n = 35); Group 3, complete obstruction with perforation proximal to the cancer (n = 13); and Group 4, nonobstructing, nonperforated cancers (n = 1682).

RESULTS

When compared with Group 4, Group 1 had a more advanced Dukes' stage, older age, greater incidence of colonic versus rectal cancers, and a poorer cancer-free survival (P < or = .005). Groups 2 and 3 had a greater incidence of colonic versus rectal cancers (P < or = .004), and Group 3 had a greater operative mortality (P < .001). No significant differences were found between Groups 1, 2, and 3. Multivariate analysis revealed that the independent factors favorable to cancer-free survival (> 5-year survival) were female gender (P = .035), well-differentiated pathology (P < .001), uncomplicated cases (P = .004), colon versus rectal location (P < .001), and early stage (P < .001).

CONCLUSIONS

The perioperative mortality rate for perforated colorectal cancer at the site of the cancer was 9%; for obstructive colorectal cancer, 5%. Perioperative mortality was much greater for perforations of the colon and rectum occurring proximal to the cancer (31%). Survival was worse (P < .001) for patients with obstruction (33%) or perforation proximal to the cancer (33%). The site of perforation did not appear to impact the 5-year survival, although the numbers are relatively small.

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Authors+Show Affiliations

Chen HS
Department of Colon and Rectal Surgery and General Surgery, Chang-Gung Memorial Hospital, Kaohsiung, Taiwan, Republic of China.
Sheen-Chen SM
No affiliation info available

MeSH

AdenocarcinomaAdultAge FactorsAgedColonic DiseasesColonic NeoplasmsColorectal NeoplasmsDisease-Free SurvivalFemaleHumansIntestinal ObstructionIntestinal PerforationMaleMiddle AgedNeoplasm StagingPrognosisRectal DiseasesRectal NeoplasmsRetrospective StudiesSex Factors

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

10776426

Citation

Chen, H S., and S M. Sheen-Chen. "Obstruction and Perforation in Colorectal Adenocarcinoma: an Analysis of Prognosis and Current Trends." Surgery, vol. 127, no. 4, 2000, pp. 370-6.
Chen HS, Sheen-Chen SM. Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery. 2000;127(4):370-6.
Chen, H. S., & Sheen-Chen, S. M. (2000). Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery, 127(4), 370-6.
Chen HS, Sheen-Chen SM. Obstruction and Perforation in Colorectal Adenocarcinoma: an Analysis of Prognosis and Current Trends. Surgery. 2000;127(4):370-6. PubMed PMID: 10776426.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. AU - Chen,H S, AU - Sheen-Chen,S M, PY - 2000/4/25/pubmed PY - 2000/5/16/medline PY - 2000/4/25/entrez SP - 370 EP - 6 JF - Surgery JO - Surgery VL - 127 IS - 4 N2 - BACKGROUND: In adenocarcinoma of the colon and rectum, obstruction and perforation may occur either alone or together at the site of the neoplasm or proximally. Both events carry a poor prognosis. This retrospective study sought to determine whether a correlation exists between perforation and obstruction, and between these conditions and different clinicopathological factors in colorectal adenocarcinoma. METHODS: The medical records of 1950 patients with colorectal adenocarcinoma treated in our hospital during a 7-year period were retrospectively analyzed. One hundred patients (5%) were excluded from this study because of a loss of follow-up. Data on clinicopathological factors including age, sex, tumor location, surgical mortality, pathological type, stage, and long-time cancer-free rate were simultaneously analyzed. Patients were grouped as follows: Group 1, complete colonic obstruction without perforation (n = 120). Group 2, complete obstruction with perforation at the site of the cancer (n = 35); Group 3, complete obstruction with perforation proximal to the cancer (n = 13); and Group 4, nonobstructing, nonperforated cancers (n = 1682). RESULTS: When compared with Group 4, Group 1 had a more advanced Dukes' stage, older age, greater incidence of colonic versus rectal cancers, and a poorer cancer-free survival (P < or = .005). Groups 2 and 3 had a greater incidence of colonic versus rectal cancers (P < or = .004), and Group 3 had a greater operative mortality (P < .001). No significant differences were found between Groups 1, 2, and 3. Multivariate analysis revealed that the independent factors favorable to cancer-free survival (> 5-year survival) were female gender (P = .035), well-differentiated pathology (P < .001), uncomplicated cases (P = .004), colon versus rectal location (P < .001), and early stage (P < .001). CONCLUSIONS: The perioperative mortality rate for perforated colorectal cancer at the site of the cancer was 9%; for obstructive colorectal cancer, 5%. Perioperative mortality was much greater for perforations of the colon and rectum occurring proximal to the cancer (31%). Survival was worse (P < .001) for patients with obstruction (33%) or perforation proximal to the cancer (33%). The site of perforation did not appear to impact the 5-year survival, although the numbers are relatively small. SN - 0039-6060 UR - https://www.unboundmedicine.com/medline/citation/10776426/Obstruction_and_perforation_in_colorectal_adenocarcinoma:_an_analysis_of_prognosis_and_current_trends_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0039606000065776 DB - PRIME DP - Unbound Medicine ER -