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Perforated colonic cancer. Evolution and prognosis
F Alcobendas1, R Jorba, I Poves
1General Surgery and Gastroenterology Service, Hospital Príncipes de España, Ciudad Sanitario, Barcelona, Spain.
Revista Espanola De Enfermedades Digestivas
|August 6, 2000
Summary
Emergency surgery for perforating colon cancer does not indicate a worse prognosis. This study found no significant difference in survival or disease progression between perforating and obstructive colon cancer cases requiring emergency surgery.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Clinical Epidemiology
Background:
- Perforating colon cancer is often considered to have a worse prognosis than obstructive cases, particularly in emergency surgical settings.
- This perception influences clinical decision-making and patient counseling.
Purpose of the Study:
- To investigate whether perforating colon cancer, in the context of emergency surgery, is associated with a poorer prognosis compared to obstructive cases.
- To challenge or confirm the traditional view on the prognostic implications of perforating versus obstructive colon cancer.
Main Methods:
- Retrospective analysis of 91 emergency primary resection cases for colon carcinoma, categorizing them into perforating (22 cases) and obstructive (69 cases).
- Comparison with a synchronous series of 112 patients undergoing elective surgery.
- Exclusion of Dukes A stage patients due to zero mortality/recurrence, focusing analysis on 84 remaining emergency patients.
Main Results:
- Among 84 emergency patients (excluding Dukes A), 38 experienced disease progression (local recurrence, distant metastases).
- A total of 26 deaths occurred, with 6 in the perforating group and 20 in the obstructive group.
- No statistically significant difference was observed in survival rates or disease progression between patients with perforating and obstructive colon cancer.
Conclusions:
- The study findings do not substantiate the classical belief that perforating colon cancer carries a significantly worse prognosis in emergency surgical patients.
- This suggests that clinical management and prognostic assessments for emergency colon cancer surgery should not disproportionately emphasize the perforating nature of the disease.