Oncologic outcome of colon cancer with perforation and obstruction

Clinical effect and prognosis of laparoscopic surgery on colon cancer complicated with intestinal obstruction patients

BACKGROUND

Colon cancer is one of the most common malignancies of the digestive tract, often complicated by intestinal obstruction, which can significantly impact patient outcomes. While traditional laparotomy is the standard treatment, it is associated with large wounds, slower recovery, and higher complication rates. Laparoscopic surgery, a minimally invasive approach, may offer better outcomes for these patients.

AIM

To evaluate the clinical effects and prognosis of laparoscopic surgery in patients with colon cancer complicated by intestinal obstruction compared to traditional laparotomy.

METHODS

A retrospective analysis was conducted on 100 patients diagnosed with colon cancer and intestinal obstruction who underwent surgical treatment between January 2020 and December 2022. Patients were divided into two groups: The control group (CG), treated with traditional laparotomy, and the observation group (OG), treated with laparoscopic surgery. Clinical effects, surgical indicators, postoperative pain, inflammatory response, complication rates, quality of life, and prognosis were assessed and compared between the two groups.

RESULTS

The OG showed superior clinical outcomes compared to the CG (P < 0.05). Patients in the OG had shorter operation times, reduced intraoperative blood loss, faster recovery of intestinal function, earlier mobilization, and shorter hospital stays (P < 0.05). Postoperative pain (numerical rating scale scores) and inflammatory markers [tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), C-reactive protein (CRP)] were lower in the OG (P < 0.05). The incidence of complications was significantly reduced in the OG (6.00% vs 22.00%, P < 0.05). Quality of life scores, including physical function, psychological state, social communication, and self-care ability, were significantly higher in the OG (P < 0.05). There were no significant differences between groups in abdominal drainage volume, 1-year tumor recurrence or metastasis rates, or 1- and 3-year survival rates (P > 0.05).

CONCLUSION

The OG showed superior clinical outcomes compared to the CG (P < 0.05). Patients in the OG had shorter operation times, reduced intraoperative blood loss, faster recovery of intestinal function, earlier mobilization, and shorter hospital stays (P < 0.05). Postoperative pain (NRS scores) and inflammatory markers (TNF-α, IL-6, CRP) were lower in the OG (P < 0.05). The incidence of complications was significantly reduced in the OG (6.00% vs 22.00%, P < 0.05). Quality of life scores, including physical function, psychological state, social communication, and self-care ability, were significantly higher in the OG (P < 0.05). There were no significant differences between groups in abdominal drainage volume, 1-year tumor recurrence or metastasis rates, or 1- and 3-year survival rates (P > 0.05).

Prognostic determinants in surgical critial patients undergoing emergency surgery for Stage III or higher colorectal cancer

PURPOSE

Emergency surgery in patients with colorectal cancer (CRC) is associated with elevated mortality and morbidity compared to elective operations. This study was conducted to identify the factors influencing both short and long term outcomes in emergent CRC operations, particularly in critically ill patients.

METHOD

This single center retrospective analysis focuses on patients with stage III or higher CRC who underwent emergency surgery and were admitted to the intensive care unit postoperatively.

RESULTS

Among 64 patients, 46 presented with generalized peritonitis due to free perforation. Non-survivors at 90 days had a higher incidence of preoperative shock (53.3% vs. 4.1%, P = 0.000), elevated perioperative Sequential Organ Failure Assessment scores (P = 0.000; P = 0.013), and fewer retrieved lymph nodes (LN) (P = 0.010). Multivariate analysis identified LNs retrieval as a significant predictor of 90-day mortality (AUC = 0.727). For overall survival, younger age, lower American Society of Anesthesiologists (ASA) physical status, absence of metastasis, adjuvant chemotherapy (CTx), and lower LN ratio (LNR) were associated with improved outcomes. Multivariate analysis showed ASA physical status and adjuvant CTx as significant predictors. In predicting 3-year recurrence (51% of patients), the Random Forest model achieved 65% accuracy. Age and LNR were major predictors, with 0.01 unit increase in LNR raising recurrence risk by 1.025-fold and each additional year of age by 1.035-fold.

CONCLUSION

The number of retrieved LNs was identified as a predictor of 90 day survival, ASA physical status and adjuvant CTx were identified as prognostic factors for overall survival, and age and the LNR were found to be predictors of disease recurrence within three years.

The Clinical Characteristics of a Stage II Colorectal Cancer T4 Tumor: A Ten-Year Single-Center Research Report

AIM

The tumor staging of colorectal cancer (CRC) plays a significant role in both treatment and prognosis, impacting surgical planning and adjuvant therapy decisions. Currently, the staging of CRC is based on the TNM system developed by the American Joint Committee on Cancer. Prior studies have suggested that survival rates and recurrent rates of T4a tumors appear to be worse than that of T4b tumors, although there is currently no consensus. Therefore, we collected patient data from Taichung Veterans General Hospital over the past decade in order to conduct further research.

METHOD

Between 2010 and 2018, a total of 5760 newly diagnosed CRC patients were seen at the hospital. To eliminate the influence of any local lymph node involvement or distant organ metastasis on the research results, we focused on patients with pathologic Stage IIc disease (T4a-bN0M0). Patients with rectal cancer who had received neoadjuvant concurrent chemoradiotherapy were excluded. Ultimately, 132 patients were included in this study. A multivariate Cox regression analysis was conducted to identify independent risk factors for both 10-year cancer-specific survival (CSS) and overall survival (OS).

RESULTS

A total of 132 patients were included in the study, with 90 classified as T4a and 42 as T4b. The 10-year CSS for pT4a and pT4b was 72.5% and 56.5%, respectively, with a p-value of 0.011. The 10-year OS for pT4a and pT4b was 48.4% and 42.5%, respectively, with a p-value of 0.086. There was no significant difference in the site of first recurrence between the pT4a and pT4b groups (p-value = 0.936). Overall, patients who received adjuvant chemotherapy therapy had a significantly better prognosis (p-value < 0.05). However, there was no significant difference in prognosis between oral 5-FU and FOLFOX.

CONCLUSION

Based on our data, patients diagnosed with pathologic T4aN0M0 CRC appeared to experience a trend toward better 10-year OS when compared to those with T4bN0M0 disease, but this trend lacks statistical significance. Patients with locally advanced Stage II colon cancer clearly benefited from adjuvant chemotherapy therapy; therefore, FOLFOX may not necessarily be required.

Comparison of postoperative prognoses for resectable colorectal cancer with vs. without oncologic emergency using propensity score‑matched analyses: A single-center retrospective observational study

While oncological emergencies in colorectal cancer present distinct challenges, existing literature offers conflicting evidence regarding long-term outcomes. Therefore, the present study compared the postoperative prognoses between patients with and without oncological emergencies. A retrospective evaluation was conducted on patients who had undergone radical surgery for pathological stages II and III colorectal cancer at a single center between January 2012 and December 2020. Patients were classified into the non-emergency and oncological emergency groups. The status of oncologic emergency was divided into obstruction and perforation. The outcomes were compared using propensity score matching. The primary objective was to compare the postoperative prognoses between non-emergency and oncological emergency situations. The secondary objectives included comparing prognoses between obstruction and perforation, identifying the type of recurrence depending on the status of oncologic emergency, and assessing the effect of adjuvant chemotherapy for oncologic emergencies. This study included 524 patients. After propensity score matching, the prognoses of oncological emergencies were worse compared with those without any emergency, whereas those of obstruction and perforation did not significantly differ. Regarding the type of recurrence, peritoneal dissemination in obstruction and local recurrence in perforation was more common compared with that in non-emergency cases. Adjuvant chemotherapy improved the recurrence-free survival for cases with oncological emergencies. The prognoses in cases with oncological emergencies could be worse compared with those without any emergency, whereas obstruction and perforation outcomes can be comparable. The administration of adjuvant chemotherapy should be strongly considered for oncological emergencies.

Inadvertent laparoscopic lavage of perforated colon cancer: a systematic review

BACKGROUND

Although laparoscopic lavage for perforated diverticulitis with peritonitis has been grabbing the headlines, it is known that the clinical presentation of peritonitis can also be caused by an underlying perforated carcinoma. The aim of this study was to determine the incidence of patients undergoing inadvertent laparoscopic lavage of perforated colon cancer as well as the delay in cancer diagnosis.

METHODS

The PubMed database was systematically searched to include all studies meeting inclusion criteria. Studies were screened through titles and abstracts with potentially eligible studies undergoing full-text screening. The primary endpoints of this meta-analysis were the rates of perforated colon cancer patients having undergone inadvertent laparoscopic lavage as well as the delay in cancer diagnosis. This was expressed in pooled rate % and 95% confidence intervals.

RESULTS

Eleven studies (three randomized, two prospective, six retrospective) totaling 642 patients met inclusion criteria. Eight studies reported how patients were screened for cancer and the number of patients who completed follow-up. The pooled cancer rate was 3.4% (0.9%, 5.8%) with low heterogeneity (Isquare2 = 34.02%) in eight studies. Cancer rates were 8.2% (0%, 3%) (Isquare2 = 58.2%) and 1.7% (0%, 4.5%) (Isquare2 = 0%) in prospective and retrospective studies, respectively. Randomized trials reported a cancer rate of 7.2% (3.1%, 11.2%) with low among-study heterogeneity (Isquare2 = 0%) and a median delay to diagnosis of 2 (1.5-5) months.

CONCLUSIONS

This systematic review found that 7% of patients undergoing laparoscopic lavage for peritonitis had perforated colon cancer with a delay to diagnosis of up to 5 months.

Surgical tactics in peritonitis, caused by complicated course of colorectal cancer

Objective. To improve surgical tactics in peritonitis, caused by complicated course of colorectal cancer. Materials and methods. Through the 2017 - 2020 yrs period in Department of Surgery in Brovary Multidisciplinary Clinical Hospital 18 patients with colorectal cancer, complicated by peritonitis, were operated. Among them there were 14 (77.8%) men and 4 (22.2%) women, ageing in spectrum 42 – 83 yrs old. In 12 (66.7%) patients the cancer of Stage III was diagnosed, while in 6 (33.3%) – Stage ІV. Results. The right-sided hemicolectomy was performed in 22.2% of the patients, resection of transverse colon – in 3 (16.7%), a left-sided hemicolectomy – 1 (5.6%), Hartmann operation – 9 (50.0%), subtotal colectomy – 1 (5.6%). All the operations were performed without formation of primary anastomoses, and with stoma construction in proximal part of intestine. Reoperation were performed in 4 (22.2%) patients. There were 3 (16.7%) postoperative deaths – in patients with the cancer Stage IV, peritonitis in a terminal stage – due to development of the polyorgan insufficiency syndrome. Conclusion. Formation of primary interintestinal anastomoses while doing surgical intervention for colorectal cancer, complicated by peritonitis, is contraindicated because of high risk of the sutures insufficiency presence.