P G Carraro1, M Segala, B M Cesana, G Tiberio. 1. Istituto di Chirurgia d'Urgenza, Università di Milano, Ospedale Maggiore Policlinico, Instituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy.
Abstract
BACKGROUND: Large-bowel cancers that present as obstructing lesions have a poor prognosis. However, little is known of the reasons for the dismal survival and of failure patterns after potentially curative treatment. METHOD: An observational study and multivariate analysis were conducted to identify determinants of survival and to compare recurrence patterns between obstructing and nonobstructing tumors after primary resection and anastomosis as curative treatment. RESULTS: Over a period of ten years (1980-1989), 528 patients with colonic cancer were treated at one institution. The cancer was obstructing in 179 cases and nonobstructing in 349. One-stage primary resection and anastomosis as curative treatment were performed in 107 obstructed and 256 nonobstructed patients. Three hundred thirty-six potentially cured survivors (94 in the former group and 242 in the latter) were followed for a median of 55 months. During follow-up, local recurrence occurred in 37 patients (12 obstructed (12.8 percent) and 25 nonobstructed (10.4 percent), P = 0.44) and metastatic disease in 68 (25 obstructed (27.6 percent) and 43 nonobstructed (17.8 percent), P = 0.029). Multivariate analysis of survival showed that age over 70 years, Dukes stage, histologic grade, and recurrence were the only prognostic factors. No statistically significant determinant turned out for local recurrence, whereas at multivariate analysis for metastatic and overall relapse, Dukes stage, positive nodes, and obstruction remained independent prognostic factors. CONCLUSIONS: After one-stage emergency curative treatment, patients presenting with obstructing tumors of the colon have a smaller survival probability than that of patients with nonobstructing lesions. Local recurrence pattern is similar between groups. Conversely, obstruction, along with pathologic stage and positive nodes, carries a significantly higher risk of metastatic tumor recurrence and death.
BACKGROUND: Large-bowel cancers that present as obstructing lesions have a poor prognosis. However, little is known of the reasons for the dismal survival and of failure patterns after potentially curative treatment. METHOD: An observational study and multivariate analysis were conducted to identify determinants of survival and to compare recurrence patterns between obstructing and nonobstructing tumors after primary resection and anastomosis as curative treatment. RESULTS: Over a period of ten years (1980-1989), 528 patients with colonic cancer were treated at one institution. The cancer was obstructing in 179 cases and nonobstructing in 349. One-stage primary resection and anastomosis as curative treatment were performed in 107 obstructed and 256 nonobstructed patients. Three hundred thirty-six potentially cured survivors (94 in the former group and 242 in the latter) were followed for a median of 55 months. During follow-up, local recurrence occurred in 37 patients (12 obstructed (12.8 percent) and 25 nonobstructed (10.4 percent), P = 0.44) and metastatic disease in 68 (25 obstructed (27.6 percent) and 43 nonobstructed (17.8 percent), P = 0.029). Multivariate analysis of survival showed that age over 70 years, Dukes stage, histologic grade, and recurrence were the only prognostic factors. No statistically significant determinant turned out for local recurrence, whereas at multivariate analysis for metastatic and overall relapse, Dukes stage, positive nodes, and obstruction remained independent prognostic factors. CONCLUSIONS: After one-stage emergency curative treatment, patients presenting with obstructing tumors of the colon have a smaller survival probability than that of patients with nonobstructing lesions. Local recurrence pattern is similar between groups. Conversely, obstruction, along with pathologic stage and positive nodes, carries a significantly higher risk of metastatic tumor recurrence and death.
Authors: Femke Julie Amelung; Werner Adriaan Draaisma; Esther Catharina Josephina Consten; Peter Derk Siersema; Frank Ter Borg Journal: Surg Endosc Date: 2017-04-13 Impact factor: 4.584
Authors: Hun Jin Kim; Jung Wook Huh; Wu Seong Kang; Chang Hyun Kim; Sang Woo Lim; Young Eun Joo; Hyeong Rok Kim; Young Jin Kim Journal: Surg Endosc Date: 2013-02-23 Impact factor: 4.584
Authors: Dae Young Cheung; Jin Yong Kim; Sung Pil Hong; Min Kyu Jung; Byong Duk Ye; Sang Gyun Kim; Jin Hong Kim; Kang Moon Lee; Kyung Ho Kim; Gwang Ho Baik; Ho Gak Kim; Chang Soo Eun; Tae Il Kim; Sang Woo Kim; Chang Duck Kim; Chang Heon Yang Journal: Surg Endosc Date: 2012-05-19 Impact factor: 4.584
Authors: Antonios-Apostolos K Tentes; Charalambos G Mirelis; Stilianos Kakoliris; Odisseas S Korakianitis; Ioannis G Bougioukas; Evanthia G Tsalkidou; Athanasios I Xanthoulis; Konstantina A Bekiaridou; Abraham I Dimoulas Journal: Langenbecks Arch Surg Date: 2008-02-26 Impact factor: 3.445
Authors: Abdel-Hamid A Ghazal; Walid G El-Shazly; Samer S Bessa; Mohamed T El-Riwini; Ahmed M Hussein Journal: J Gastrointest Surg Date: 2013-01-29 Impact factor: 3.452