1. Emergency management of perforated colon cancers: how aggressive should we be?
- Author
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Zielinski, Martin, Merchea, Amit, Heller, Stephanie, You, Y., Zielinski, Martin D, Heller, Stephanie F, and You, Y Nancy
- Subjects
COLON cancer treatment ,EMERGENCY medical services ,MEDICAL statistics ,HEALTH outcome assessment ,SEPTIC shock ,CRITICAL care medicine ,DECISION making in clinical medicine ,COLON tumors ,DIGESTIVE organ surgery ,PATIENT-family relations ,PSYCHOLOGICAL tests ,SURGICAL complications ,SURVIVAL analysis (Biometry) ,TUMOR classification ,TREATMENT effectiveness ,ACQUISITION of data ,RETROSPECTIVE studies ,INTESTINAL perforation ,DISEASE complications - 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. [ABSTRACT FROM AUTHOR]- Published
- 2011
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