Back to Search
Start Over
Emergency management of perforated colon cancers: how aggressive should we be?
- Source :
-
Journal of Gastrointestinal Surgery . Dec2011, Vol. 15 Issue 12, p2232-2238. 7p. - Publication Year :
- 2011
-
Abstract
- <bold>Background: </bold>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.<bold>Study Design: </bold>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.<bold>Results: </bold>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.<bold>Conclusions: </bold>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]
- Subjects :
- *COLON cancer treatment
*EMERGENCY medical services
*MEDICAL statistics
*HEALTH outcome assessment
*SEPTIC shock
*CRITICAL care medicine
*DECISION making in clinical medicine
*COLON tumors
*PATIENT-family relations
*PSYCHOLOGICAL tests
*SURGICAL complications
*SURVIVAL analysis (Biometry)
*TUMOR classification
*TREATMENT effectiveness
*ACQUISITION of data
*RETROSPECTIVE studies
*INTESTINAL perforation
*DISEASE complications
DIGESTIVE organ surgery
Subjects
Details
- Language :
- English
- ISSN :
- 1091255X
- Volume :
- 15
- Issue :
- 12
- Database :
- Academic Search Index
- Journal :
- Journal of Gastrointestinal Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 67318692
- Full Text :
- https://doi.org/10.1007/s11605-011-1674-8