Perforated colon cancer (PCC) is a distinct clinical entity with implications for treatment and prognosis, however data on PCC seems scarce. The aim of this systematic review is to provide a comprehensive overview of the recent literature on clinical outcomes of PCC.
Materials and methods
A systematic literature search of MEDLINE (PubMed), Embase, Cochrane library and Google scholar was performed. Studies describing intentionally curative treatment for patients with PCC since 2010 were included. The main outcome measures consisted of short-term surgical complications and long-term oncological outcomes.
Eleven retrospective cohort studies were included, comprising a total of 2696 PCC patients. In these studies, various entities of PCC were defined. Comparative studies showed that PCC patients as compared to non-PCC patients have an increased risk of 30-day mortality (8–33% vs 3–5%), increased post-operative complications (33–56% vs 22–28%), worse overall survival (36–40% vs 48–65%) and worse disease-free survival (34–43% vs 50–73%). Two studies distinguished free-perforations from contained perforations, revealing that free-perforation is associated with significantly higher 30-day mortality (19–26% vs 0–10%), lower overall survival (24–28% vs 42–64%) and lower disease-free survival (15% vs 53%) as compared to contained perforations.
Data on PCC is scarce, with various PCC entities defined in the studies included. Heterogeneity of the study population, definition of PCC and outcome measures made pooling of the data impossible. In general, perforation, particularly free perforation, seems to be associated with a substantial negative effect on outcomes in colon cancer patients undergoing surgery. Better definition and description of the types of perforation in future studies is essential, as outcomes seem to differ between types of PCC and might require different treatment strategies.
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- Dutch cancer center.https://iknl.nl/kankersoortenDate: 2021
- Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends.Surgery. 2000; 127https://doi.org/10.1067/msy.2000.104674
- High mortality rates after nonelective colon cancer resection: results of a national audit.Colorectal Dis. 2016; 18https://doi.org/10.1111/codi.13262
- Intraoperative tumor perforation is associated with decreased 5-year survival in colon cancer: a nationwide database study.Scand J Surg. 2017; 106https://doi.org/10.1177/1457496916683091
- Retroperitoneal cecal perforation resulting from obstructive ascending colon adenocarcinoma.Case Rep Surg. 2020; : 2020https://doi.org/10.1155/2020/9371071
- Colon sparing resection versus extended colectomy for left-sided obstructing colon cancer with caecal ischaemia or perforation: a nationwide study from the French Surgical Association.Colorectal Dis. 2020; 22https://doi.org/10.1111/codi.15111
- Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology.Insights Img. 2020; 11: 31https://doi.org/10.1186/s13244-019-0823-6
- Emergency surgery for obstructing and perforated colon cancer: patterns of recurrence and prognostic factors.Tech Coloproctol. 2019; 23https://doi.org/10.1007/s10151-019-02110-x
- WSES guidelines on colon and rectal cancer emergencies: obstruction and perforation.World J Emerg Surg. 2017; 13https://doi.org/10.1186/s13017-018-0192-3
- Postoperative complications predict long-term outcome after curative resection for perforated colorectal cancer.In Vivo. 2021; 35https://doi.org/10.21873/invivo.12291
- Treatment of perforated colon carcinomas—outcomes of radical surgery.Int J Colorectal Dis. 2015; 30https://doi.org/10.1007/s00384-015-2336-1
- Guidelines systematic review.
- Emergency management of perforated colon cancers: how aggressive should we Be?.J Gastrointest Surg. 2011; 15https://doi.org/10.1007/s11605-011-1674-8
- Risk factors for local recurrence after emergency resection for colon cancer: scenario in Sweden.Dig Surg. 2016; 33https://doi.org/10.1159/000447069
- Nonelective left-sided colon cancer resections are associated with worse postoperative and oncological outcomes: a propensity-matched study.Chirurgia (Bucur). 2018; 113https://doi.org/10.21614/chirurgia.113.2.218
- Outcome of colon cancer initially presenting as colon perforation and obstruction.World J Surg Oncol. 2017; 15https://doi.org/10.1186/s12957-017-1228-y
- Is neoadjuvant therapy an alternative strategy to immediate surgery in locally perforated colon cancer?.Colorectal Dis. 2021; (Published online December)https://doi.org/10.1111/codi.15868
- Adjuvant chemotherapy use and outcomes of patients with high-risk versus low-risk stage II colon cancer.Cancer. 2015; 121https://doi.org/10.1002/cncr.29072
- Decompressing stoma a s bridge to elective surgery is an effective strategy for left-sided obstructive colon cancer.Ann Surg. 2020; 272: 738-743https://doi.org/10.1097/SLA.0000000000004173
- Colon cancer with perforation.Surg Today. 2019; 49https://doi.org/10.1007/s00595-018-1661-8
- Postoperative abdominal infections after resection of T4 colon cancer increase the risk of intra-abdominal recurrence.Eur J Surg Oncol. 2018; 44: 1880-1888https://doi.org/10.1016/j.ejso.2018.09.016
- The effect of obstruction and perforation on colorectal cancer disease-free survival.World J Surg. 2010; 34https://doi.org/10.1007/s00268-010-0443-2
- Pre-operative FOLFOX chemotherapy in advanced colon cancer: pathology analysis of the FOxTROT trial.Ann Oncol. 2019; 30https://doi.org/10.1093/annonc/mdz246.010
- Neoadjuvant therapy in locally advanced colon cancer: a meta-analysis and systematic review.J Gastrointest Oncol. 2020; 11https://doi.org/10.21037/jgo-20-220
- Adjuvant hyperthermic intraperitoneal chemotherapy in patients with locally advanced colon cancer (COLOPEC): a multicentre, open-label, randomised trial.Lancet Gastroenterol Hepatol. 2019; 4: 761-770https://doi.org/10.1016/S2468-1253(19)30239-0
Published online: August 15, 2022
Accepted: August 10, 2022
Received: July 13, 2022
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