Abstract
Introduction
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.
Results
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.
Conclusion
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.
Keywords
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Article info
Publication history
Published online: August 15, 2022
Accepted:
August 10,
2022
Received:
July 13,
2022
Identification
Copyright
© 2022 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
