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Outcomes of patients with perforated colon cancer: A systematic review

  • B. Zamaray
    Affiliations
    Department of Surgery, Isala, Zwolle, the Netherlands

    Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands

    Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
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  • R.A. van Velzen
    Affiliations
    Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
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  • P. Snaebjornsson
    Affiliations
    Department of Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
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  • E.C.J. Consten
    Affiliations
    Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands

    Department of Surgery, Meander Medical Centre, Amersfoort, the Netherlands
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  • P.J. Tanis
    Affiliations
    Department of Surgery, Amsterdam UMC, Cancer Centre Amsterdam, University of Amsterdam, Amsterdam, the Netherlands

    Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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  • H.L. van Westreenen
    Correspondence
    Corresponding author. Isala hospital, Department of surgery, Dokter van Heesweg 2, 8025 AB, Zwolle, the Netherlands.
    Affiliations
    Department of Surgery, Isala, Zwolle, the Netherlands
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  • on behalf ofDutch Complex Colon Cancer Initiative (DCCCI)
Published:August 15, 2022DOI:https://doi.org/10.1016/j.ejso.2022.08.008

      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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