Abstract
BackgroundPerforated colon cancer is a rare complication, but has a high risk of recurrence. However, most studies have not distinguished sealed-off perforation from free perforation, and the prognosis is unclear. The aim of this study was to evaluate the oncologic outcome of colon cancer with sealed-off perforation.MethodsEighty-six consecutive patients who underwent resection for colon cancer with sealed-off or free perforation were included. We defined sealed-off perforation as a colon perforation with localized abscess identified on operative, computed tomography, or pathologic findings, with no evidence of free perforation, including fecal contamination and dirty fluid collection in the peritoneal cavity. Oncologic outcomes were compared between patients with colon cancer with sealed-off perforation and free perforation using a log-rank test and Cox regression analysis.ResultsThe sealed-off perforation group included 62 patients, and 24 patients were in the free perforation group. TNM stage and lymphatic, venous, and perineural invasion were similar between the groups. The median follow-up period was 28.9 months (range 0–159). The sealed-off perforation group had better prognosis compared with the free perforation group in terms of progression-free survival (PFS) and overall survival (OS), although there were no statistically significant differences in PFS (5-year PFS 53.7% vs. 40.5%, p = 0.148; 5-year OS 53.6% vs. 22.9%, p = 0.001). However, in multivariable analysis using the Cox progression test, sealed-off perforation did not show a significant effect on cancer progression (p = 0.138) and OS (p = 0.727).ConclusionsColon cancer with sealed-off perforation showed no difference in prognosis compared with free perforation.
Highlights
The prevalence of perforation in colon cancer patients is reported to be 3–10% [1,2,3]
A previous study reported that local inflammation affects the prognosis of colorectal cancer [7]; sealed-off perforation is suspected to exhibit oncological outcomes different from those of free perforation, due to local inflammation caused by the formation of localized abscess
After excluding patients with perforations caused by stenting or colonoscopy and those with perforations distant from the tumor, 86 patients were included in the final study cohort
Summary
The prevalence of perforation in colon cancer patients is reported to be 3–10% [1,2,3]. Colon cancer patients with perforation exhibit a greater frequency of recurrence and poorer overall survival (OS) compared with those without perforation [4, 5]. Perforations caused by colon cancer appear as free or sealed-off perforations. A previous study reported that local inflammation affects the prognosis of colorectal cancer [7]; sealed-off perforation is suspected to exhibit oncological outcomes different from those of free perforation, due to local inflammation caused by the formation of localized abscess. To the best of our knowledge, no prior study has assessed the prognostic difference in colon cancer patients with free or sealed-off perforation. The aim of this study was to evaluate the oncologic outcome of colon cancer with sealed-off perforation
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