2001 Abstract: 2409 Long-Term Results of Treatment for Perforated and Obstructing Colo-Rectal Carcinoma
Abstracts 2001 Digestive Disease Week
# 2409 Long-Term Results of Treatment for Perforated and Obstructing Colo-Rectal Carcinoma Andrew Averbach, Binu Kunjummen, Brian Heeringa, Armando Sardi, Baltimore, MD
Patients with perforated and obstructing colo-rectal carcinoma (POCRC) are thought to have worse prognosis than those with non-complicated colo-rectal carcinoma (NCCRC). Palliation is considered to be the main objective by some authors while others advocate therapy with curative intent. Retrospective analysis of a single institution experience was based on treatment results of 1028 pts operated in 1987-1997. Patients with POCRC were included in the study group (75 pts, 7.3% of all pts) and 953 pts with NCCRC constituted control group. Average age was 71 with 1:1 male:female ratio. Tumors were located in the right colon in 34.4%, in the left colon in 51.6% and in the rectum in 14%. POCRC occurred in 7.9%, 7.6% and 3.4% of pts with respective location. Adenocarcinoma was a predominant type in both the study and control group. Groups were not statistically different in terms of age, sex, tumor location and histological types. Contrary to that stage distribution was statistically different between groups, namely due to lack of pts with stage I and 3 times higher incidence of pts with stage IV (38.7% vs. 12.1%;p<0.05) in the study group. As a result curative procedures were performed in 52% of the study group and 88% in the control group (p=0.001). Patients in the POCRC group were followed for an average of 29 months, while controls - for 32 months. Kaplan-Meir analysis at 5 years demonstrated overall survival of 32% in the POCRC and 59% in the NCCRC groups (p=0.001). When survival was analyzed by stage it appeared not different between the groups of pts with stage II and IV. For pts with stage III survival was statistically different at 5 years but difference disappeared at 6 years. Perforations were detected in 32 of 75 pts with 26 of them (81%) occurring at the tumor site. In the POCRC group diverting ostomy was utilized in 51 pts (68%) and bypass procedure in 3 (4%). Curative resection was done in 39 pts (52% of all pts). Anastomosis after resection was performed in 21 pts (28% of all or 58.8% of curative resections). In the POCRC group morbidity was 37% and mortality was 5.3%. It can be concluded that decreased 5-year survival in pts with POCRC was attributable to the higher proportion of pts with stage IV compared to the NCCRC group. Stage for stage comparison of survival demonstrates no difference between groups. Though risk of morbility and mortality is increased in pts with POCRC, curative resection of the primary cancer must be the goal of surgery when possible.