Retrospective observational study on the oncological outcomes in patients with perforated or obstructed colon cancer

BACKGROUND: Colorectal cancer is a significant health problem worldwide, with surgical resection being the main treatment strategy. This study was designed to assess the oncological outcomes of patients with colon cancer who presented with obstruction or perforation.METHODS: A retrospective observational study was conducted at Mansoura University Hospital between 2019 and 2023. Patients who underwent surgery for complicated colorectal cancer were eligible for study inclusion. The patients were divided into two categories: perforation and obstruction. Patients with rectal cancer and colon perforation during colonoscopic stenting were excluded from the study. Survival analysis was performed on patient characteristics using Kaplan-Meier curves to estimate survival probabilities.RESULTS: Forty-five patients met the selection criteria; 13 and 32 patients had perforation and obstruction, respectively, as the initial symptoms. The median age of the patients was 57 years. The median tumor stage was stage III. The perforation and obstruction groups did not significantly differ in body mass index (BMI) (P=0.15), American Society of Anesthesiologists Physical Status (ASA) Score (P=0.718), and comorbidities. The 1- and 3-year survival rates were 93.7% and 71.9%, respectively. There were substantial variations in the proportion of patients with peritonitis and the rate of critical care unit stay between the obstruction and perforation groups (P=0.0001 and P=0.01, respectively). However, no significant differences in tumor stage, postoperative wound infection, and anastomotic leakage were observed between the two groups. Furthermore, no significant differences in mortality and recurrence rates were found between the two groups (P=0.205 and P=0.6288, respectively). This study showed a statistically significant difference in the overall cancer-related survival between the two groups (P=0.0337).CONCLUSIONS: Perforated colon cancer had a lower overall survival rate than obstructed colon cancer; however, no difference in recurrence or recurrence-free survival rate was observed.