The effect of obstruction and perforation on colorectal cancer disease-free survival.
BACKGROUND
Obstruction (OBSTR) and perforation (PERF) in colorectal cancer impact adversely upon outcomes, and cancer-related survival may also be affected. However, data are sparse, particularly on disease-free survival (DFS) where the cancer is both obstructed and perforated (OBS-PERF).


METHODS
Data were extracted from a prospectively collected database of 1876 colorectal cancer patients managed and followed up at the Royal Brisbane Hospital from 1984 to 2004. The patients who had curative surgery (n = 1426) were classified as OBSTR (n = 153), PERF (n = 53), OBS-PERF (n = 19), and uncomplicated (UNCOM; n = 1201). Kaplan-Meier survival and Cox proportional hazard analyses were performed.


RESULTS
Postoperative mortality within 30 days of surgery was 1.5% (n = 22) and the overall complication rate was 40.8% (n = 582). However, only 7.2% (n = 102) required reoperations. The median survival time was 71 (IQR = 64.9-77.1) months and the median follow-up for DFS was 37.5 (IQR 14-68) months. The overall recurrence rate was 32.7% (n = 466), the local recurrence rate was 9.4% (n = 135), and local and distant recurrences occurred in the same patient in 4.7% (n = 67). Male gender, OBSTR, PERF, OBS-PERF, emergency operation, major medical and surgical complications, reoperation, TNM staging, tumor grading, and tumor venous invasion adversely affected DFS (p < 0.05). Multivariate analysis showed that OBS-PERF (p = 0.008), major medical complications (p = 0.011), reoperation (p = 0.018), TNM staging (p < 0.001), grading (p = 0.018), and venous invasion (p = 0.002) were independently associated with a poorer DFS.


CONCLUSIONS
OBS-PERF colorectal cancer is associated with a poorer DFS, which may be worse than either OBSTR or PERF alone.
Department of Surgery, School of Medicine and Dentistry, North Queensland Centre for Cancer Research, James Cook University, Townsville, QLD, Australia. yikhong.ho@jcu.edu.au
Yik-Hong
YH
Ho
Simon K K
SK
Siu
Petra
P
Buttner
Andrew
A
Stevenson
John
J
Lumley
Russel
R
Stitz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000401:mortality*; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D055815:Young Adult