title: Differences between proximal and distal obstructing colonic cancer after curative surgery.
abstract: OBJECTIVE
  To study any possible differences in morbidity, mortality and overall survival rate after curative surgery for obstructive colon cancer according to tumour location.
  
  
  METHODS
  From January 1994 to December 2006, patients with colonic cancer presenting as obstruction were analysed. The two groups were defined as proximal and distal according to the tumour location with respect to the splenic flexure. In relation to the surgeon specialization, patients were operated on by a colorectal surgeon and by a general surgeon. Postoperative morbidity and mortality and cancer-related survival at 3 years were analysed.
  
  
  RESULTS
  Of the 377 patients included in the study, there were 173 patients (45.9%) in the proximal group and 204 patients (54.1%) in the distal group. The global morbidity was 54.9% without differences in postoperative morbidity except for anastomotic leakage, which was higher in the proximal group (P < 0.014). No differences in postoperative mortality were observed. After patients were stratified by the tumour node metastasis system, the differences between the groups, with respect to 3-year overall survival, cancer-related survival and probability of being free from recurrence, did not reach statistical significance. The overall survival after radical surgery for colonic obstruction was 57.6%.
  
  
  CONCLUSIONS
  Mortality and morbidity after emergency surgery for obstructing colon cancer are high. Specialization in colorectal surgery influences postoperative results in terms of lower anastomotic dehiscence rate after emergency proximal colon resection. After radical surgery, tumour location does not appear to influence the prognosis of obstructive colon cancer.
authors.affiliation: Department of Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Frago
authors.forename: S
authors.initials: S
authors.lastname: Biondo
authors.forename: M
authors.initials: M
authors.lastname: Millan
authors.forename: E
authors.initials: E
authors.lastname: Kreisler
authors.forename: T
authors.initials: T
authors.lastname: Golda
authors.forename: D
authors.initials: D
authors.lastname: Fraccalvieri
authors.forename: B
authors.initials: B
authors.lastname: Miguel
authors.forename: E
authors.initials: E
authors.lastname: Jaurrieta
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology; D003082:Colectomy / Q000009:adverse effects / Q000401:mortality*; D003110:Colonic Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D003107:Colorectal Surgery; D005260:Female; D013502:General Surgery; D006801:Humans; D007415:Intestinal Obstruction / Q000209:etiology / Q000601:surgery*; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome