title: Peri-operative bowel perforation in early stage colon cancer is associated with an adverse oncological outcome.
abstract: BACKGROUND
  The presence of an inflammatory response resulting from bowel perforation or anastomotic leakage has been suggested to enhance recurrence rates in colorectal cancer patients. Currently, it is unknown if bowel perforation or anastomotic leakage has prognostic significance in early stage colon cancer patients. In this study, the impact of peri-operative bowel perforation including anastomotic leakage on disease-free survival of stage I/II colon cancer patients was investigated.
  
  
  METHODS
  Prospective follow up data of 448 patients with stages I/II colon cancer that underwent resection were included. Patients who died within 3 months after initial surgery were excluded.
  
  
  RESULTS
  Median follow up was 56.0 months. Patients with peri-operative bowel perforation (n = 25) had a higher recurrence rate compared to patients without perforation (n = 423), 36.0 % vs. 16.1 % (p = 0.01). Disease-free survival was significantly worse for the perforation group compared to patients without perforation (p = 0.004). Multivariate analysis including T-stage, histological grade, and adjuvant chemotherapy showed peri-operative bowel perforation to be an independent factor significantly associated with disease recurrence (odds ratio, 2.7; 95 % CI, 1.1-6.7).
  
  
  CONCLUSIONS
  Peri-operative bowel perforation is associated with increased recurrence rates and impaired disease-free survival in early-stage colon cancer patients.
authors.affiliation: Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: E J T
authors.initials: EJ
authors.lastname: Belt
authors.forename: H B A C
authors.initials: HB
authors.lastname: Stockmann
authors.forename: G S A
authors.initials: GS
authors.lastname: Abis
authors.forename: J M
authors.initials: JM
authors.lastname: de Boer
authors.forename: E S M
authors.initials: ES
authors.lastname: de Lange-de Klerk
authors.forename: M
authors.initials: M
authors.lastname: van Egmond
authors.forename: G A
authors.initials: GA
authors.lastname: Meijer
authors.forename: S J
authors.initials: SJ
authors.lastname: Oosterling
mesh_terms: D000368:Aged; D003108:Colonic Diseases / Q000150:complications* / Q000401:mortality; D003110:Colonic Neoplasms / Q000150:complications* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007416:Intestinal Perforation / Q000150:complications* / Q000401:mortality; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D011446:Prospective Studies; D015996:Survival Rate