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Prognostic factors and patterns of recurrence after emergency management for obstructing colon cancer: multivariate analysis from a series of 2120 patients

  • Original Article
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Abstract

Purpose

At equal TNM stage, obstructing colon cancer (OCC) is associated with worse prognosis in comparison with uncomplicated cancer. Our aim was to identify prognostic factors of overall (OS) and disease-free survival (DFS) in patients treated for OCC.

Methods

From 2000 to 2015, 2325 patients were treated for OCC in French surgical centers, members of the French National Surgical Association (AFC). Patients with palliative management were excluded. The main endpoints were OS and DFS. A multivariate analysis, using Cox proportional hazards regression model, was performed to determine independent prognostic factors.

Results

The cohort included 2120 patients. The median of follow-up was 13.2 months. In multivariate analysis, age > 75 years, ASA score ≥ 3, ECOG score ≥ 3, right-sided colon cancer, presence of synchronous metastases, anastomotic leakage, and absence of adjuvant chemotherapy were independent OS factors. Age > 75 years, ASA score ≥ 3, right-sided colon cancer, presence of synchronous metastases, and absence of postoperative chemotherapy were independent factors of poor OS after exclusion of patients who died postoperatively. Age ≥ 75 years, ASA score ≥ 3, ECOG score ≥ 3, right-sided colon cancer, lymph node involvement, presence of vascular, lymphatic or perineural invasion, less than 12 harvested lymph nodes, and absence of adjuvant chemotherapy were independent DFS factors.

Conclusions

Management of OCC should take into account prognostic factors related to the patient (age, comorbidities), tumor location, and tumor stage. Adjuvant chemotherapy administration plays an important role. For patients undergoing initial defunctionning stoma, neoadjuvant chemotherapy could be an option to improve prognosis.

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Collaborator list from the AFC working group

T Codjia, M Dazza, G Gagnat, S Hamel, L Mallet, P Martre, G Philouze, E Roussel, P Tortajada, AS Dumaine, B Heyd, B Paquette, F Brunetti, F Esposito, V Lizzi, N Michot, Q Denost, C Tresallet, O Tetard, JM Regimbeau, C Sabbagh, P Rivier, E Fayssal, M Collard, D Moszkowicz, R Lupinacci, F Peschaud, JC Etienne, L Loge, T Bege, H Corte, E D’Annunzio, M Humeau, J Issard, N Munoz, J Abba, Y Jafar, L Lacaze, PY Sage, L Susoko, B Trilling, C Arvieux, F Mauvais, B Ulloa-Severino, S Pitel, A Vauchaussade de Chaumont, B Badic, B Blanc, M Bert, P Rat, P Ortega-Deballon, A Chau, C Dejeante, G Piessen, E Grégoire, A Alfarai, M Cabau, A David, D Kadoche, F Dufour, G Goin, Y Goudard, G Pauleau, P Sockeel, B De la Villeon, K Pautrat, C Eveno, A Brouquet, S Abdalla, AC Couchard, G Balbo, JY Mabrut, J Bellinger, M Bertrand, A Aumont, E Duchalais, AS Messière, A Tranchart, JB Cazauran, V Pichot-Delahaye, V Dubuisson, L Maggiori, B Djawad-Boumediene, D Fuks, X Kahn, E Huart, JM Catheline, G Lailler, O Baraket, P Baque, JM Diaz de Cerio, P Mariol, B Maes, P Fernoux, P Guillem, E Chatelain, C de Saint Roman, K Fixot, Y Parc.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Sorbonne Université, Assistance Publique Hôpitaux de Paris, Department of Digestive Surgery, Pitié Salpêtrière University Hospital, Paris, France

    Gilles Manceau MD-PhD & Mehdi Karoui MD-PhD

  2. Sorbonne Université, Assistance Publique Hôpitaux de Paris, Saint Antoine University Hospital, Department of Digestive Surgery, Paris, France

    Thibault Voron MD & Jeremie H Lefèvre MD-PhD

  3. Timone University Hospital, Department of Digestive Surgery, Marseille, France

    Diane Mege MD-PhD & Igor Sielezneff MD-PhD

  4. Charles Nicolle University Hospital, Department of Digestive Surgery, Rouen, France

    Valérie Bridoux MD-PhD

  5. Besançon University Hospital, Department of Digestive Surgery, Besançon, France

    Zaher Lakkis MD

  6. Angers University Hospital, Department of Digestive Surgery, Angers, France

    Aurélien Venara MD

  7. Assistance Publique Hôpitaux de Marseille, North University Hospital, Department of Digestive Surgery, Marseille, France

    Laura Beyer-Berjot MD-PhD

  8. Université Paris–Sud, Assistance Publique Hôpitaux de Paris, Bicêtre University Hospital, Department of Digestive Surgery, Le Kremlin Bicêtre, France

    Solafah Abdalla MD

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  1. Gilles Manceau MD-PhD
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  2. Thibault Voron MD
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  3. Diane Mege MD-PhD
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  4. Valérie Bridoux MD-PhD
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  5. Zaher Lakkis MD
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  6. Aurélien Venara MD
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  7. Laura Beyer-Berjot MD-PhD
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  8. Solafah Abdalla MD
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  9. Igor Sielezneff MD-PhD
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  10. Jeremie H Lefèvre MD-PhD
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  11. Mehdi Karoui MD-PhD
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Consortia

On behalf of the AFC (French Surgical Association) Working Group

  • T. Codjia
  • , M. Dazza
  • , G. Gagnat
  • , S. Hamel
  • , L. Mallet
  • , P. Martre
  • , G. Philouze
  • , E. Roussel
  • , P. Tortajada
  • , A. S. Dumaine
  • , B. Heyd
  • , B. Paquette
  • , F. Brunetti
  • , F. Esposito
  • , V. Lizzi
  • , N. Michot
  • , Q. Denost
  • , C. Tresallet
  • , O. Tetard
  • , J. M. Regimbeau
  • , C. Sabbagh
  • , P. Rivier
  • , E. Fayssal
  • , M. Collard
  • , D. Moszkowicz
  • , R. Lupinacci
  • , F. Peschaud
  • , J. C. Etienne
  • , L. Loge
  • , T. Bege
  • , H. Corte
  • , E. D’Annunzio
  • , M. Humeau
  • , J. Issard
  • , N. Munoz
  • , J. Abba
  • , Y. Jafar
  • , L. Lacaze
  • , P. Y. Sage
  • , L. Susoko
  • , B. Trilling
  • , C. Arvieux
  • , F. Mauvais
  • , B. Ulloa-Severino
  • , S. Pitel
  • , A. Vauchaussade de Chaumont
  • , B. Badic
  • , B. Blanc
  • , M. Bert
  • , P. Rat
  • , P. Ortega-Deballon
  • , A. Chau
  • , C. Dejeante
  • , G. Piessen
  • , E. Grégoire
  • , A. Alfarai
  • , M. Cabau
  • , A. David
  • , D. Kadoche
  • , F. Dufour
  • , G. Goin
  • , Y. Goudard
  • , G. Pauleau
  • , P. Sockeel
  • , B. De la Villeon
  • , K. Pautrat
  • , C. Eveno
  • , A. Brouquet
  • , S. Abdalla
  • , A. C. Couchard
  • , G. Balbo
  • , J. Y. Mabrut
  • , J. Bellinger
  • , M. Bertrand
  • , A. Aumont
  • , E. Duchalais
  • , A. S. Messière
  • , A. Tranchart
  • , J. B. Cazauran
  • , V. Pichot-Delahaye
  • , V. Dubuisson
  • , L. Maggiori
  • , B. Djawad-Boumediene
  • , D. Fuks
  • , X. Kahn
  • , E. Huart
  • , J. M. Catheline
  • , G. Lailler
  • , O. Baraket
  • , P. Baque
  • , J. M. Diaz de Cerio
  • , P. Mariol
  • , B. Maes
  • , P. Fernoux
  • , P. Guillem
  • , E. Chatelain
  • , C. de Saint Roman
  • , K. Fixot
  •  & Y. Parc

Contributions

Gilles Manceau, Diane Mege, Igor Sielezneff, and Mehdi Karoui contributed to the conception and design of the study. Gilles Manceau, Thibault Voron, Diane Mege, Valérie Bridoux, Zaher Lakkis, Aurélien Venara, Laura Beyer-Berjot, Solafah Abdalla, Igor Sielezneff, Jeremie H Lefèvre, and Mehdi Karoui are responsible for acquisition of data. Gilles Manceau and Mehdi Karoui analyzed and interpreted the data. Gilles Manceau, Thibault Voron, Diane Mege, Jeremie H Lefèvre, and Mehdi Karoui are responsible for drafting the manuscript. Gilles Manceau, Thibault Voron, Diane Mege, Valérie Bridoux, Zaher Lakkis, Aurélien Venara, Laura Beyer-Berjot, Solafah Abdalla, Igor Sielezneff, Jeremie H Lefèvre, and Mehdi Karoui critically revised the manuscript.

Corresponding author

Correspondence to Mehdi Karoui MD-PhD.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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The present article is based on a previous communication to the JFHOD (Journées Francophones d’Hépato-gastroentérologie et d’Oncologie Digestive) meeting on 25 March 2017 in Paris.

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Manceau, G., Voron, T., Mege, D. et al. Prognostic factors and patterns of recurrence after emergency management for obstructing colon cancer: multivariate analysis from a series of 2120 patients. Langenbecks Arch Surg 404, 717–729 (2019). https://doi.org/10.1007/s00423-019-01819-5

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