Emergency resections in patients with complicated rightand left-sided colon cancer: long-term outcomes

Objective: to evaluate five-year overall and relapse-free survival in patients with complicated rightand left-sided colon cancer that underwent emergency resection.

Materials and methods. The study included 501 patients with urgent complications of rightand left-sided colon cancer that underwent emergency resection. The data was obtained from an electronic register containing the information on patients with urgent complications of colorectal cancer treated in general and specialized surgical hospitals in Smolensk between 2001 and 2013 (13 years). We assessed fiveyear overall and relapse-free survival in these patients.

Results. A total of 501 resections were performed during the study period. We observed significant differences in resection statuses of patients after emergency resection: the R1 resection status was more frequent in individuals with right-sided colon cancer compared to those with left-sided colon cancer (20.8 % vs. 6.9 %, p = 0.0002). Mean number of lymph nodes examined was 4.6 ± 2.0 in patients with right-sided cancer and 5.3 ± 3.0 in patients with left-sided cancer (p = 0.18). There were no differences in the number of patients receiving adjuvant treatment between the groups (p = 0.11). Patients with left-sided stage II/IIIB/IIIС complicated colon cancer demonstrated better overall and relapse-free survival than those with right-sided tumors of the same stages (overall survival: p = 0.007, p = 0.0002, p = 0.0001 for stages II, IIIB, IIIС respectively; relapse-free survival: p = 0.005, p = 0.0003, p = 0.0002 for stages II, IIIB, IIIС respectively).

Conclusion. The observed differences in the outcomes of treatment for rightand left-sided complicated colon cancer can be explained by the fact that the majority of emergency resections for right-sided tumors were one-stage and were performed in general surgery hospitals. Patients with left-sided cancer underwent tumor removal on the second stage more often than those with right-sided cancer (32 % vs. 13 %). Treatment of patients with complicated colon cancer should be consistent, stepwise, and pathogenetically reasonable.

1. Barsukov Yu.A., Tkachev S.I., Kuzmichev D.V. et al. Combination therapy for operable distal rectal cancer. Onkologicheskaya koloproktologiya = Colorectal Oncology 2012;(3):28–37. (In Russ.). DOI: 10.17650/2220-3478-2012-0-3-28-37. [

2. Malignant tumors in Russia in 2016(morbidity and mortality). Eds.:A.D. Kaprin, V.V. Starinskiy, G.V. Petrova. Moscow: MNIOI im. P.A. Gertsena – filial FGBU “NMIRTS” Minzdrava Rossii, 2017. 236 p. (In Russ.).

3. Bagnenko S.F., Belyaev A.M., Vasilyev S.V., Zakharenko A.A. Acute tumor-associated intestinal obstruction(draft of the National Clinical Guidelines). Vestnik khirurgii im. I.I. Grekova = I.I. Grekov Journal of Surgery 2015;174(3):76–80. (In Russ.).

4. Shelygin Yu.A. Coloproctology. Clinical guidelines. Ed. by Yu.A. Shelygin. Moscow: GEOTARMedia, 2015. Pp. 491–517. (In Russ.).

5. Ascanelli S., Navarra G., Tonini G., Feo C. Early and late outcome after surgery for colorectal cancer: elective versus emergency surgery. Tumori 2003;89(1):36–41. PMID: 12729359.

6. Imyanitov E.N. Clinical and molecular aspects of colorectal cancer: etiopathogenesis, prevention, and individualization of treatment. Prakticheskaya onkologiya = Practical Oncology 2005;6(2):65–70. (In Russ.).

7. Chernikovskiy I.L., Savanovich N.V., Smirnov A.A. et al. Topographical anatomy and oncologic colon surgery: new or well forgotten old? Onkologicheskaya koloproktologiya = Colorectal Oncology 2017;7(3):49–55. (In Russ.). DOI: 10.17650/2220-3478-2017-7-3-49-55.

8. Teixeira F., Akaishi E.H., Ushinohama A.Z. et al. Can we respect the principles of oncologic resection in an emergency surgery to treat colon cancer? World J Emerg Surg 2015;10(1):1186–91. PMID: 26191078. DOI: 10.1186/1749-7922-10-5.

9. Weixler B., Warschow R., Ramser M. et al. Urgent surgery after emergency presentation for colorectal cancer has no impact on overall and disease-free survival: a propensity score analysis. BMC Cancer 2016;16:208–19. PMID: 26968526. DOI: 10.1186/s12885-016-2239-8.

10. Ansaloni L., Andersson R.E., Bazzoli F. et al. Guidelenines in the management of obstructing cancer of the left colon: consensus conference of the world society of emergency surgery (WSES) and peritoneum and surgery (PnS) society. World J Emerg Surg 2010;5:29–39. PMID: 21189148. DOI: 10.1186/1749-7922-5-29.

11. Biondo S., Marti-Rague J., Kreisler E. et al. A prospective study of outcomes of emergency and elective surgeries for complicated colonic cancer. Am J Surg 2005;189(4):377–83. PMID: 15820446.

12. Khan MA., Hakeem AR, Scott N. et al. Significance of R1 resection margin in colon cancer resection in the modern era. Colorectal Dis 2015;11(17):943–53. PMID: 25808496. DOI: 10.1111/codi.12960.

13. MсArdle C.S., Hole D.L. Emergency presentation of colorectal cancer is associated with poor 5-year survival. Br J Surg 2004;91(5):605–9. PMID: 15122613. DOI: 10.1002/bjs.4456.

14. Tobaruela E., Camunas J., Navascues J.M. et al. Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery. Rev Esp Enferm Dig 1997;89(1):13–22. PMID: 9055584.

15. Moritani K., Hasegawa H., Okabayashi K. et al. Difference in the recurrence rate between rightand left-sided colon cancer: a 17-year experience at a single institution. Surg Today 2014;44(9):1685–91. PMID: 24126535. DOI: 10.1007/s00595-013-0748-5.

16. Lim D.R., Kuk J.K., Kim T., Shin E.J. Comparison of oncological outcomes of right-sided colon cancer versus leftsided colon cancer after curative resection: which side is better outcome? Medicine(Baltimore) 2017;96(42):1–7. PMID: 29049212. DOI: 10.1097/MD.0000000000008241.

17. Hansen I.O., Jess P. Possible better longterm survival in left versus right-sided colon cancer: a systematic review. Dan Med J 2012;59(6):A4444. PMID: 22677242.

18. Yahagi M., Okabayashi K., Hasegawa H. et al. The worse prognosis of right-sided compared with left-sided colon cancers: a systematic review and meta-analysis. J Gastrointest Surg 2016;20(3):648–55. PMID: 26573851. DOI: 10.1007/s11605-015-3026-6.

19. Lee G.H., Malietzis G., Askari A. et al. Is right-sided colon cancer different to left-sided colorectal cancer? A systematic review. Eur J Surg Oncol 2015;41(3):300–8. PMID: 25468456. DOI: 10.1016/j.ejso.2014.11.001.

20. Petrelli F., Tomasello G., Borgonovo K. et al. Prognostic survival associated with left-sided vs right-sided colon cancer: a systematic review and meta-analysis. JAMA Oncol 2016;27:4227. PMID: 27787550. DOI: 10.1001/jamaoncol.2016.4227.

21. Meguid R.A., Slidell M.B., Wolfgang C.L. et al. Is there a difference in survival between rightversus left-sided colon cancers? Ann Surg Oncol 2008;15(9):2388–94. PMID: 18622647. DOI: 10.1245/s10434-008-0015-y.

22. Jess P., Hansen I.O., Gamborg M. et al. A nation wide Danish cohort study challenging the categorization into right-sided and left-sided colon cancer. BMJ Open 2013;3(5):e002608. PMID: 23793665. DOI: 10.1136/bmjopen-2013-002608.

23. Hussain M., Waqas O., Hassan U. et al. Right-sided and Left-sided colon cancers are two distinct disease entities: an analysis of 200 cases in Pakistan. Asian Pac J Cancer Prev 2016;17(5):2545–8. PMID: 27268627.

24. Saltzstein S.L., Behling C.A. Age and time as factors in the left to right shift of the subsite of colorectal adenocarcinoma: a study of 213,383 cases from the California Cancer Registry. J Clin Gastroenterol 2007;41(2):173–7. PMID: 17245216. DOI: 10.1097/01.mcg.0000225550.26751.6a.