• 76% meglumine diatrizoate
• Colorectal cancer
• enhanced recovery after surgery
• intestinal obstruction
• postoperative ileus

• Humans
• Male
• Female
• Middle Aged
• Diatrizoate Meglumine/administration & dosage
• Ileus/prevention & control
• Ileus/etiology
• Postoperative Complications/prevention & control
• Administration, Oral
• Aged
• Adult

• Humans
• Peritonitis/etiology
• Feces/chemistry

• cancer care facility
• healthcare quality assessment
• healthcare quality indicators
• medical emergency services
• surgical oncology
• operative procedures

• Humans
• Neoplasms/surgery
• Quality Indicators, Health Care
• Brazil
• Surgical Oncology/standards
• Surgical Oncology/education
• Emergencies

• CA colon
• CA rectum
• Colorectal carcinoma
• Emergency
• Malignant bowel obstruction
• Nonobstructing cancer
• Obstructing cancer

• BMI (body mass index)
• Colorectal cancer
• ERAS (enhanced recovery after surgery)
• Obesity
• Predictive, preventive and personalized medicine (3PM/PPPM)
• SMI (skeletal muscle index)
• Weight management

Perforation and obstruction in colorectal cancer are poor prognostic factors. We aimed to evaluate the oncological outcomes of patients with colon cancer presenting with perforation or obstruction.

A total of 260 patients underwent surgery for colon cancer between January 2015 and December 2017. Among them, 54 patients who underwent emergency surgery for perforated (n = 32) or obstructive (n = 22) colon cancer were included.

The perforation (PG, n = 32) and obstruction groups (OG, n = 22) did not differ significantly in age (p = 0.486), sex (p = 0.821), tumor stage (p = 0.221), tumor location (p = 0.895), histologic grade (p = 0.173), or 3-year overall survival rate (55.6% vs. 50.0%, p = 0.784). However, the PG had a higher postoperative complication rate (44% vs. 17%, p = 0.025), longer intensive care unit stay (4.8 days vs. 0.8 days, p = 0.047), and lower 3-year recurrence-free survival (42.4% vs. 78.8%, p = 0.025) than the OG. In the multivariate analysis, perforation was significantly increased risk of recurrence (hazard ratio = 3.67, 95% confidence interval: 1.049–12.839, p = 0.042).

Patients with colon cancer initially presenting with perforation had poorer recurrence-free survival, higher postoperative complication rates, and longer ICU stays than those who had obstruction.

Despite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality.

A retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes.

The most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery.

Age and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.

• Intestinal perforation
• Peritonitis
• Postoperative complication
• Surgical stomas

The Hartmann procedure is currently recognized as a common, safe, and feasible surgical procedure. However, its reversal rate is low, and the optimal timing for Hartmann reversal surgery is controversial.

A 65-year-old man came to our hospital with a complaint of an intestinal fistula next to the stoma. The patient had undergone a Hartmann procedure 13 years prior. We performed colonoscopy, computed tomography, and other diagnostics before successfully reversing the stoma.

Although the optimal time for Hartmann procedure reversal is controversial, time may ultimately not be a factor in the success of reversal.

• Hartmann
• Hartmann's procedure
• Reversal
• Time
• Complications
• Case study
• Case report

• Colorectal cancer
• colorectal cancer perforation
• intestinal perforation

• colorectal surgery
• emergency
• guideliness

• Colorectal Surgery
• Consensus
• Digestive System Surgical Procedures
• Emergency Service, Hospital
• Humans
• United Kingdom

• Colonic Neoplasms
• Colorectal Neoplasms/pathology
• Colorectal Neoplasms/therapy
• Endoscopy
• Humans
• Neoplasm Staging
• Prognosis
• Retrospective Studies

Clinically suspected T4 stage colon cancer from a preoperative exam is often diagnosed as T3 stage colon cancer pathologically after surgery, raising concerns about understaging. The aims of this study were to compare the survival of clinical T3 and T4 colon cancer patients who had received a pathologic T3 stage diagnosis postoperatively.

Patients who were diagnosed with pathologic T3 stage colon cancer postoperatively were reviewed. Patients with clinically suspected T3 or T4 stage cancer on preoperative exam were enrolled in the study. We compared patient demographics and survival of the cT3 and cT4 groups.

Out of the 536 patients with pT3 colon cancer, 503 patients were cT3 (93.8%) and 33 patients were cT4 (6.2%) preoperatively. The most common reason for suspected clinical T4 stage cancer was free perforation (78.8%). There were no statistically significant differences between the 5-year overall survival and the total 5-year disease-free survival (DFS) between the cT3 and cT4 groups; however, local recurrence was significantly higher in the cT4 group (local 5-year DFS: 98.6% vs. 84.0%, P < 0.001). Multivariate analysis showed cT stage was associated with local recurrence, but the association was not statistically significant (P = 0.056).

Preoperative clinically suspected T4 stage colon cancer showed inferior local recurrence despite a postoperative pathologic diagnosis of T3 stage cancer. It is necessary to address the shortcomings of pathologic exams in the matter of the understaging of T4 colon cancer, and to reinforce the treatment for local control in patients with cT4 colon cancer.

• Colonic neoplasms
• Diagnosis
• Survival
• Tumor Staging

• Colorectal cancer
• Emergency surgery
• Obstruction
• Oncological outcome
• Survival

• Cancer
• Colon
• Emergency
• Obstruction
• Perforation
• Rectum

• Colectomy/methods
• Colorectal Neoplasms/therapy
• Colostomy/methods
• Guidelines as Topic/standards
• Humans
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/therapy
• Intestinal Perforation/diagnosis
• Intestinal Perforation/therapy
• Self Expandable Metallic Stents
• Tomography, X-Ray Computed/methods

• Colon cancer
• Laparoscopic surgery
• Perforation

Emergency complications of colon cancer include perforation and obstruction which were recognized as poor prognostic factors. Few studies have directly compared the outcomes of these two groups. In this study, we evaluated mortality and morbidity in patients with colon cancer initially presenting as perforation and obstruction.

Newly diagnosed colon cancer cases initially presenting with perforation or obstruction at Tzu Chi General Hospital, Hualien, Taiwan, between 2009 and 2015 were included. Cases of iatrogenic perforation or perforation sites far away from the tumor sites and rectal (< 15 cm from the anal verge) cancer were excluded. Progression-free survival, local recurrence rate, distant metastasis rate, and overall survival were the evaluated outcomes.

Eighty-one patients met the selection criteria; 23 and 58 patients had perforation and obstruction, respectively, as the initial symptom. The median age was 72 years. The median tumor stage was stage IIIB. The 1-year and 3-year survival rates were 83.7 and 59.7%, respectively. The perforation group (PRG) and obstruction group (OBG) did not differ significantly in intensive care unit (ICU) stay rate (p = 0.147), sex (p = 0.45), comorbidities (heart, liver, and renal diseases and diabetes mellitus), median stage (p = 0.198), and overall survival (p = 0.328). However, PRG had a higher age at diagnosis (74 vs. 64 years, p = 0.037), a higher APACHE II score (12 vs. 7, p = 0.002), lower disease-free survival (p = 0.001), a higher recurrence rate (56.5 vs. 19%, p = 0.002), a higher distant metastasis rate (39.1 vs. 13.8%, p = 0.015), and a higher local recurrence rate (43.5 vs. 5.2%, p < 0.001) than did OBG. OBG had a higher two-stage operation rate (46.6 vs. 17.4%, p = 0.022). After adjustment for the tumor stage, comorbidity (chronic renal disease), body mass index (BMI), and adjuvant chemotherapy or radiotherapy in multivariate statistics, PRG had lower disease-free survival (p = 0.005) than OBG but overall survival was identical.

For colon cancer initially presenting as perforation or obstruction, the PRG had poorer progression-free survival, a higher local recurrence rate, and a higher distant metastasis rate than did OBG. Overall survival did not differ between these two groups.

• Colon cancer
• Obstruction
• Perforation

AIM: To investigate the long-term oncologic outcomes and prognostic factors in patients with obstructive colorectal cancer (CRC) at multiple Japanese institutions.

METHODS: We identified 362 patients diagnosed with obstructive colorectal cancer from January 1, 2002 to December 31, 2012 in Yokohama Clinical Oncology Group’s department of gastroenterological surgery. Among them, 234 patients with stage II/III disease who had undergone surgical resection of their primary lesions were analyzed, retrospectively. We report the long-term outcomes, the risk factors for recurrence, and the prognostic factors.

RESULTS: The five-year disease free survival and cancer-specific survival were 50.6% and 80.3%, respectively. A multivariate analysis showed the ASA-PS (HR = 2.23, P = 0.026), serum Albumin ≤ 4.0 g/dL (HR = 2.96, P = 0.007), T4 tumor (HR = 2.73, P = 0.002) and R1 resection (HR = 6.56, P = 0.02) to be independent risk factors for recurrence. Furthermore, poorly differentiated cancers (HR = 6.28, P = 0.009), a T4 tumor (HR = 3.46, P = 0.011) and R1 resection (HR = 6.16, P = 0.006) were independent prognostic factors in patients with obstructive CRC.

CONCLUSION: The outcomes of patients with obstructive CRC was poor. T4 tumor and R1 resection were found to be independent prognostic factors for both recurrence and survival in patients with obstructive CRC.

• Obstructive colorectal cancer
• Prognostic factor
• Survival

• Adult
• Aged
• Aged, 80 and over
• Cell Differentiation
• Chemotherapy, Adjuvant
• Colectomy/adverse effects
• Colectomy/mortality
• Colorectal Neoplasms/complications
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/mortality
• Colorectal Neoplasms/surgery
• Disease Progression
• Disease-Free Survival
• Female
• Humans
• Intestinal Obstruction/diagnosis
• Intestinal Obstruction/etiology
• Intestinal Obstruction/mortality
• Intestinal Obstruction/surgery
• Japan
• Kaplan-Meier Estimate
• Male
• Margins of Excision
• Middle Aged
• Multivariate Analysis
• Neoplasm Metastasis
• Neoplasm Recurrence, Local
• Neoplasm Staging
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Time Factors
• Treatment Outcome

• Anastomotic leakage
• colon cancer
• mortality
• nonelective

• colon cancer
• colon perforation
• colonic stent
• large bowel obstruction
• multivisceral resection

• CME
• Outcome
• Perforated colon cancer
• Surgical treatment

• Adult
• Age Factors
• Aged
• Aged, 80 and over
• Carcinoma/complications
• Carcinoma/mortality
• Carcinoma/surgery
• Colonic Neoplasms/complications
• Colonic Neoplasms/mortality
• Colonic Neoplasms/surgery
• Female
• Humans
• Intestinal Perforation/etiology
• Intestinal Perforation/surgery
• Lymph Node Excision
• Male
• Mesocolon/surgery
• Middle Aged
• Postoperative Complications
• Survival Analysis

• Aged
• Aged, 80 and over
• Colonic Neoplasms/complications
• Colonic Neoplasms/mortality
• Colonic Neoplasms/surgery
• Digestive System Surgical Procedures/methods
• Digestive System Surgical Procedures/statistics & numerical data
• Emergency Treatment/methods
• Emergency Treatment/statistics & numerical data
• Female
• Humans
• Intestinal Perforation/complications
• Intestinal Perforation/mortality
• Intestinal Perforation/surgery
• Intraoperative Complications
• Male
• Middle Aged
• Minnesota
• Neoplasm Staging
• Outcome Assessment, Health Care
• Postoperative Complications
• Registries
• Retrospective Studies
• Survival Analysis
• Treatment Outcome

A broad spectrum of colonic complications can occur in patients with colon cancer. Clinically, some of these complications can obscure the presence of underlying malignancies in the colon and these complications may require emergency surgical management. The complications of the colon that can be associated with colon cancer include obstruction, perforation, abscess formation, acute appendicitis, ischemic colitis and intussusception. Although the majority of these complications only rarely occur, familiarity with the various manifestations of colon cancer complications will facilitate making an accurate diagnosis and administering prompt management in these situations. The purpose of this pictorial essay is to review the CT appearance of the colonic complications associated with colon cancer.

• Colon
• Colon neoplasms
• Complications
• Computed tomography (CT)
• Introduction