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Oncological outcome after incidental perforation in radical rectal cancer surgery

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

Identification of risk factors of poor oncological outcome in rectal cancer surgery is of utmost importance. This study examines the impact of incidental perforation on the oncological outcome.

Methods

Using the Swedish Rectal Cancer Registry, patients were selected who received major abdominal surgery for rectal cancer between 1995 and 1997 with registered incidental perforation. A control group was also selected for analysis of the oncological outcome after 5-year follow-up. Multivariate analysis was performed. Registry data were validated, and additional data were supplemented from medical records.

Results

After validation and exclusion of non-radically operated patients, 118 patients with incidental perforation and 155 controls in TNM stages I–III were included in the analysis. The rate of local recurrence (LR) [20% (23/118) vs. 8% (12/155) (p = 0.007)] was significantly higher among patients with perforation, whereas the rates of distant metastasis [27% (32/118) vs. 21% (33/155) (p = 0.33)] and overall recurrence (OAR) [35% (41/118) vs. 25% (38/155) (p = 0.087)] were not significantly different between the groups. Overall as well as cancer-specific 5-year survival rates were significantly reduced for the patients with perforation [44 vs. 64% (p = 0.002) and 66 vs. 80% (p = 0.026), respectively]. In the multivariate analysis, perforation was a significant risk factor of increased rates of LR and OAR as well as reduced 5-year overall and cancer-specific survival.

Conclusions

Incidental perforation in rectal cancer surgery is an important risk factor of poor oncological outcome and should be considered in the discussion concerning postoperative adjuvant treatment as well as the follow-up regime.

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Acknowledgements

This work was supported by grants from the foundations of Stig and Ragna Gorthon (GL), Greta Andersson (FJ), Vera and Carl J Michaelsen (FJ) Thorsten-Birger Segerfalk (FJ) and Thelma Zoéga (FJ), Helsingborg, Sweden, and Skåne County Council’s Research and Development Foundation (FJ), Kristianstad, Sweden.

Gunilla Andersson, clinical assistant at the Umeå Regional Oncological Centre, is gratefully acknowledged for the valuable administrative support.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Surgery, Helsingborg Hospital, Helsingborg, Lund University, Lund, Sweden

    Fredrik Jörgren & Gudrun Lindmark

  2. Oncological Centre, University Hospital, Umeå University, Umeå, Sweden

    Robert Johansson & Lena Damber

  3. Department of Surgery, Helsingborg Hospital, 251 87, Helsingborg, Sweden

    Fredrik Jörgren

Authors
  1. Fredrik Jörgren
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  2. Robert Johansson
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  3. Lena Damber
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  4. Gudrun Lindmark
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Correspondence to Fredrik Jörgren.

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This paper is not based on a previous communication to a society or meeting.

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Jörgren, F., Johansson, R., Damber, L. et al. Oncological outcome after incidental perforation in radical rectal cancer surgery. Int J Colorectal Dis 25, 731–740 (2010). https://doi.org/10.1007/s00384-010-0930-9

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  • DOI: https://doi.org/10.1007/s00384-010-0930-9

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