Comparison of early and long-term clinical outcomes in obstructed proximal and distal colon cancers undergoing emergent surgery.

Introduction: Studies comparing proximal and distal colon tumours undergoing emergent surgery for obstruction are limited.

Aim: The purpose of our study was to compare the clinical and oncological outcomes of patients with proximal and distal colon cancer, who underwent emergent surgery for obstruction.

Material and methods: From January 2012 to June 2022, patients with colon cancer presenting with obstruction and undergoing emergent surgery were analysed. The 2 groups were defined as proximal and distal according to the tumour location with respect to the splenic flexure. Postoperative early and long-term clinical and oncological outcomes were analysed.

Results: Of the 118 patients included in the study, there were 46 patients (38.9%) in the proximal group and 72 patients (61.1%) in the distal group. Single-session surgery including resection and anastomosis was performed on 31 (67.4%) and 29 (40.3%) patients in the proximal and distal groups, respectively (p = 0.007). The global mortality rate was 11%, and there was no difference between the groups. Five-year survival was similar in the proximal and distal groups, being 80.4% and 68.1%, respectively. In the analysis of patients who did not develop early mortality and underwent R0 resection, 3-year disease-free survival was 89.5% in the proximal group and 81.5% in the distal group; the difference was not significant (p = 0.165).

Conclusions: Mortality is high in emergent surgeries for obstructed proximal and distal colon cancers. If curative resection is achieved, oncological results are good and tumour localisation does not affect survival.