Purpose: A large bowel obstruction as a result of primary colorectal cancer has a poor outcome. A retrospective study was designed to verify the recurrence patterns and to determine the prognostic factors after a curative resection in patients with a completely obstructing colorectal cancer.
Methods: Eight hundred patients with stage Ⅱ and Ⅲ colorectal adenocarcinomas (37 patients with a complete obstruction and 763 patients without an obstruction) underwent curative surgery between 1989 and 1996 at the Asan Medical Center. The median follow-up period was 55 (3~107) months.
Results: Clinicopathologic variables, i.e. sex, serum carcino-embryonic antigen (CEA), Borrmann type, differentiation, and tumor stage in the two groups were similar. Patients with obstructing colorectal cancer were significantly older than those without an obstruction (61±14 vs. 56±12 years, P=0.02). Rectal cancers were more frequent in the non-obstructing cancers than in the obstructing cancers (P=0.02). The recurrence rate in the two groups was similar (obstructing vs. non-obstructing cancer, 27.0% vs. 28.0%). Ten patients with 12 recurrences were identified in 37 obstructing αlorectal cancer patients, three with local recurrences (8.1%) and nine with distant metastasis (24.3%). The 5-year survival rate between the same stages was not different between the two groups (77.8% vs. 85.3% in stage Ⅱ, 65.1% vs. 60.4% in stage Ⅲ). Among the various clinicopathologic variables, neural invasion was strongly associated with a poor prognosis in obstructing colorectal cancer on multivariate analysis (P<0.05).
Conclusion: Because the obstructing cancers and the non-obstructing colorectal cancers had a similar outcome, curative surgery appears to offer the best chance of a cure in stage Ⅱ and Ⅲ obstructing colorectal cancer.
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