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.