Histotype influences emergency presentation and prognosis in colon cancer surgery

Aim: To investigate whether differences in histotype in colon cancer correlate with clinical presentation and if they might influence oncological outcomes and survival. Methods: Data regarding colon cancer patients operated both electively or in emergency between 2009 and 2014 were retrospectively collected from a prospectively maintained database and analyzed for the purpose of this study. Rectal cancer was excluded from this analysis. Statistical univariate and multivariate analyses were performed to investigate possible significant variables influencing clinical presentation, as well as oncological outcomes and survival. Results: Data from 219 patients undergoing colo-rectal resection for cancer of the colon only were retrieved. One hundred seventy-four patients had an elective procedure and forty-five had an emergency colectomy. Emergency presentation was more likely to occur in mucinous (p<0.05) and signet-ring cell (p<0.01) tumors. No definitive differences in 5-year overall (44.7% vs. 60.6%, p=0.078) and disease free survival (51.2% vs. 64.4%, p=0.09) were found between the two groups as a whole, but the T3 emergency patients showed worse prognosis than the elective (p<0.03). Lymph-node invasion, laparoscopy, histology, and blood transfusions were independent variables found to influence survival. Distribution assessed for pTNM stage showed T3 cancers were more common in emergency (p<0.01). Conclusions and discussion: Mucinous and signet-ring cell tumors are related to emergency presentation, pT3 stage, poorest outcomes and survival. Disease-free survival in patients who had emergency surgery for T3 colon cancer seems related to the histotype.