Colon cancer with a peritumoural abscess: Real-world evidence on prognostic and therapeutic implications of a disregarded entity

INTRODUCTION: Colon cancer with a peritumoural abscess (CCPA) is an uncommon disease entity. This study aimed to analyse its prognostic implications and to evaluate strategies to treat CCPA using real-world data.

METHODS: This was a multicentre cross-sectional cohort study of patients who underwent resection of stage I-IV colon cancer in 50 Dutch hospitals in 2014-2015. Patients with CCPA were propensity score matched to controls without CCPA (1:4). Additional outcome analyses were performed after stratifying treatment of CCPA into acute/urgent resection, bridge-to-surgery (BTS), and planned resection.

RESULTS: CCPA was diagnosed in 244/9040 patients (2.7%). Of these patients, 243 were matched to 967 control patients. Five-year locoregional recurrence rate was higher in CCPA (30.8% vs 11.9%, HR 1.64, 95% CI 1.06-2.54) with non-significantly lower 5-year overall survival (52.7% vs 60.6%, p = 0.34). Among patients with CCPA, 98 (40.2%) underwent acute/urgent resection, 48 (19.7%) BTS approach, and 98 (40.2%) planned resection. Patients managed with BTS had the highest proportions of 90-day complications (75%, p = 0.05), reinterventions (60%, p = 0.003), and permanent stoma (44%, p = 0.02). Five-year LRR rates were 32% for acute/urgent resection, 43% for BTS, and 24% for planned resection (p = 0.12). Locoregional recurrences were predominantly peritoneal metastases in the acute/urgent resection group and anastomotic recurrences in the BTS group. Corresponding 5-year overall survival rates were 45%, 51%, and 60%, respectively (p = 0.05).

DISCUSSION: The presence of a peritumoural abscess was associated with a higher risk of locoregional recurrence, possibly influenced by the therapeutic strategy applied. Future studies should focus on optimizing treatment approach to reduce the high burden of CCPA.