Histopathological Characteristics – Immediate Prognostic Factors for Left Colon Cancer

Introduction: Colorectal cancer represents the second leading cause of cancer mortality in our country, the survival rates being determined by the stage of the disease and the presence of metastases, being of 90% for early stages at 5 years, of 70% for the tumors with local invasion and of 10% in case of distal metastases. The aim of our study is to evaluate the prognosis of left colon cancer according to its histopathological characteristics. Material and methods: A number of 171 patients with left colon cancer (splenic flexure, descending colon, sigmoid colon and rectosigmoidian junction) were included in the study. The patients were admitted to the Surgical Unit of the Emergency Clinical Hospital of Bucharest between January 1st 2015 – December 31st 2016. The histopathological analysis followed the norms of the Americal College of Pathologists, and the determination of tumor staging was done based on the TNM classification. Results: Most patients are in the 3rd stage (65.5%) and in the 4th stage (19.3%) of cancer, only 2.3% being diagnosed in the 1st stage. A number of 36 patients present distal metastases, the most frequent location being in the liver (21 patients). 24% of the patients presented postoperative complications, while 2.3% died, without any differences determined by the presence of lymph nodes or distal metastases. Distal metastases are associated with the resistance environment (p=0.048), while the invasion of lymph nodes is significantly higher (p=0.049) in patients with tubulovillous adenoma. The degree of differentiation of tumors differs significantly from a statistical point of view (p=0.002), according to the histopathological type. Conclusions: The incidence of lymphatic metastases differs according to the histopathological type of the tumor, the tubulovillous adenoma being more frequently associated with lymphatic metastases; distal metastases are more frequently seen in patients in the rural areas, based on the low addressability and accessibility to medical services. The frequency of postoperative complications and nosocomial death is determined by the advanced stage of the disease (stages 3 and 4), as well as by the late arrival of the patient to the emergency room, especially patients with intestinal occlusion.