PERFORATED COLORECTAL CARCINOMAS

BACKGROUND: Colorectal carcinomas that present with perforation are st ated in the literature to carry a poor prognosis. This study is to ver ify or refute the dismal connotation associated with perforated colore ctal carcinomas (PCCs). METHODS: A retrospective analysis of 1551 pati ents with colorectal carcinoma revealed that 51 (3.3%) patients presen ted with perforation. Mary Immaculate and St. John's Queens Hospital D ivisions of the Catholic Medical Center of Brooklyn and Queens chart a nd tumor board data were retrieved for the period 1983 through 1993. R ESULTS: Localized perforation with abscess formation occurred in 31 (6 1%) patients, and free perforation with generalized peritonitis in occ urred 20 (39%) patients. Sixteen (31%) patients had distant metastasis at diagnosis with a mean survival of only 6 months. Overall operative mortality rate was 12%, and overall 5-year survival rate was 32%. By excluding 16 patients with documented Stage IV disease at diagnosis an d 6 operative mortalities (3 of whom also had Stage IV disease at diag nosis), the remaining 32 patients had a mean survival of 59 months and a 5-year survival of 58%. CONCLUSION: In view of the 58% survival in our subset of patients, aggressive management is recommended. This inc ludes management of sepsis and radical surgical resection of adjacent involved organs. A negative attitude associated with PCC is not substa ntiated in this retrospective 10-year study.