PERFORATED COLORECTAL-CANCER

Perforations are rare but serious complications of colorectal cancer, with mortality rates of 30 to 40 percent. The aim of this retrospectiv e study was to investigate possible indicators of prognosis and causes of death and to evaluate the risk of this complication by comparing r esults in perforated tumors with uncomplicated cancers or large-bowel perforations attributable to benign causes. METHODS: Data of postopera tive and long-term results of 35 patients with perforated colorectal c ancers were compared in 868 patients with uncomplicated cancers and 13 0 patients with large-bowel perforations attributable to benign diseas es. Postoperative survival in perforated cancers (mortality, 40 percen t) was determined by degree of peritonitis, septic state, and tumor st ages. RESULTS: Comparison of the three groups demonstrated advanced tu mor stages, a higher rate of septic organ failures, and higher mortali ty rates for perforated cancers. Long-term survival depended on tumor stages but did not differ in perforated and uncomplicated cancers. CON CLUSIONS: A cumulative effect of malignancy and sepsis may be responsi ble for the high postoperative mortality in malignant perforation. Pat ients with perforated cancers represent the highest risk group in colo nic perforation.