OUTCOME OF LARGE-BOWEL PERFORATION IN PATIENTS WITH COLORECTAL-CANCER

PURPOSE: Perforation of the colon is seldom associated with malignant disease. Operative mortality varies widely in published studies and li ttle is known about patterns of failure and long-term outcome. An obse rvational study was undertaken to assess the outcome of colorectal can cer complicated by perforation. METHOD: we reviewed a series of 83 con secutive patients treated during a ii-year period at one institution. RESULTS: Fifty-four (65 percent) patients had perforation of the tumor itself, and 29 (35 percent) had diastatic perforation proximal to an obstructing tumor. Twenty-six (31.5 percent) patients had metastatic d isease at laparotomy. Primary resection of the diseased segment was pe rformed in 47 (87 percent) patients with perforation of the tumor itse lf and in 21 (72.4 percent) patients with diastatic perforation proxim al to an obstructing tumor. However, only 57 patients (39 (72.2 percen t) with perforation of the tumor itself; 18 (62 percent) with diastati c perforation proximal. to an obstructing tumor; P = not significant) were potentially cured. Operative mortality was 16.7 and 48.3 percent, respectively (P < 0.01) and correlated significantly with Hinchey's s tage (P < 0.001) and advanced disease (P = 0.023). At a mean follow-up of 43 (median 31) months, 21 (46 percent) of the 46 potentially cured survivors were alive. The local recurrence rate was 22.9 percent in p atients with perforation of the tumor itself and 18.2 percent in patie nts with diastatic perforation proximal to an obstructing tumor (P = n ot significant). Peritoneal seeding occurred in 17 and 0 percent (P = not significant); the mean disease-free interval was 33.9 and 49.9 mon ths (P = not significant); and five-year cumulative disease-related su rvival probability was 0.51 and 0.90 (P = 0.049), respectively. CONCLU SIONS: Diastatic perforation proximal to an obstructing tumor is assoc iated with higher operative mortality and better cancer-related surviv al than a tumor perforating through the bowel wall. Early diagnosis in diastatic perforation and aggressive management of sepsis associated with radical surgical resection is recommended.