Surgery may be curative for patients with a localized perforation of rectal carcinoma

Background: Perforation at the time of operation adversely affects the prog nosis of rectal cancer. These procedures have been termed 'palliative' or ' non-curative'. The long-term outcome of generalized perforations may be dif ferent from that of localized or contained perforations. Although. the onco logical results may be compromised when the tumour is perforated, results i n cases where the perforation is contained may not be as bad as previously thought. An attempt was made to examine the intermediate and long-term resu lts for locally contained perforated rectal cancers. Methods: Some 848 patients with rectal cancer were operated on between Marc h 1989 and December 1995. Of these, 42 (5 per cent) had a locally contained perforation of the rectum. Median follow-up was 23 (range 12-74) months. Results: The survival of patients with locally contained tumour perforation who underwent resection without macroscopic residual disease (40 per cent at 5 years) was significantly better than that of patients with metastatic disease at the time of surgery (zero at 4 years) (P < 0.01). The survival o f patients in whom the tumour was inadvertently perforated during operation was similar to that of patients with locally contained spontaneous tumour perforations. The incidence of local recurrence in these perforated cases w as low provided that a wide tumour clearance was achievable at the time of operation. Operative mortality and morbidity rates were not significantly d ifferent but the incidence of postoperative wound infection was marginally higher among patients with perforation. Conclusion: If clear margins can be obtained at the time of operation the p rognosis of locally contained perforated rectal cancers is good and approac hes that of a potentially curative resection.