Our purpose was to evaluate long-term outcome in patients presenting with a
cute colonic perforation in the setting of colorectal cancer. We conducted
a retrospective review of 48 consecutive patients presenting with acute col
onic perforation associated with colorectal cancer at a single institution.
Patients presented either with free air or acute peritonitis. No patients
with colonic obstruction were included. Forty-eight patients presented with
colon perforation. Thirty-six had perforation at the tumor, 11 proximal to
the tumor, and one distal to the primary tumor. Patients who perforated pr
oximal to the tumor were older (74.5 +/- 2 vs 64.7 +/- 3; P < 0.04) and had
a longer length of stay (46.8 +/- 17 vs 11.6 +/- 1 P < 0.001). Fourteen pa
tients had stage II disease, 19 stage III, and 15 stage IV. Thirty-day mort
ality was 14 per cent (n = 7) with nine in-hospital deaths. Of 30-day survi
vors 29 (60%) had curative resection (21 with local perforation and nine wi
th proximal perforation). Of these 14 received adjuvant chemotherapy. Eleve
n patients (33%) had either unresectable or metastatic disease on explorati
on. Mean follow-up was 21.5 months. Ten patients developed metastatic disea
se after potentially curative resections. Of these nine patients had perfor
ations of the primary tumor. Three patients developed local recurrence and
all had local tumor perforations. One-year survival was 55 per cent (n = 16
), Five-year disease-free survival was 14 per cent (n = 4). There were no l
ong-term survivors after perforation proximal to the tumor, although diseas
e stage was comparable in both groups. We conclude that perforation proxima
l to a cancer is associated with a higher perioperative mortality and worse
long-term outcome when compared with acute perforations at the site of the
tumor. Long-term survival requires both aggressive management of the conco
mitant sepsis and definitive oncologic surgery.