Acute Colonic Perforation Associated with Colorectal Cancer

Abstract

Our purpose was to evaluate long-term outcome in patients presenting with acute colonic perforation in the setting of colorectal cancer. We conducted a retrospective review of 48 consecutive patients presenting with acute colonic 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 proximal 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 patients had stage II disease, 19 stage III, and 15 stage IV. Thirty-day mortality was 14 per cent (n = 7) with nine in-hospital deaths. Of 30-day survivors 29 (60%) had curative resection (21 with local perforation and nine with proximal perforation). Of these 14 received adjuvant chemotherapy. Eleven patients (33%) had either unresectable or metastatic disease on exploration. Mean follow-up was 21.5 months. Ten patients developed metastatic disease after potentially curative resections. Of these nine patients had perforations 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 long-term survivors after perforation proximal to the tumor, although disease stage was comparable in both groups. We conclude that perforation proximal 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 concomitant sepsis and definitive oncologic surgery.

Curative resection after percutaneous drainage followed by preoperative panitumumab monotherapy for locally advanced sigmoid colon cancer with intra-abdominal abscess: a case report

“…In general, the possibility of down-staging when judging the indication of ACT for preoperative treatment cases in colorectal cancer should be considered, although down-staging may not be likely in our patient considering the minimal pathological tumor regression. Furthermore, perforation is generally associated with poor prognosis in colorectal cancer [ 15 , 16 ], even in cases of stage II colon cancer, and ACT should be considered based on patient preference according to the NCCN guidelines. Given these factors and our patient’s preference, oral fluoropyrimidine-based ACT was selected.…”

Insufficient Lymph Node Sampling in Patients with Colorectal Cancer Perforation is Associated with an Adverse Oncological Outcome

“…CRC perforation is reportedly associated with poor prognosis [3, 5, 9–13, 15, 16, 24] and was therefore included in the analysis of risk factors for poor prognosis in Stage II CRC patients. The following clinical characteristics also reportedly increase the risk of poor prognosis: number of LNs sampled <12, poorly differentiated tumor, vascular or lymphatic or perineural invasion and tumor presentation with obstruction or tumor perforation or pT4 stage [2, 14, 21, 25–28].…”

“…To date, the impact of LN dissection on prognosis of CRC perforation has yet to be established. CRC perforations are associated with a poor prognosis [8][9][10][11][12] and high recurrence rates [11][12][13][14]. The overall survival rates of patients suffering CRC with perforations were 73-92 % at 1 year, 58-68 % at 3 years and 32-57.8 % at 5 years, respectively, while those of CRC without perforation were 93-95 % at 1 year, 75-81 % at 3 years and 49.2-75 % at 5 years, respectively [5,11,12,15,16].…”