Colon cancer with perforation

Abstract

Perforation of the colon is a rare complication for patients with colon cancer and usually requires emergent surgery. The characteristics of perforation differ based on the site of perforation, presenting as either perforation at the cancer site or perforation proximal to the cancer site. Peritonitis due to perforation tends to be more severe in cases of perforation proximal to the cancer site; however, the difference in the outcome between the two types remains unclear. Surgical treatment of colon cancer with perforation has changed over time. Recently, many reports have shown the safety and effectiveness of single-stage operation consisting of resection and primary anastomosis with intraoperative colonic lavage. Under certain conditions, laparoscopic surgery can be feasible and help minimize the invasion. However, emergent surgery for colon cancer with perforation is associated with a high rate of mortality and morbidity. The long-term prognosis seems to have no association with the existence of perforation. Oncologically curative resection may be warranted for perforated colon cancer. In this report, we perform a literature review and investigate the characteristics and surgical strategy for colon cancer with perforation.

Prognostic Factors Analysis for Colon Cancer with Lymph Node Negative

“…Intestinal perforation at the time of diagnosis is not a significant risk factor for relapse, as our study shows, against to other studies in the literature (6,(25)(26)(27)(28). The risk of relapse is 2 times greater for patients with perforation compared to nonperforated cases, and is higher in the first 30 months post-op, eventually the survival curves getting close to each other, being almost similar at 60 months post-op.…”

Postoperative chemotherapy improves survival in patients with resected high‐risk Stage II colorectal cancer: results of a systematic review and meta‐analysis

“…Tumour or bowel perforation is considered a highrisk factor for Stage II colorectal cancer and the current review found a benefit in overall survival with adjuvant chemotherapy in patients who had undergone emergency surgery for bowel obstruction or perforation. Other studies also suggested that adjuvant chemotherapy improves the long-term prognosis of perforated colorectal cancer [57,58] and recommended adjuvant chemotherapy for Stage III and high-risk Stage II colon cancer with perforation [25]. Similarly, Chen et al [59] evaluated the outcomes of colon cancer with perforation or obstruction and showed that the tumour stage was a risk factor, while receiving adjuvant chemotherapy or radiotherapy was a protective factor, in their multivariate analysis of the overall survival.…”

“…Tumour or bowel perforation is considered a high‐risk factor for Stage II colorectal cancer and the current review found a benefit in overall survival with adjuvant chemotherapy in patients who had undergone emergency surgery for bowel obstruction or perforation. Other studies also suggested that adjuvant chemotherapy improves the long‐term prognosis of perforated colorectal cancer [57,58] and recommended adjuvant chemotherapy for Stage III and high‐risk Stage II colon cancer with perforation [25]. Similarly, Chen et al .…”

Gastrointestinal perforation: clinical and MDCT clues for identification of aetiology

“…Malignancy is the commonest cause, accounting for 36% of perforations [48]. Perforation may also be iatrogenic (20%), diverticula-related (19%) and less commonly due to trauma, foreign body ingestion, faecal impaction, ischemia, inflammatory bowel disease, endometriosis, connective tissue disease, radiotherapy, drugs and spontaneous [4,6,7,10,11,49]. The site of perforation is often linked with its cause [4,8,10]; therefore, neoplastic, spontaneous, diverticular (in western countries), blunt trauma and ischemic perforations commonly occur on the left side of colon, whereas inflammatory bowel disease, diverticulitis (in eastern countries) and penetrating trauma perforations tend to be right-sided.…”

“…Perforation complicates 2.6-10% of colon cancers, occurring most commonly in the sigmoid colon (47.3%) and cecum (24.8%) [2,6,11,49,51]. Two mechanisms are recognised [2,4,6,11,49]: the first consists of tumour necrosis and subsequent perforation at the tumour site. The second occurs proximal to the malignancy, as a result of bowel distension secondary to obstruction, frequently occurs at the cecum and usually leads to massive pneumoperitoneum (Fig.…”