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Surgery for perforated colorectal malignancy in an Asian population: an institution’s experience over 5 years

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Introduction

Perforated colorectal malignancy is associated with numerous peri-operative complications and dismal long-term survival. The study aimed to review the outcome and factors predicting peri-operative complications and long-term survival of patients who underwent surgery for perforated colorectal malignancy.

Methods

A retrospective review of all patients who underwent operative intervention for perforated colorectal malignancy from February 2003 to April 2008 was performed. The severity of peritonitis was graded using the Mannheim peritonitis index (MPI).

Results

Forty-five patients, median age 67 years (36–97 years), formed the study group. Sigmoid colon (37.8%) and cecum (28.9%) were the most common sites of perforation. Sixteen (35.6%) patients had stage IV disease, while 14 (31.1%) had severe peritoneal contamination (MPI > 26). Hartmann’s procedure and right hemicolectomy were performed most frequently in 17 (37.8%) and 15 (33.4%) patients, respectively. The mortality rate in our series was 17.8%, with another 26.7% requiring surgical intensive care unit care. The independent variables predicting worse peri-operative complications were American Society of Anesthesiologists (ASA) score ≥3 and MPI >26. Left-sided perforation was the only independent factor predicting stoma creation. The only factor predicting long-term survival was the stage of malignancy (p < 0.001). The overall mean survival time for stage II, III, and IV disease were 63.7, 38.1, and 13.8 months, respectively.

Conclusions

Surgery for perforated colorectal malignancy is associated with high morbidity and mortality rates. Short-term outcome is determined by ASA score and severity of peritonitis, while long-term outcome is determined by staging of the cancer.

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References

  1. Carraro PG, Segala M, Orlotti C, Tiberio G (1998) Outcome of large-bowel perforation in patients with colorectal cancer. Dis Colon Rectum 41(11):1421–1426

    Article  CAS  PubMed  Google Scholar 

  2. Lee IK, Sung NY, Lee YS, Lee SC, Kang WK, Cho HM, Ahn CH, Lee do S, Oh ST, Kim JG, Jeon HM, Chang SK (2007) The survival rate and prognostic factors in 26 perforated colorectal cancer patients. Int J Colorectal Dis 22(5):467–473

    Article  PubMed  Google Scholar 

  3. Anwar MA, D’Souza F, Coulter R, Memon B, Khan IM, Memon MA (2006) Outcome of acutely perforated colorectal cancers: experience of a single district general hospital. Surg Oncol 15(2):91–96

    Article  PubMed  Google Scholar 

  4. Alvarez JA, Baldonedo RF, Bear IG, Truán N, Pire G, Alvarez P (2005) Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg 190(3):376–382

    Article  PubMed  Google Scholar 

  5. Chen HS, Sheen-Chen SM (2000) Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery 127(4):370–376

    Article  CAS  PubMed  Google Scholar 

  6. Mandava N, Kumar S, Pizzi WF, Aprile IJ (1996) Perforated colorectal carcinomas. Am J Surg 172(3):236–238

    Article  CAS  PubMed  Google Scholar 

  7. Billing A, Fröhlich D, Schildberg FW (1994) Prediction of outcome using the Mannheim peritonitis index in 2003 patients. Peritonitis Study Group. Br J Surg 81(2):209–213

    Article  CAS  PubMed  Google Scholar 

  8. Astler VB, Coller FA (1954) The prognostic significance of direct extension of carcinoma of the colon and rectum. Ann Surg 139(6):846–852

    Article  CAS  PubMed  Google Scholar 

  9. Clavien PA, Sanabria JR, Mentha G, Borst F, Buhler L, Roche B, Cywes R, Tibshirani R, Rohner A, Strasberg SM (1992) Recent results of elective open cholecystectomy in a North American and a European center. Comparison of complications and risk factors. Ann Surg 216(6):618–626

    Article  CAS  PubMed  Google Scholar 

  10. Clavien PA, Camargo CA Jr, Croxford R, Langer B, Levy GA, Greig PD (1994) Definition and classification of negative outcomes in solid organ transplantation. Application in liver transplantation. Ann Surg 220(2):109–120

    Article  CAS  PubMed  Google Scholar 

  11. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213

    Article  PubMed  Google Scholar 

  12. Kriwanek S, Armbruster C, Dittrich K, Beckerhinn P (1996) Perforated colorectal cancer. Dis Colon Rectum 39:1409–1414

    Article  CAS  PubMed  Google Scholar 

  13. Shinkawa H, Yasuhara H, Naka S, Yanagie H, Nojiri T, Furuya Y, Ariki K, Niwa H (2003) Factors affecting the early mortality of patients with nontraumatic colorectal perforation. Surg Today 33(1):13–17

    Article  PubMed  Google Scholar 

  14. Tan KK, Zhang J, Liu JZ, Shen SF, Earnest A, Sim R (2009) Right colonic perforation in an Asian population: predictors of morbidity and mortality. J Gastrointest Surg 13(12):2252–2259

    Article  PubMed  Google Scholar 

  15. Khan S, Pawlak SE, Eggenberger JC, Lee CS, Szilagy EJ, Margolin DA (2001) Acute colonic perforation associated with colorectal cancer. Am Surg 67(3):261–264

    CAS  PubMed  Google Scholar 

  16. Welch JP, Donaldson GA (1974) Perforative carcinoma of colon and rectum. Ann Surg 180(5):734–740

    Article  CAS  PubMed  Google Scholar 

  17. Veyrie N, Ata T, Muscari F, Couchard AC, Msika S, Hay JM, Fingerhut A, Dziri C (2007) Anastomotic leakage after elective right versus left colectomy for cancer: prevalence and independent risk factors. J Am Coll Surg 205(6):785–793

    Article  PubMed  Google Scholar 

  18. Konishi T, Watanabe T, Kishimoto J, Nagawa H (2006) Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance. J Am Coll Surg 202(3):439–444

    Article  PubMed  Google Scholar 

  19. Lipska MA, Bissett IP, Parry BR, Merrie AE (2006) Anastomotic leakage after lower gastrointestinal anastomosis: men are at a higher risk. ANZ J Surg 76(7):579–585

    Article  PubMed  Google Scholar 

  20. Duchesne JC, Wang YZ, Weintraub SL, Boyle M, Hunt JP (2002) Stoma complications: a multivariate analysis. Am Surg 68:961–966

    PubMed  Google Scholar 

  21. Leong QM, Koh DC, Ho CK (2008) Emergency Hartmann’s procedure: morbidity, mortality and reversal rates among Asians. Tech Coloproctol 12(1):21–25

    Article  CAS  PubMed  Google Scholar 

  22. Arumugam PJ, Bevan L, Macdonald L, Watkins AJ, Morgan AR, Beynon J, Carr ND (2003) A prospective audit of stomas—analysis of risk factors and complications and their management. Colorectal Dis 5(1):49–52

    Article  CAS  PubMed  Google Scholar 

  23. David GG, Al-Sarira AA, Willmott S, Cade D, Corless DJ, Slavin JP (2009) Use of Hartmann’s procedure in England. Colorectal Dis 11(3):308–312

    Article  CAS  PubMed  Google Scholar 

  24. Tan KK, Sim R (2010) Surgery for obstructed colorectal malignancy in an Asian population: predictors of morbidity and comparison between left and right sided cancers. J Gastrointest Surg 14(2):295–302

    Article  PubMed  Google Scholar 

  25. Steinberg SM, Barkin JS, Kaplan RS, Stablein DM (1986) Prognostic indicators of colon tumors. The Gastrointestinal Tumor Study Group experience. Cancer 57(9):1866–1870

    Article  CAS  PubMed  Google Scholar 

  26. Runkel NS, Schlag P, Schwarz V et al (1991) Outcome after emergency surgery for cancer of the large intestine. Br J Surg 78:183–188

    Article  CAS  PubMed  Google Scholar 

  27. Griffin MR, Bergstralh EJ, Coffey RJ et al (1987) Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer 60:2318–2324

    Article  CAS  PubMed  Google Scholar 

  28. Kagda FH, Nyam DC, Ho YH, Eu KW, Leong AF, Seow-Choen F (1999) Surgery may be curative for patients with a localized perforation of rectal carcinoma. Br J Surg 86(11):1448–1450

    Article  CAS  PubMed  Google Scholar 

  29. Figueredo A, Coombes ME, Mukherjee S (2008) Adjuvant therapy for completely resected stage II colon cancer. Cochrane Database Syst Rev (3):CD005390

  30. Figueredo A, Germond C, Maroun J, Browman G, Walker-Dilks C, Wong S (1997) Adjuvant therapy for stage II colon cancer after complete resection. Provincial Gastrointestinal Disease Site Group. Cancer Prev Control 1(5):379–392

    CAS  PubMed  Google Scholar 

  31. Fahy BN, D’Angelica M, DeMatteo RP, Blumgart LH, Weiser MR, Ostrovnaya I, Gonen M, Jarnagin WR (2009) Synchronous hepatic metastases from colon cancer: changing treatment strategies and results of surgical intervention. Ann Surg Oncol 16(2):361–370

    Article  PubMed  Google Scholar 

  32. Shah SA, Haddad R, Al-Sukhni W, Kim RD, Greig PD, Grant DR, Taylor BR, Langer B, Gallinger S, Wei AC (2006) Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma. J Am Coll Surg 202(3):468–475

    Article  PubMed  Google Scholar 

  33. Abdalla EK, Vauthey JN, Ellis LM, Ellis V, Pollock R, Broglio KR, Hess K, Curley SA (2004) Recurrence and outcomes following hepatic resection, radiofrequency ablation, and combined resection/ablation for colorectal liver metastases. Ann Surg 239(6):818–825

    Article  PubMed  Google Scholar 

  34. Scheele J, Stangl R, Altendorf-Hofmann A (1990) Hepatic metastases from colorectal carcinoma: impact of surgical resection on the natural history. Br J Surg 77(11):1241–1246

    Article  CAS  PubMed  Google Scholar 

  35. Kemeny MM, Adak S, Gray B, Macdonald JS, Smith T, Lipsitz S, Sigurdson ER, O’Dwyer PJ, Benson AB 3rd (2002) Combined-modality treatment for resectable metastatic colorectal carcinoma to the liver: surgical resection of hepatic metastases in combination with continuous infusion of chemotherapy—an intergroup study. J Clin Oncol 20(6):1499–1505

    Article  PubMed  Google Scholar 

  36. Adam R, Delvart V, Pascal G, Valeanu A, Castaing D, Azoulay D, Giacchetti S, Paule B, Kunstlinger F, Ghémard O, Levi F, Bismuth H (2004) Rescue surgery for unresectable colorectal liver metastases downstaged by chemotherapy: a model to predict long-term survival. Ann Surg 240(4):644–657

    PubMed  Google Scholar 

  37. Sugarbaker PH (2006) New standard of care for appendiceal epithelial neoplasms and pseudomyxoma peritonei syndrome? Lancet Oncol 7(1):69–76

    Article  PubMed  Google Scholar 

  38. Yan TD, Black D, Savady R, Sugarbaker PH (2006) Systematic review on the efficacy of cytoreductive surgery combined with perioperative intraperitoneal chemotherapy for peritoneal carcinomatosis from colorectal carcinoma. J Clin Oncol 24(24):4011–4019

    Article  PubMed  Google Scholar 

  39. Verwaal VJ, Bruin S, Boot H, van Slooten G, van Tinteren H (2008) 8-year follow-up of randomized trial: cytoreduction and hyperthermic intraperitoneal chemotherapy versus systemic chemotherapy in patients with peritoneal carcinomatosis of colorectal cancer. Ann Surg Oncol 15(9):2426–2432

    Article  PubMed  Google Scholar 

  40. Verwaal VJ, Boot H, Aleman BM, van Tinteren H, Zoetmulder FA (2004) Recurrences after peritoneal carcinomatosis of colorectal origin treated by cytoreduction and hyperthermic intraperitoneal chemotherapy: location, treatment, and outcome. Ann Surg Oncol 11(4):375–379

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore

    Ker-Kan Tan, Choon-Chiet Hong, Junren Zhang, Jody Zhiyang Liu & Richard Sim

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  1. Ker-Kan Tan
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  2. Choon-Chiet Hong
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  3. Junren Zhang
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Correspondence to Ker-Kan Tan.

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Tan, KK., Hong, CC., Zhang, J. et al. Surgery for perforated colorectal malignancy in an Asian population: an institution’s experience over 5 years. Int J Colorectal Dis 25, 989–995 (2010). https://doi.org/10.1007/s00384-010-0945-2

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