Skip to main content

Advertisement

SpringerLink
Log in

Treatment of perforated colon carcinomas—outcomes of radical surgery

  • Original Article
  • Published:
International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Purpose

When patients present with a perforation of a colon cancer (CC), this situation increases the challenge to treat them properly. The question arises how to deal with these patients adequately, more restrictively or the same way as with elective cases.

Methods

Between January 1995 and December 2009, 52 patients with perforated CC and 1206 nonperforated CC were documented in the Erlangen Registry of Colorectal Carcinomas (ERCRC). All these patients underwent radical resection of the primary including systematic lymph node dissection with CME. The median follow-up period was 68 months.

Results

The median age of the patients in the perforated CC group was significantly higher than in the nonperforated CC group (p = 0.010). Significantly, more patients with perforated CC were classified in ASA categories 3 and 4 (p = 0.014). Hartmann procedures were performed significantly more frequently with perforation than with the nonperforated ones (p < 0.001). If an anastomosis was performed, the leakage rate of primary anastomoses did not differ (p = 1.0). Cancer-related survival was significantly lower with perforated cancer (difference 12.8 percentage points) and by 9.6 percentage points for observed survival, if postoperative mortality was excluded.

Conclusions

Perforated CC patients should be treated basically following the same oncologic demands, which are CME for colonic cancer including multivisceral resections, if needed. This strategy can only be performed if high-quality surgery is available, permanently.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Abdelrazeq AS, Scott N, Thorn C, Verbeke CS, Ambrose NS, Botterill ID, Jayne DG (2008) The impact of spontaneous tumour perforation on outcome following colon cancer surgery. Colorectal Dis 10(8):775–780. doi:10.1111/j.1463-1318.2007.01412.x

    Article  CAS  PubMed  Google Scholar 

  2. Cheynel N, Cortet M, Lepage C, Ortega-Debalon P, Faivre J, Bouvier AM (2009) Incidence, patterns of failure, and prognosis of perforated colorectal cancers in a well-defined population. Dis Colon Rectum 52(3):406–411. doi:10.1007/DCR.0b013e318197e351

    Article  PubMed  Google Scholar 

  3. 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. doi:10.1007/s00384-006-0184-8

    Article  PubMed  Google Scholar 

  4. Zielinski MD, Merchea A, Heller SF, You YN (2011) Emergency management of perforated colon cancers: how aggressive should we be? J Gastrointest Surg 15(12):2232–2238. doi:10.1007/s11605-011-1674-8

    Article  PubMed  Google Scholar 

  5. Alvarez JA, Baldonedo RF, Bear IG, Truan 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. doi:10.1016/j.amjsurg.2005.01.045

    Article  PubMed  Google Scholar 

  6. Coco C, Verbo A, Manno A, Mattana C, Covino M, Pedretti G, Petito L, Rizzo G, Picciocchi A (2005) Impact of emergency surgery in the outcome of rectal and left colon carcinoma. World J Surg 29(11):1458–1464. doi:10.1007/s00268-005-7826-9

    Article  PubMed  Google Scholar 

  7. Charbonnet P, Gervaz P, Andres A, Bucher P, Konrad B, Morel P (2008) Results of emergency Hartmann’s operation for obstructive or perforated left-sided colorectal cancer. World J Surg Oncol 6:90. doi:10.1186/1477-7819-6-90

    Article  PubMed Central  PubMed  Google Scholar 

  8. Pox CP, Schmiegel W (2013) German S3-guideline colorectal carcinoma. Dtsch Med Wochenschr 138(49):2545. doi:10.1055/s-0033-1353953

    Article  CAS  PubMed  Google Scholar 

  9. West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P (2010) Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 28(2):272–278. doi:10.1200/JCO.2009.24.1448

    Article  PubMed  Google Scholar 

  10. Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S (2009) Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis 11(4):354–364. doi:10.1111/j.1463-1318.2008.01735.x, discussion 364–355

    Article  CAS  PubMed  Google Scholar 

  11. Ghazi S, Berg E, Lindblom A, Lindforss U (2013) Clinicopathological analysis of colorectal cancer: a comparison between emergency and elective surgical cases. World J Surg Oncol 11:133. doi:10.1186/1477-7819-11-133

    Article  PubMed Central  PubMed  Google Scholar 

  12. Ho YH, Siu SK, Buttner P, Stevenson A, Lumley J, Stitz R (2010) The effect of obstruction and perforation on colorectal cancer disease-free survival. World J Surg 34(5):1091–1101. doi:10.1007/s00268-010-0443-2

    Article  PubMed  Google Scholar 

  13. Wong SK, Jalaludin BB, Morgan MJ, Berthelsen AS, Morgan A, Gatenby AH, Fulham SB (2008) Tumor pathology and long-term survival in emergency colorectal cancer. Dis Colon Rectum 51(2):223–230. doi:10.1007/s10350-007-9094-2

    Article  PubMed  Google Scholar 

  14. Schwenter F, Morel P, Gervaz P (2010) Management of obstructive and perforated colorectal cancer. Expert Rev Anticancer Ther 10(10):1613–1619. doi:10.1586/era.10.147

    Article  PubMed  Google Scholar 

  15. Merkel S, Meyer C, Papadopoulos T, Meyer T, Hohenberger W (2007) Urgent surgery in colon carcinoma. Zentralbl Chir 132(1):16–25. doi:10.1055/s-2006-958708

    Article  CAS  PubMed  Google Scholar 

  16. Anderson JH, Hole D, McArdle CS (1992) Elective versus emergency surgery for patients with colorectal cancer. Br J Surg 79(7):706–709

    Article  CAS  PubMed  Google Scholar 

  17. Zorcolo L, Covotta L, Carlomagno N, Bartolo DC (2003) Toward lowering morbidity, mortality, and stoma formation in emergency colorectal surgery: the role of specialization. Dis Colon Rectum 46(11):1461–1467. doi:10.1097/01.DCR.0000095228.91284.AE, discussion 1467–1468

    Article  PubMed  Google Scholar 

  18. Hermanek P Jr, Wiebelt H, Riedl S, Staimmer D, Hermanek P (1994) Long-term results of surgical therapy of colon cancer. Results of the Colorectal Cancer Study Group. Chirurg 65(4):287–297

    PubMed  Google Scholar 

  19. Gunnarsson H, Jennische K, Forssell S, Granstrom J, Jestin P, Ekholm A, Olsson LI (2014) Heterogeneity of colon cancer patients reported as emergencies. World J Surg 38(7):1819–1826. doi:10.1007/s00268-014-2449-7

    Article  CAS  PubMed  Google Scholar 

  20. van der Sluis FJ, Espin E, Vallribera F, de Bock GH, Hoekstra HJ, van Leeuwen BL, Engel AF (2014) Predicting postoperative mortality after colorectal surgery: a novel clinical model. Colorectal Dis 16(8):631–639. doi:10.1111/codi.12580

    Article  PubMed  Google Scholar 

  21. Burton S, Norman AR, Brown G, Abulafi AM, Swift RI (2006) Predictive poor prognostic factors in colonic carcinoma. Surg Oncol 15(2):71–78. doi:10.1016/j.suronc.2006.08.003

    Article  CAS  PubMed  Google Scholar 

  22. Ambrosetti P, Gervaz P, Fossung-Wiblishauser A (2012) Sigmoid diverticulitis in 2011: many questions; few answers. Colorectal Dis 14(8):e439–e446. doi:10.1111/j.1463-1318.2012.03026.x

    Article  CAS  PubMed  Google Scholar 

  23. McDermott FD, Collins D, Heeney A, Winter DC (2014) Minimally invasive and surgical management strategies tailored to the severity of acute diverticulitis. Br J Surg 101(1):e90–e99. doi:10.1002/bjs.9359

    Article  CAS  PubMed  Google Scholar 

  24. Afshar S, Kurer MA (2012) Laparoscopic peritoneal lavage for perforated sigmoid diverticulitis. Colorectal Dis 14(2):135–142. doi:10.1111/j.1463-1318.2011.02606.x

    Article  CAS  PubMed  Google Scholar 

  25. Runkel NS, Hinz U, Lehnert T, Buhr HJ, Herfarth C (1998) Improved outcome after emergency surgery for cancer of the large intestine. Br J Surg 85(9):1260–1265

    Article  CAS  PubMed  Google Scholar 

  26. Poon RT, Law WL, Chu KW, Wong J (1998) Emergency resection and primary anastomosis for left-sided obstructing colorectal carcinoma in the elderly. Br J Surg 85(11):1539–1542. doi:10.1046/j.1365-2168.1998.00903.x

    Article  CAS  PubMed  Google Scholar 

  27. Schrock TR, Deveney CW, Dunphy JE (1973) Factor contributing to leakage of colonic anastomoses. Ann Surg 177(5):513–518

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Krarup PM, Jorgensen LN, Harling H (2014) Management of anastomotic leakage in a nationwide cohort of colonic cancer patients. J Am Coll Surg 218(5):940–949. doi:10.1016/j.jamcollsurg.2014.01.051

    Article  PubMed  Google Scholar 

  29. Runkel NS, Schlag P, Schwarz V, Herfarth C (1991) Outcome after emergency surgery for cancer of the large intestine. Br J Surg 78(2):183–188

    Article  CAS  PubMed  Google Scholar 

  30. Sperling D, Spratt JS Jr, Carnes VM (1963) Adenocarcinoma of the Large Intestine with Perforation. Mo Med 60:1104–1107

    CAS  PubMed  Google Scholar 

  31. Miller LD, Boruchow IB, Fitts WT Jr (1966) An analysis of 284 patients with perforative carcinoma of the colon. Surg Gynecol Obstet 123(6):1212–1218

    CAS  PubMed  Google Scholar 

  32. Peloquin AB (1975) Factors influencing survival with complete obstruction and free perforation of colorectal cancers. Dis Colon Rectum 18(1):11–21

    Article  CAS  PubMed  Google Scholar 

  33. 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 

  34. Koperna T, Kisser M, Schulz F (1997) Emergency surgery for colon cancer in the aged. Arch Surg 132(9):1032–1037

    Article  CAS  PubMed  Google Scholar 

  35. Osler M, Iversen LH, Borglykke A, Martensson S, Daugbjerg S, Harling H, Jorgensen T, Frederiksen B (2011) Hospital variation in 30-day mortality after colorectal cancer surgery in denmark: the contribution of hospital volume and patient characteristics. Ann Surg 253(4):733–738. doi:10.1097/SLA.0b013e318207556f

    Article  PubMed  Google Scholar 

  36. Iversen LH (2012) Aspects of survival from colorectal cancer in Denmark. Dan Med J 59(4):B4428

    PubMed  Google Scholar 

  37. Dixon E, Buie WD, Heise CP (2014) What is the preferred surgery for perforated left-sided diverticulitis? J Am Coll Surg 218(3):495–497. doi:10.1016/j.jamcollsurg.2013.12.011

    Article  PubMed  Google Scholar 

  38. Meyer F, Grundmann RT (2011) Hartmann’s procedure for perforated diverticulitis and malignant left-sided colorectal obstruction and perforation. Zentralbl Chir 136(1):25–33. doi:10.1055/s-0030-1262753

    Article  CAS  PubMed  Google Scholar 

  39. Thornell A, Angenete E, Haglind E (2011) Perforated diverticulitis operated at Sahlgrenska University Hospital 2003–2008. Dan Med Bull 58(1):A4173

    PubMed  Google Scholar 

  40. 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. doi:10.1016/j.suronc.2006.09.001

    Article  PubMed  Google Scholar 

  41. Biondo S, Kreisler E, Millan M, Fraccalvieri D, Golda T, Marti Rague J, Salazar R (2008) Differences in patient postoperative and long-term outcomes between obstructive and perforated colonic cancer. Am J Surg 195(4):427–432. doi:10.1016/j.amjsurg.2007.02.027

    Article  PubMed  Google Scholar 

  42. Amri R, Bordeianou LG, Sylla P, Berger DL (2015) Colon cancer surgery following emergency presentation: effects on admission and stage-adjusted outcomes. Am J Surg 209(2):246–253. doi:10.1016/j.amjsurg.2014.07.014

    Article  PubMed  Google Scholar 

  43. McArdle CS, McMillan DC, Hole DJ (2003) Male gender adversely affects survival following surgery for colorectal cancer. Br J Surg 90(6):711–715. doi:10.1002/bjs.4098

    Article  CAS  PubMed  Google Scholar 

  44. Widdison AL, Barnett SW, Betambeau N (2011) The impact of age on outcome after surgery for colorectal adenocarcinoma. Ann R Coll Surg Engl 93(6):445–450. doi:10.1308/003588411X587154

    Article  PubMed Central  CAS  PubMed  Google Scholar 

Download references

Competing interest

The authors declare that they have no conflict of interest.

Statement of human rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

Author information

Authors and Affiliations

  1. Universitätsklinikum Erlangen, Chirurgische Klinik, Krankenhausstraße 12, 91054, Erlangen, Germany

    M. Daniels, S. Merkel & W. Hohenberger

  2. Universitätsklinikum Erlangen, Pathologisches Institut, Krankenhausstraße 8-10, 91054, Erlangen, Germany

    A. Agaimy

Authors
  1. M. Daniels
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Merkel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Agaimy
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. W. Hohenberger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M. Daniels.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Daniels, M., Merkel, S., Agaimy, A. et al. Treatment of perforated colon carcinomas—outcomes of radical surgery. Int J Colorectal Dis 30, 1505–1513 (2015). https://doi.org/10.1007/s00384-015-2336-1

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00384-015-2336-1

Keywords

Search

Navigation