Journal of Gastrointestinal Surgery

, Volume 15, Issue 12, pp 2232–2238

Emergency Management of Perforated Colon Cancers: How Aggressive Should We Be?

  • Martin D. Zielinski
  • Amit Merchea
  • Stephanie F. Heller
  • Y. Nancy You
Original Article



Emergency treatment of perforated colon cancer has traditionally been linked with dismal outcomes due to the double jeopardy of a septic insult combined with a malignant disease, leaving unclear how aggressive emergency surgical procedures should be. We aimed to define short- and long-term outcomes in the current era of critical care support and oncologic advances, to provide updated data for decision making.

Study Design

Patients with perforations associated with a primary colon cancer were identified. Peri-operative and long-term survival were compared among free (FP; n = 41) and contained perforations (CP; n = 45) and to age-, stage-, and resection status case-matched, non-perforated (NP; n = 85), controls.


Tumors were completely resected in 67% of FP but fewer lymph nodes were harvested (median, 11 vs. 11 and 16 in CP and NP; p = 0.21 and p < 0.001). Peri-operative mortality was highest in FP: 19% vs. 0% and 5% in CP and NP (p = 0.038), respectively. After adjusting for peri-operative mortality, 5-year overall survival was comparable: 55%, 59%, and 54% for FP, CP, and NP, respectively. Advanced age, higher ASA class, presence of residual disease, and advanced stage, but not perforation, were independent predictors of poorer long-term overall survival.


Patients with malignant colonic perforation face high risk of peri-operative death, making septic source control the priority in the acute setting. Pursuit of an oncologically oriented resection and long-term cancer-directed treatments, however, may lead to improved long-term outcomes.


Complicated colon cancer Peforated viscous Long-term outcomes Septic shock Intensive care 


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Copyright information

© The Society for Surgery of the Alimentary Tract 2011

Authors and Affiliations

  • Martin D. Zielinski
    • 1
    • 2
  • Amit Merchea
    • 1
  • Stephanie F. Heller
    • 1
  • Y. Nancy You
    • 1
  1. 1.Department of SurgeryMayo ClinicRochesterUSA
  2. 2.Division of Trauma, Critical Care and General Surgery, Mary Brigh 2-810St. Mary’s Hospital, Mayo ClinicRochesterUSA

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