Skip to main content

Advertisement

SpringerLink
Log in

Colonic perforation due to colorectal cancer: predicting postoperative organ failure with a preoperative scoring system and selecting the optimal surgical method based on the prognosis

  • Original Article
  • Published:
Surgery Today Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to predict the postoperative organ derangement before surgery and to select the optimal surgical methods for a perforation due to colorectal cancer.

Methods

The Mannheim Peritonitis Index (MPI) was used to determine the preoperative status and Sequential Organ Failure Assessment (SOFA) score for postoperative status, retrospectively.

Results

There were 25 cases of colorectal cancer-related colon perforation. These patients were classified as having a preoperative MPI ≤ 29 or ≥ 30 and the mean postoperative SOFA scores were 2.30 ± 2.45 and 7.93 ± 3.45 (p = 0.0002), respectively. Seven of 20 patients who underwent tumor resection received a bowel anastomosis without a stoma. The MPI of these seven patients was low (23.1 ± 7.47) and there were no severe postoperative organ disorders (SOFA score 1.86 ± 2.26). Eighteen of the 25 patients had no distant metastasis. Eight of these 18 patients underwent lymph node (LN) dissection, including intermediate LNs, while the other 10 cases only had the pericolic/perirectal LNs dissected. The average preoperative MPI was 23.9 ± 7.68 and 32.8 ± 5.77, and the postoperative SOFA scores were 3.75 ± 3.01 and 7.10 ± 5.34, respectively.

Conclusion

The MPI could be used to predict postoperative organ disorders and thus represents a useful index that can be used to determine the optimal surgical methods.

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
Fig. 2

Similar content being viewed by others

References

  1. Omori H, Hatamochi A, Koike M, Sato Y, Kosho T, Kitakado Y, et al. Sigmoid colon perforation induced by the vascular type of Ehlers–Danlos syndrome: report of a case. Surg Today. 2011;41:733–6.

    Article  PubMed  Google Scholar 

  2. Nespoli A, Ravizzini C, Trivella M, Segala M. The choice of surgical procedure for peritonitis due to colonic perforation. Arch Surg. 1993;128:814–8.

    Article  PubMed  CAS  Google Scholar 

  3. Mandava N, Kumar S, Pizzi WF, Aprile IJ. Perforated colorectal carcinomas. Am J Surg. 1996;172:236–8.

    Article  PubMed  CAS  Google Scholar 

  4. Chen HS, Sheen-Chen SM. Obstruction and perforation in colorectal adenocarcinoma: an analysis of prognosis and current trends. Surgery. 2000;127:370–6.

    Article  PubMed  CAS  Google Scholar 

  5. Bielecki K, Kaminski P, Klukowski M. Large bowel perforation: morbidity and mortality. Tech Coloproctol. 2002;6:177–82.

    Article  PubMed  CAS  Google Scholar 

  6. Carraro PG, Segala M, Orlotti C, Tiberio G. Outcome of large-bowel perforation in patients with colorectal cancer. Dis Colon Rectum. 1998;41:1421–6.

    Article  PubMed  CAS  Google Scholar 

  7. Khan S, Pawlak SE, Eggenberger JC, Lee CS, Szilagy EJ, Margolin DA. Acute colonic perforation associated with colorectal cancer. Am Surg. 2001;67:261–4.

    PubMed  CAS  Google Scholar 

  8. Pisanu A, Cois A, Uccheddu A. Surgical treatment of perforated diverticular disease: evaluation of factors predicting prognosis in the elderly. Int Surg. 2004;89:35–8.

    PubMed  Google Scholar 

  9. Komatsu S, Shimomatsuya T, Nakajima M, Amaya H, Kobuchi T, Shiraishi S, et al. Prognostic factors and scoring system for survival in colonic perforation. Hepatogastroenterology. 2005;52:761–4.

    PubMed  Google Scholar 

  10. Horiuchi A, Watanabe Y, Doi T, Sato K, Yukumi S, Yoshida M, et al. Evaluation of prognostic factors and scoring system in colonic perforation. World J Gastroenterol. 2007;13:3228–3231.

    Google Scholar 

  11. Gooszen AW, Tollenaar RA, Geelkerken RH, Smeets HJ, Bemelman WA, Van Schaardenburgh P, et al. Prospective study of primary anastomosis following sigmoid resection for suspected acute complicated diverticular disease. Br J Surg. 2001;88:693–7.

    Article  PubMed  CAS  Google Scholar 

  12. Linder MM, Wacha H, Feldmann U, Wesch G, Streifensand RA, Gundlach E. The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis. Chirurg. 1987;58:84–92.

    PubMed  CAS  Google Scholar 

  13. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13:818–29.

    Article  PubMed  CAS  Google Scholar 

  14. Copeland GP, Jones D, Walters M. POSSUM: a scoring system for surgical audit. Br J Surg. 1991;78:355–60.

    Article  PubMed  CAS  Google Scholar 

  15. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonca A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med. 1996;22:707–10.

    Article  PubMed  CAS  Google Scholar 

  16. Vincent JL, de Mendonca A, Cantraine F, Moreno R, Takala J, Suter PM, et al. Use of the SOFA score to assess the incidence of organ dysfunction/failure in intensive care units: results of a multicenter, prospective study. Working group on “sepsis-related problems” of the European Society of Intensive Care Medicine. Crit Care Med. 1998;26:1793–800.

    Article  PubMed  CAS  Google Scholar 

  17. Strand K, Flaatten H. Severity scoring in the ICU: a review. Acta Anaesthesiol Scand. 2008;52:467–78.

    Article  PubMed  CAS  Google Scholar 

  18. Demmel N, Muth G, Maag K, Osterholzer G. Prognostic scores in peritonitis: the Mannheim Peritonitis Index or APACHE II? Langenbecks Arch Chir. 1994;379:347–52.

    PubMed  CAS  Google Scholar 

  19. Pacelli F, Doglietto GB, Alfieri S, Piccioni E, Sgadari A, Gui D, et al. Prognosis in intra-abdominal infections. Multivariate analysis on 604 patients. Arch Surg. 1996;131:641–5.

    Article  PubMed  CAS  Google Scholar 

  20. Japanese Classification of Colorectal Carcinoma. Second English Edition. Tokyo: Kanehara & Co, Ltd.; 2009.

    Google Scholar 

  21. Komatsu S, Shimomatsuya T, Nakajima M, Ono S, Maruhashi K. Severity scoring systems for prognosis and efficacy of polymyxin B-immobilized fiber treatment for colonic perforation. Surg Today. 2006;36:807–10.

    Article  PubMed  CAS  Google Scholar 

  22. Ermolov AS, Bagdat’ev VE, Chudotvortseva EV, Rozhnov AV. Evaluation of the Mannheim Peritonitis Index. Vestn Khir Im I I Grek. 1996;155:22–3.

    PubMed  CAS  Google Scholar 

  23. Law WL, Choi HK, Lee YM, Ho JW, Seto CL. Anastomotic leakage is associated with poor long-term outcome in patients after curative colorectal resection for malignancy. J Gastrointest Surg. 2007;11:8–15.

    Article  PubMed  Google Scholar 

  24. Bell SW, Walker KG, Rickard MJ, Sinclair G, Dent OF, Chapuis PH, et al. Anastomotic leakage after curative anterior resection results in a higher prevalence of local recurrence. Br J Surg. 2003;90:1261–6.

    Article  PubMed  CAS  Google Scholar 

  25. Fujita S, Teramoto T, Watanabe M, Kodaira S, Kitajima M. Anastomotic leakage after colorectal cancer surgery: a risk factor for recurrence and poor prognosis. Jpn J Clin Oncol. 1993;23:299–302.

    PubMed  CAS  Google Scholar 

  26. Umpleby HC, Fermor B, Symes MO, Williamson RC. Viability of exfoliated colorectal carcinoma cells. Br J Surg. 1984;71:659–63.

    Article  PubMed  CAS  Google Scholar 

  27. Skipper D, Cooper AJ, Marston JE, Taylor I. Exfoliated cells and in vitro growth in colorectal cancer. Br J Surg. 1987;74:1049–52.

    Article  PubMed  CAS  Google Scholar 

  28. Balkwill F, Mantovani A. Inflammation and cancer: back to Virchow? Lancet. 2001;357:539–45.

    Article  PubMed  CAS  Google Scholar 

  29. Abdelrazeq AS, Scott N, Thorn C, Verbeke CS, Ambrose NS, Botterill ID, et al. The impact of spontaneous tumour perforation on outcome following colon cancer surgery. Colorectal Dis. 2008;10:775–80.

    Article  PubMed  CAS  Google Scholar 

  30. Charbonnet P, Gervaz P, Andres A, Bucher P, Konrad B, Morel P. Results of emergency Hartmann’s operation for obstructive or perforated left-sided colorectal cancer. World J Surg Oncol. 2008;6:90.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors are grateful to Drs. Seiji Mita, Yuji Yamaguchi, Kotaro Inoue, Kenichiro Yamamoto, Hironobu Shigaki, and Kensuke Yamamura for their valuable clinical advice. The authors are also grateful to Dr. Takihiro Kamio for the pathological diagnosis. There is no grant support for the research reported.

Conflict of interest

No author has any conflict of interest.

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan

    Hiroshi Sawayama & Hideo Baba

  2. Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Kumamoto, 861-4193, Japan

    Hiroshi Sawayama, Shinjiro Tomiyasu, Kiichiro Kanemitsu, Takatsugu Matsumoto & Hideyuki Tanaka

  3. Department of Emergency, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Kumamoto, 861-4193, Japan

    Takatsugu Matsumoto

Authors
  1. Hiroshi Sawayama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shinjiro Tomiyasu
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kiichiro Kanemitsu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Takatsugu Matsumoto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hideyuki Tanaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Hideo Baba
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hideo Baba.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sawayama, H., Tomiyasu, S., Kanemitsu, K. et al. Colonic perforation due to colorectal cancer: predicting postoperative organ failure with a preoperative scoring system and selecting the optimal surgical method based on the prognosis. Surg Today 42, 1082–1087 (2012). https://doi.org/10.1007/s00595-012-0220-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00595-012-0220-y

Keywords

Search

Navigation