Skip to main content
SpringerLink
Log in

The effect of inadvertent intraoperative perforation on survival and recurrence in colorectal cancer

  • Published:
Diseases of the Colon & Rectum

Abstract

Inadvertent perforation of the bowel during curative resection for colorectal cancer has serious consequences. In 174 curative resections with spillage, five-year survival was 29 per cent. In 67 patients where the cancer itself was disrupted during dissection, five-year surival fell to 14 per cent in the colon and to 9.3 per cent in the rectum. Local recurrence developed in 65 per cent of spillage cases. In Dukes' C tumors that were perforated during surgery, local recurrence occurred in 87 per cent. As surgeons, our efforts must be directed toward preventing injury to the bowel during definitive resection of colorectal cancers. The instillation of tumoricidal solutions within the bowel lumen and the application of bowel ligatures prior to dissection may help toward preventing recurrence, should inadvertent perforation and spillage occur.

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

Similar content being viewed by others

References

  1. Lack HL. A contribution to the operative treatment of malignant disease of the larynx, with special reference to the danger of cancerous wound infection. Lancet 1896;1:1638–41.

    Google Scholar 

  2. Ryall C. Cancer infection and cancer recurrence: a danger to avoid in cancer operations. Lancet 1907;2:1311–6.

    Article  Google Scholar 

  3. Ryall C. Technique of cancer operations, with reference to the danger of cancer infection. Br Med J 1908;2:1005–8.

    Google Scholar 

  4. Mayo WJ. Gralting and traumatic dissemination of carcinoma in the course of operations for malignant disease. JAMA 1913;60:512–3.

    Google Scholar 

  5. Saphir O. The transfer of tumor cells by the surgical knife. Surg Gynecol Obstet 1936;63:775–6.

    Google Scholar 

  6. Brandes WW, White WC, Sutton JE. Accidental transplantation of cancer in the operating room. Surg Gynecol Obstet 1946;82:212–4.

    Google Scholar 

  7. Keynes WM. Implantation from the bowel lumen in cancer of the large intestine. Ann Surg 1961;153:357–64.

    Article  PubMed  CAS  Google Scholar 

  8. Cohn I Jr. Control of tumor spread during gastrointestinal, operations. Surg Clin North Am 1969;49:621–5.

    PubMed  Google Scholar 

  9. Cohn I Jr. Implantation of cancer of the colon. Surg Gynecol Obstet 1967;124:501–8.

    PubMed  Google Scholar 

  10. LeQuesne LP, Thomson AD. Implantation recurrence of carcinoma of rectum and colon. N Engl J Med 1958;258:578–82.

    Article  CAS  Google Scholar 

  11. McGrew EA, Laws JF, Cole WH. Free malignant cells in relation to recurrence of carcinoma of the colon. JAMA 1954;154:1251–4.

    CAS  Google Scholar 

  12. Manson PN, Corman ML, Coller JA, Veidenheimer MC. Anastomotic recurrence after anterior resection for carcinoma: Lahey Clinic experience. Dis Colon Rectum 1976;19:219–24.

    PubMed  CAS  Google Scholar 

  13. Pihl E, Hughes ESR, McDermott FT, Price AB. Recurrence of carcinoma of the colon and rectum at the anastomotic suture line. Surg Gynecol Obstet 1981;153:495–6.

    PubMed  CAS  Google Scholar 

  14. Pomeranz A, Garlock JH. Postoperative recurrence of cancer of colon due to desquamated malignant cells. JAMA 1955;158:1434–6.

    CAS  Google Scholar 

  15. Slanetz CA Jr. In preparation.

  16. Atik M, Massri F, Cohn I Jr. The influence of clorpactin XCB on the spread of tumors of the colon. Surg Forum 1960;11:76–7.

    PubMed  CAS  Google Scholar 

  17. Bacon HE. Cancer of the colon, rectum and anal canal. Philadelphia: JB Lippincott, 1964:539–43.

    Google Scholar 

  18. Cohn I Jr, Gonzales EA Jr, Floyd CE, Freeman CM, Atik M. Influence of nitrogen mustard on tumor implantation. JAMA 1963;185:575–7.

    PubMed  CAS  Google Scholar 

  19. Gubareff N, Suntzeff V. Preliminary report on application of iodine in prevention of surgical dissemination of viable malignant cells. J Surg Res 1962;2:144–5.

    Article  PubMed  CAS  Google Scholar 

  20. Smith RR, Thomas LB, Hilberg AW. Cancer cell contamination of operative wounds. Cancer 1958;11:53–62.

    Article  PubMed  CAS  Google Scholar 

  21. Weilbaecher DA, Holton DB, Cohn I Jr. The influence of iodine on peritoneal implantation of tumors. J Surg Res 1965;5:249–51.

    Article  PubMed  CAS  Google Scholar 

  22. Douglass HO Jr, LeVeen HH. Tumor recurrence in colon anastomoses: prevention by coagulation and fixation with formalin. Ann Surg 1971;173:201–5.

    Article  PubMed  Google Scholar 

  23. Haverback CZ, Smith RR. Transplantation of tumor by suture thread and its prevention: an experimental study. Cancer 1959;12:1029–42.

    Article  PubMed  CAS  Google Scholar 

  24. Morgan CN, Lloyd-Davies OV. Section of surgery: discussion on conservative resection in carcinoma of rectum. Proc R Soc Med 1950;43:701–10.

    Google Scholar 

  25. Cole WH. Recurrence in carcinoma of the colon and proximal rectum following resection for carcinoma. Arch Surg 1952;65:264–70.

    CAS  Google Scholar 

  26. Slanetz CA Jr. Effects of surgical technique on survival and recurrence in colorectal cancer (In press).

  27. Yu SK, Cohn I Jr. Tumor implantation on colon mucosa. Arch Surg 1968;96:956–8.

    PubMed  CAS  Google Scholar 

  28. Mathieu FJ, Floyd CE, Cohn I Jr. Closed colon anastomosis for control of tumor spread. Am Surg 1966;32:5–8.

    PubMed  CAS  Google Scholar 

  29. Cohn I Jr, Corley RG, Floyd CE. Iodized suture for control of tumor implantation in a colon anastomosis. Surg Gynecol Obstet 1963;116:366–70.

    PubMed  Google Scholar 

  30. DiVincente FC, Cohn I Jr. The role of suture material on tumor implantation. JAMA 1965;191:107–9.

    Google Scholar 

  31. Gubareff N, Suntzeff V. Iodized catgut and its possible application in the control of tumor implantation following cancer operations. Missouri Med 1965;62:372–3.

    Google Scholar 

  32. Keller JW, Kelley HJ, Kinsey DL. Efficiency of iodized suture in prevention of suture transferral of malignant tumors. Cancer 1966;19:549–51.

    Article  PubMed  CAS  Google Scholar 

  33. Phalkornkul C, Pezzutti JE, Tassoni EM, Bacon HE. Experimental study using iodized suture material to prevent implantation of tumor cells in a colon anastomosis: preliminary report. Dis Colon Rectum 1964;7:513–17.

    Google Scholar 

  34. Herter FP, Sbuelz B. Inhibition of tumor growth by iodized catgut. J Surg Res 1966;6:393–6.

    Article  PubMed  CAS  Google Scholar 

  35. Vink M. Local recurrence of cancer in the large bowel: the role of implantation metastases and bowel disinfection. Br J Surg 1953; 41:431–3.

    Google Scholar 

  36. Cohn I Jr, Atik M. The influence of antibiotics on the spread of tumors of the colon: an experimental study. Ann Surg 1960;151:917–29.

    PubMed  CAS  Google Scholar 

  37. Herter FP, Slanetz CA Jr. Preoperative intestinal preparation in relation to the subsequent development of cancer at the suture line. Surg Gynecol Obstet 1968;127:49–56.

    PubMed  CAS  Google Scholar 

  38. Slanetz CA Jr. Postoperative mortality and morbidity in the surgical resection of colorectal cancer. In preparation.

  39. Ranbarger KR, Johnston WD, Chang JC. Prognostic significance of surgical perforation of the rectum during abdominoperineal resection for rectal carcinoma. Am J Surg 1982;143:186–8.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, College of Physicians and Surgeons, Columbia Presbyterian Medical Center, New York, New York

    Charles A. Slanetz Jr. M.D.

Authors
  1. Charles A. Slanetz Jr. M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Slanetz, C.A. The effect of inadvertent intraoperative perforation on survival and recurrence in colorectal cancer. Dis Colon Rectum 27, 792–797 (1984). https://doi.org/10.1007/BF02553942

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02553942

Key words

Search

Navigation