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Colon cancer with perforation

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Abstract

Perforation of the colon is a rare complication for patients with colon cancer and usually requires emergent surgery. The characteristics of perforation differ based on the site of perforation, presenting as either perforation at the cancer site or perforation proximal to the cancer site. Peritonitis due to perforation tends to be more severe in cases of perforation proximal to the cancer site; however, the difference in the outcome between the two types remains unclear. Surgical treatment of colon cancer with perforation has changed over time. Recently, many reports have shown the safety and effectiveness of single-stage operation consisting of resection and primary anastomosis with intraoperative colonic lavage. Under certain conditions, laparoscopic surgery can be feasible and help minimize the invasion. However, emergent surgery for colon cancer with perforation is associated with a high rate of mortality and morbidity. The long-term prognosis seems to have no association with the existence of perforation. Oncologically curative resection may be warranted for perforated colon cancer. In this report, we perform a literature review and investigate the characteristics and surgical strategy for colon cancer with perforation.

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References

  1. Shinkawa H, Yasuhara H, Naka S, Yanagie H, Nojiri T, Furuya Y, et al. Factors affecting the early mortality of patients with nontraumatic colorectal perforation. Surg Today. 2003;33(1):13–7.

    Article  Google Scholar 

  2. Crowder VH Jr, Cohn I Jr. Perforation in cancer of the colon and rectum. Dis Colon Rectum. 1967;10(6):415–20.

    Article  Google Scholar 

  3. Kelley WE Jr, Brown PW, Lawrence W Jr, Terz JJ. Penetrating, obstructing, and perforating carcinomas of the colon and rectum. Arch Surg. 1981;116(4):381–4.

    Article  Google Scholar 

  4. Kriwanek S, Armbruster C, Beckerhinn P, Dittrich K. Prognostic factors for survival in colonic perforation. Int J Colorectal Dis. 1994;9(3):158–62.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  7. Tan KK, Hong CC, Zhang J, Liu JZ, Sim R. Surgery for perforated colorectal malignancy in an Asian population: an institution’s experience over 5 years. Int J Colorectal Dis. 2010;25(8):989–95.

    Article  Google Scholar 

  8. Tan KK, Hong CC, Zhang J, Liu JZ, Sim R. Predictors of outcome following surgery in colonic perforation: an institution’s experience over 6 years. J Gastrointest Surg. 2011;15(2):277–84.

    Article  Google Scholar 

  9. Kyllonen LE. Obstruction and perforation complicating colorectal carcinoma. An epidemiologic and clinical study with special reference to incidence and survival. Acta Chir Scand. 1987;153(10):607–14.

    CAS  PubMed  Google Scholar 

  10. Runkel NS, Schlag P, Schwarz V, Herfarth C. Outcome after emergency surgery for cancer of the large intestine. Br J Surg. 1991;78(2):183–8.

    Article  CAS  Google Scholar 

  11. Kriwanek S, Armbruster C, Dittrich K, Beckerhinn P. Perforated colorectal cancer. Dis Colon Rectum. 1996;39(12):1409–14.

    Article  CAS  Google Scholar 

  12. Tobaruela E, Camunas J, Enriquez-Navascues JM, Diez M, Ratia T, Martin A, et al. Medical factors in the morbidity and mortality associated with emergency colorectal cancer surgery. Rev Esp Enferm Dig. 1997;89(1):13–22.

    CAS  PubMed  Google Scholar 

  13. Umpleby HC, Williamson RC. Survival in acute obstructing colorectal carcinoma. Dis Colon Rectum. 1984;27(5):299–304.

    Article  CAS  Google Scholar 

  14. Bakker IS, Snijders HS, Grossmann I, Karsten TM, Havenga K, Wiggers T. High mortality rates after nonelective colon cancer resection: results of a national audit. Colorectal Dis. 2016;18(6):612–21.

    Article  CAS  Google Scholar 

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

    Article  CAS  Google Scholar 

  16. Anwar MA, D’Souza F, Coulter R, Memon B, Khan IM, Memon MA. Outcome of acutely perforated colorectal cancers: experience of a single district general hospital. Surg Oncol. 2006;15(2):91–6.

    Article  Google Scholar 

  17. Carraro PG, Segala M, Orlotti C, Tiberio G. Outcome of large-bowel perforation in patients with colorectal cancer. Dis Colon Rectum. 1998;41(11):1421–6.

    Article  CAS  Google Scholar 

  18. Khan S, Pawlak SE, Eggenberger JC, Lee CS, Szilagy EJ, Margolin DA. Acute colonic perforation associated with colorectal cancer. Am Surg. 2001;67(3):261–4.

    CAS  PubMed  Google Scholar 

  19. Alvarez JA, Baldonedo RF, Bear IG, Truan N, Pire G, Alvarez P. Presentation, treatment, and multivariate analysis of risk factors for obstructive and perforative colorectal carcinoma. Am J Surg. 2005;190(3):376–82.

    Article  Google Scholar 

  20. Welch JP, Donaldson GA. Perforative carcinoma of colon and rectum. Ann Surg. 1974;180(5):734–40.

    Article  CAS  Google Scholar 

  21. Goligher JC, Smiddy FG. The treatment of acute obstruction or perforation with carcinoma of the colon and rectum. Br J Surg. 1957;45(191):270–4.

    Article  CAS  Google Scholar 

  22. Glenn F, McSherry CK. Obstruction and perforation in colo-rectal cancer. Ann Surg. 1971;173(6):983–92.

    Article  CAS  Google Scholar 

  23. Mealy K, Salman A, Arthur G. Definitive one-stage emergency large bowel surgery. Br J Surg. 1988;75(12):1216–9.

    Article  CAS  Google Scholar 

  24. Fielding LP, Stewart-Brown S, Blesovsky L. Large-bowel obstruction caused by cancer: a prospective study. Br Med J. 1979;2(6189):515–7.

    Article  CAS  Google Scholar 

  25. Buechter KJ, Boustany C, Caillouette R, Cohn I Jr. Surgical management of the acutely obstructed colon. A review of 127 cases. Am J Surg. 1988;156(3 Pt 1):163–8.

    Article  CAS  Google Scholar 

  26. Runkel NS, Hinz U, Lehnert T, Buhr HJ, Herfarth C. Improved outcome after emergency surgery for cancer of the large intestine. Br J Surg. 1998;85(9):1260–5.

    Article  CAS  Google Scholar 

  27. Mulherin JL Jr, Sawyers JL. Evaluation of three methods for managing penetrating colon injuries. J Trauma. 1975;15(7):580–7.

    Article  Google Scholar 

  28. Sasaki LS, Allaben RD, Golwala R, Mittal VK. Primary repair of colon injuries: a prospective randomized study. J Trauma. 1995;39(5):895–901.

    Article  CAS  Google Scholar 

  29. Maddern GJ, Nejjari Y, Dennison A, Siriser F, Bardoxaglou E, Launois B. Primary anastomosis with transverse colostomy as an alternative to Hartmann’s procedure. Br J Surg. 1995;82(2):170–1.

    Article  CAS  Google Scholar 

  30. Wedell J, Banzhaf G, Chaoui R, Fischer R, Reichmann J. Surgical management of complicated colonic diverticulitis. Br J Surg. 1997;84(3):380–3.

    Article  CAS  Google Scholar 

  31. Elliott TB, Yego S, Irvin TT. Five-year audit of the acute complications of diverticular disease. Br J Surg. 1997;84(4):535–9.

    Article  CAS  Google Scholar 

  32. Biondo S, Jaurrieta E, Jorba R, Moreno P, Farran L, Borobia F, et al. Intraoperative colonic lavage and primary anastomosis in peritonitis and obstruction. Br J Surg. 1997;84(2):222–5.

    Article  CAS  Google Scholar 

  33. Zorcolo L, Covotta L, Carlomagno N, Bartolo DC. Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis. 2003;5(3):262–9.

    Article  CAS  Google Scholar 

  34. Gonzalez R, Smith CD, Ritter EM, Mason E, Duncan T, Ramshaw BJ. Laparoscopic palliative surgery for complicated colorectal cancer. Surg Endosc. 2005;19(1):43–6

    Article  CAS  Google Scholar 

  35. Breitenstein S, Kraus A, Hahnloser D, Decurtins M, Clavien PA, Demartines N. Emergency left colon resection for acute perforation: primary anastomosis or Hartmann’s procedure? A case-matched control study. World J Surg. 2007;31(11):2117–24.

    Article  Google Scholar 

  36. Radcliffe AG, Dudley HA. Intraoperative antegrade irrigation of the large intestine. Surg Gynecol Obstet. 1983;156(6):721–3.

    CAS  PubMed  Google Scholar 

  37. Murray JJ. Nonelective colon resection. Alternatives to multistage resections. Surg Clin North Am. 1991;71(6):1187–94.

    Article  CAS  Google Scholar 

  38. Tan SG, Nambiar R, Rauff A, Ngoi SS, Goh HS. Primary resection and anastomosis in obstructed descending colon due to cancer. Arch Surg. 1991;126(6):748–51.

    Article  CAS  Google Scholar 

  39. Arnaud JP, Bergamaschi R. Emergency subtotal/total colectomy with anastomosis for acutely obstructed carcinoma of the left colon. Dis Colon Rectum. 1994;37(7):685–8.

    Article  CAS  Google Scholar 

  40. Deans GT, Krukowski ZH, Irwin ST. Malignant obstruction of the left colon. Br J Surg. 1994;81(9):1270–6.

    Article  CAS  Google Scholar 

  41. Duraker N, Bender O, Memisoglu K, Yalciner A. Intraoperative bowel irrigation improves anastomotic collagen metabolism in the left-sided colonic obstruction but not covering colostomy. Int J Colorectal Dis. 1998;13(5–6):232–4.

    Article  CAS  Google Scholar 

  42. Park UC, Chung SS, Kim KR, Seong MK, Yoon WH, Kim YJ, et al. Single-stage procedure with intraoperative colonoscopy and colonic irrigation in patients with obstructing left-sided colonic cancer. Int J Colorectal Dis. 2004;19(5):487–92.

    Article  Google Scholar 

  43. Kim J, Lee GJ, Baek JH, Lee WS. Comparison of the surgical outcomes of laparoscopic versus open surgery for colon perforation during colonoscopy. Ann Surg Treat Res. 2014;87(3):139–43.

    Article  Google Scholar 

  44. Lee IK, Sung NY, Lee YS, Lee SC, Kang WK, Cho HM, et al. The survival rate and prognostic factors in 26 perforated colorectal cancer patients. Int J Colorectal Dis. 2007;22(5):467–73.

    Article  Google Scholar 

  45. Zhong W, Qiu C, Liu C, Fang C, Xia L, Liang J, et al. Efficacy of Laparoscopic Primary Repair in the Treatment of Colonic Perforation After Colonoscopy: A Review of 40,127 Patients. Surg Laparosc Endosc Percutan Tech. 2016;26(6):e105-e108.

    PubMed  Google Scholar 

  46. Coimbra C, Bouffioux L, Kohnen L, Deroover A, Dresse D, Denoel A, et al. Laparoscopic repair of colonoscopic perforation: a new standard? Surg Endosc. 2011;25(5):1514–7.

    Article  Google Scholar 

  47. Anania G, Vedana L, Santini M, Scagliarini L, Giaccari S, Resta G, et al. Complications of diverticular disease: surgical laparoscopic treatment. G Chir. 2014;35(5–6):126–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  48. De Magistris L, Azagra JS, Goergen M, De Blasi V, Arru L, Facy O. Laparoscopic sigmoidectomy in moderate and severe diverticulitis: analysis of short-term outcomes in a continuous series of 121 patients. Surg Endosc. 2013;27(5):1766–71.

    Article  Google Scholar 

  49. Vennix S, Boersema GS, Buskens CJ, Menon AG, Tanis PJ, Lange JF, et al. Emergency laparoscopic sigmoidectomy for perforated diverticulitis with generalised peritonitis: a systematic review. Dig Surg. 2016;33(1):1–7.

    Article  Google Scholar 

  50. Vennix S, Lips DJ, Di Saverio S, van Wagensveld BA, Brokelman WJ, Gerhards MF, et al. Acute laparoscopic and open sigmoidectomy for perforated diverticulitis: a propensity score-matched cohort. Surg Endosc. 2016;30(9):3889–96.

    Article  Google Scholar 

  51. Biondo S, Kreisler E, Millan M, Fraccalvieri D, Golda T, Marti Rague J, et al. Differences in patient postoperative and long-term outcomes between obstructive and perforated colonic cancer. Am J Surg. 2008;195(4):427–32

    Article  Google Scholar 

  52. Willett C, Tepper JE, Cohen A, Orlow E, Welch C. Obstructive and perforative colonic carcinoma: patterns of failure. J Clin Oncol. 1985;3(3):379–84.

    Article  CAS  Google Scholar 

  53. Obrand DI, Gordon PH. Incidence and patterns of recurrence following curative resection for colorectal carcinoma. Dis Colon Rectum. 1997;40(1):15–24.

    Article  CAS  Google Scholar 

  54. Asano H, Kojima K, Ogino N, Fukano H, Ohara Y, Shinozuka N. Postoperative recurrence and risk factors of colorectal cancer perforation. Int J Colorectal Dis. 2017;32(3):419–24.

    Article  Google Scholar 

  55. Steinberg SM, Barkin JS, Kaplan RS, Stablein DM. Prognostic indicators of colon tumors. The Gastrointestinal Tumor Study Group experience. Cancer. 1986;57(9):1866–70.

    Article  CAS  Google Scholar 

  56. Daniels M, Merkel S, Agaimy A, Hohenberger W. Treatment of perforated colon carcinomas—outcomes of radical surgery. Int J Colorectal Dis. 2015;30(11):1505–13.

    Article  CAS  Google Scholar 

  57. Griffin MR, Bergstralh EJ, Coffey RJ, Beart RW Jr, Melton LJ. Predictors of survival after curative resection of carcinoma of the colon and rectum. Cancer. 1987;60(9):2318–24

    Article  CAS  Google Scholar 

  58. 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(8):775–80.

    Article  CAS  Google Scholar 

  59. Cheynel N, Cortet M, Lepage C, Ortega-Debalon P, Faivre J, Bouvier AM. Incidence, patterns of failure, and prognosis of perforated colorectal cancers in a well-defined population. Dis Colon Rectum. 2009;52(3):406–11.

    Article  Google Scholar 

  60. Biondo S, Ramos E, Deiros M, Rague JM, De Oca J, Moreno P, et al. Prognostic factors for mortality in left colonic peritonitis: a new scoring system. J Am Coll Surg. 2000;191(6):635–42.

    Article  CAS  Google Scholar 

  61. Zielinski MD, Merchea A, Heller SF, You YN. Emergency management of perforated colon cancers: how aggressive should we be? J Gastrointest Surg. 2011;15(12):2232–8.

    Article  Google Scholar 

  62. Benson AB, Schrag D, Somerfield MR, Cohen AM, Figueredo AT, Flynn PJ, et al. American Society of Clinical Oncology recommendations on adjuvant chemotherapy for stage II colon cancer. J Clin Oncol. 2004;22(16):3408–19.

    Article  Google Scholar 

  63. Chen TM, Huang YT, Wang GC. Outcome of colon cancer initially presenting as colon perforation and obstruction. World J Surg Oncol. 2017;15(1):164.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Surgical Oncology, The University of Tokyo, Hongo 7-3-1, Bunkyo-ku, Tokyo, 113–8655, Japan

    Kensuke Otani, Kazushige Kawai, Keisuke Hata, Toshiaki Tanaka, Takeshi Nishikawa, Kazuhito Sasaki, Manabu Kaneko, Koji Murono, Shigenobu Emoto & Hiroaki Nozawa

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  1. Kensuke Otani
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  2. Kazushige Kawai
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Correspondence to Kensuke Otani.

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Otani, K., Kawai, K., Hata, K. et al. Colon cancer with perforation. Surg Today 49, 15–20 (2019). https://doi.org/10.1007/s00595-018-1661-8

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