The survival rate and prognostic factors in 26 perforated colorectal cancer patients.
OBJECTIVE
The treatment for perforated colorectal cancer is not easy and the prognosis for this disease is not so predictable. There are some controversies about performing radical operations because colorectal cancer perforation was considered as an advanced stage disease due to the possibility of tumor cell dissemination through the perforation site.


METHODS
We selected and enrolled 26 patients with perforated colorectal cancers among the 1,227 patients who underwent operation for colorectal cancer. These cases were retrospectively analyzed by using their medical records and clinicopathological data.


RESULTS
Twenty-eight cases (2.3%) with perforated colorectal cancers were studied and the overall operative mortality rate was 11%. The overall 5-year survival rate was 57.8% when excluding the operative mortality. The overall 5-year cancer-free survival rate was 52.8%. There were significant differences in the survival rate and the cancer-free survival rate between the stages (p=0.008 and p<0.001, respectively). A univariate analysis of the prognostic factors revealed that the number of the metastatic lymph nodes (p=0.018) and the perforation proximal to the cancer (p=0.005) were significantly correlated to worse survival, and the higher number of the metastatic lymph nodes was correlated to a poorer cancer-free survival rate (p<0.001).


CONCLUSIONS
For the perforated colorectal cancers, the stage, the perforation proximal to the cancer, and the number of the metastatic lymph nodes were correlated, with the survival and the cancer-free survival as factors of a poor prognosis. The surgical approach selected for perforated colorectal cancer should be in line with the principles of an appropriate cancer operation because the clinical pathway of perforated colorectal cancer is similar to that of uncomplicated colorectal cancer.
Lee
In Kyu
IK
Department of Surgery, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, #62 Youido-dong, Yeongdeungpo-gu, Seoul 150-713, South Korea. cmcgslee@catholic.ac.kr
Sung
Na Young
NY
Lee
Yoon Suk
YS
Lee
Sang Chul
SC
Kang
Won Kyung
WK
Cho
Hyeon Min
HM
Ahn
Chang Hyeok
CH
Lee
Do Sang
DS
Oh
Seong Taek
ST
Kim
Jun-Gi
JG
Jeon
Hae Myung
HM
Chang
Suk Kyun
SK
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality* / Q000601:surgery; D007723:Korea / Q000453:epidemiology; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate