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.
OBJECTIVE
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.


CONCLUSIONS
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.
Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan.
Hiroshi
H
Sawayama
Shinjiro
S
Tomiyasu
Kiichiro
K
Kanemitsu
Takatsugu
T
Matsumoto
Hideyuki
H
Tanaka
Hideo
H
Baba
D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods; D003106:Colon / Q000473:pathology / Q000601:surgery*; D015179:Colorectal Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007416:Intestinal Perforation / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality; D009367:Neoplasm Staging; D063305:Organ Dysfunction Scores; D018579:Patient Selection; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D016896:Treatment Outcome