Perforated colorectal cancer: Postoperative short-term outcomes and factors influencing influencing the results
Haluk Recai Ünalp1, Erdinç Kamer1, Hayrullah Derici2, Kemal Atahan3, Ali Doğan Bozdağ2, Ercüment Tarcan3, Mehmet Ali Önal1
1İzmir Atatürk Eğitim ve Araştırma Hastanesi 4. Genel Cerrahi Kliniği, İZMİR
2İzmir Atatürk Eğitim ve Araştırma Hastanesi 3. Genel Cerrahi Kliniği, İZMİR
3İzmir Atatürk Eğitim ve Araştırma Hastanesi 1. Genel Cerrahi Kliniği, İZMİR
Purpose: The aim of the current study was to evaluate various factors influencing the postoperative outcomes in patients with perforated colorectal cancer.
Materials and Methods: Variables including age, sex, laboratory results, tumor localizations, site of perforation, presence of peritonitis, obstruction, metastasis or peritoneal seeding, stage of tumour, type of surgery, blood transfusions and Mannheim peritonitis index were analysed for their influence on the postoperative outcomes in 46 patients with perforated colorectal cancer, retrospectively.
Results: Of the 46 patients 22 were female and 24 were male. The mean age of the patients was 57.4 years. Thirty-six patients had perforation at the tumour. The peritonitis was localised in 36 patients. Seventeen patients had primary resection and anastomosis, 27 patients had resection with colostomy/ileostomy. Two patients had no tumour resection. The postoperative morbidity and mortality rates were 32.6% (n=15) and 19.6% (n=9), respectively. In stepwise multivariate logistic regression analysis, Mannheim peritonitis index >29 (p=0.01) was the only significant predictor of morbidity and, Mannheim peritonitis index>29, ASA>II, presence of diffuse peritonitis and age>60 were significant predictors of postoperative mortality.
Conclusion: Perforation of colorectal cancers is an abdominal emergency with high risk morbidity and mortality. Mannheim peritonitis index is closely related with morbidity. Additionaly, ASA score, advanced age and diffuse peritonitis are the factors that are significantly associated with mortality. Resection of the perforated bowel with tumour is mandatory and this may be followed by primary anastomoses in the case with localised peritonitis.
Keywords: Colorectal cancer, perforation, surgery, mortality, morbidity