Perforation associated with colorectal cancer

We studied 13 patients who underwent surgery for perforation associated with colorectal cancer in our institute. In 10 cases, the location of primary cancer was the rectum or the sigmoid colon. Five patients had perforation at the tumor itself, and 7 proximal to the obstructive tumor. The perforation proximal to the tumor was in a location that caused obstructive colitis in 4 cases, the diverticulum in 2 cases, and a location of unknown cause in 1 case. In all of the cases of perforation at the tumor there was locally advanced cancer that had invaded other organs or had peritoneal dissemination. In 1 case where perforation had caused obstructive colitis, the primary tumor was in the sigmoid colon, whilst the perforation was in the cecum. Twelve patients had resection of primary tumor and the perforated site, and one had palliative ileostomy. Five patients had stage II cancer, 3 stage IIIa, 1 stage IIIb, and 4 stage IV. Mortality at 30 days was 15.4% (n=2). Of those who survived more than 30 days, 9(81.8%) had curative resection. Of these 9 cases, 2(22.2%) died of cancer, 1 died as a result of re-perforation and 1 died from another cause. Six patients survived for more than 2 years, 3 of which had recurrence, and 2 survived without recurrence. Our surgical plan for perforated colorectal cancer is to remove the perforation site and the cancer itself. In conclusion, long-term survival required both aggressive management of the sepsis focus and definitive oncologic surgery.