An Influence of Perforation on Prognosis of Colorectal Cancer Patients

Kentaro Shirasaka, Kimihiko Funahashi, Junichi Koike, Naoyasu Saito, Hironori Shiokawa, Hideyuki Koshino, Mitunori Ushigome, Akiharu Kurihara, Tomohiko Goto and Tatsuo Teramoto

Division of General and Gastroenterological Surgery, Toho University School of Medicine

Purpose: Due to the lack of a consensus on postoperative follow-up of colorectal cancer with perforation, we retrospectively evaluated clinical cases of this type, including long-term prognosis. Patients and Methods: Subjects were 28 patients with peritonitis due to colorectal cancer occurring in the 2 decades from 1984 to 2004. We examined the clinicopathological background, postoperative recurrence, and prognosis. Results: The male-to-female ratio was 20:8 and mean age was 61.5 years (45-82 years). In 56% of patients, perforation was due to sigmoid colon cancer. Perforation was observed at the oral end of the lesion in 13 patients and at the tumor in 15. Free perforation occurred in 64.3% (18/28). For histological staging, 17 patients were in stage II, 7 in stage III, 3 in stage IV, and 1 unknown. About 60% were in stageII. Of the 28, 22 underwent radical surgery, with 4 of these dying of DIC, while 7 (32%) developed recurrence in a mean 33.6 months (5 in stage II and 2 in stage IIIa). Recurrence involved liver metastasis (n=2), lung metastasis with local recurrence (n=1) peritoneal metastasis (n=2), anastomotic recurrence (n=1), and local recurrence (n=1). Survival was 63.5%,equivalent to that of stage III in a control group. Conclusion: Perforation thus influences the prognosis of colorectal cancer, suggesting that careful follow-up is needed for colorectal cancer with perforation.

Key words
colon cancer, perforation, recurrence, prognosis, clinical staging

Reprint requests
Kimihiko Funahashi Division of Gastroenterological Surgery, Omori Hospital, Toho University Medical Center
6-11-1 Omori-nishi Ota-ku, 143-8541 JAPAN

Accepted
May 30, 2007

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