Outcome of acutely perforated colorectal cancers: Experience of a single district general hospital
Introduction
Colorectal cancer (CRC) is the second most common cause of cancer related deaths in the UK. Some 34,000 cases are diagnosed in the UK each year with 60% being colonic and 40% being rectal cancers [1]. Perforation of CRC is an uncommon complication (2.6–9%) [2], [3], [4], [5], but is associated with high mortality and morbidity. In-hospital mortality in cases of perforated CRC has been reported to be between 5% and 40% [4], [6] despite advances in modern management of sepsis and peri- and post-operative intensive care medicine. Studies [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12] have shown various risk factors responsible for the poor outcome of acutely perforated CRC patients and include degree of peritonitis, site of perforation, septic state, stage of the tumour, age and ASA grade of the patient. The aim of this study was to evaluate a number of risk factors that may have a direct bearing on the short and long term outcome of perforated CRC in our hospital.
Section snippets
Method and materials
Data was analysed from a prospectively maintained CRC Database on 762 consecutive patients presented between January 1999 and December 2003. Of these 42 (5.5%) patients presented with acute colorectal (CR) perforation. Diagnosis of perforation was made on the basis of acute presentation and surgical intervention and confirmed by histology. The case notes, operating notes and histopathology reports of these 42 patients were then reviewed in detail and a number of important variables were
Results
Demographic, pre-operative, operative data and Duke's grading are detailed in Table 1. Of the 42 patients with CRC perforation, 23 (55%) were male and 19 (45%) were female with the mean age 70 (range 44–96 yr). In only 5 patients the diagnosis of CRC cancer was known prior to the acute presentation. Thirty-four (81%) patients were admitted directly via the accident and emergency department whereas 5 patients were in-patients in non-surgical wards and were referred to the on-call surgical team
Discussion
As perforated CRCs are quite uncommon (2.6–9%) [2], [3], [4], [5], the majority of the published series span over a long period of time to achieve adequate numbers for any meaningful analysis [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12]. Our series analysed the 5 yr data on 762 consecutive CRCs which revealed a perforation rate of 5.5%, very much in keeping with the other large-scale series.
A number of previously [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12] published
Conclusion
Perforated CRCs, despite advances in modern management of sepsis and peri- and post-operative intensive care medicine, carry a substaintial mortality. The two major predictors of poor outcome are ASA grade and CR POSSUM. It is recommended that these patients should be managed expeditiously and aggresively with a multidisciplinary approach involving surgeons, anaesthetist and intensivists to optimise their perioperative and postoperative care.
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