Colonic Tumor Perforation: Predisposing Factors and Clinical Presentations

Abdullah Bahadır Öz; Hızır Akyıldız; Erdoğan Sözüer; Alper Akcan; Muhammet Akyüz; İsmail Biri; Ertan Emek

doi:10.5505/1304.7361.2013.35555

Abdullah Bahadır Öz¹, Hızır Akyıldız¹, Erdoğan Sözüer¹, Alper Akcan¹, Muhammet Akyüz¹, İsmail Biri², Ertan Emek¹

¹Department Of General Surgery, Erciyes University, Kayseri, Turkey
²Purivate Koru Hospital, General Surgery Clinic, Ankara, Turkey

Keywords: colorectal, tumor perforation, peritoneal carcinomatosis

Abstract

Objectives: Perforation of the large bowel is an ominous complication of colorectal cancer. Despite advances in surgery, antimicrobial therapy and postoperative intensive care, it remains a potentially fatal affliction. The aim of this study was to evaluate the predisposing factors and clinical presentations of the colorectal tumor perforations.
Methods: We conducted a retrospective study on 720 patients operated on for colorectal adenocarcinoma between June 2009 and May 2013. Patients were classified into 2 groups: group 1, patients who underwent surgery for perforated colorectal cancer, and group 2, patients undergoing elective surgery or undergoing surgery for obstructing or bleeding cancer. Perforation at the site of the cancer was defined as a perforation in the immediate location of the primary tumor. The medical records and clinicopathologic data were retrospectively analyzed. Significance was set at p<0.05.
Results: Among the 720 patients, 28 (0.00389 %, %95 confidence interval (CI) 0.0270-0.0556) had colorectal cancer with perforation (group 1). Group 2 consisted of 692 patients. The most common complaint was sudden onset of abdominal pain in group 1. There was no significant difference between groups with regards to demographic data, tumor differentiation, histological and nuclear grades, and local invasion. There were significant differences for perineural invasion, peritonitis carcinomatosa and T4 stage between groups (p<0.001).
Conclusion: Perineural invasion, peritonitis carcinomatosa and T4 stage were found statistically significant clinicopathologic factors for the perforation of colorectal tumors.