Treatment Outcome of Obstructive Colorectal Cancer With Bowel Perforation

The objective of this study was to analyze the short-and long-term treatment outcomes of patients with bowel perforation caused by obstructive colorectal cancer. From April 2003 to March 2013,15 patients with bowel perforation caused by obstructive colorectal cancer underwent emergency surgery at our hospital. Clinical outcomes were retrospectively analyzed by age, sex, tumor location, tumor stage, preoperative APACHE II severity score, time to surgery from diagnosis, operative method, and postoperative complications. We studied short-term outcomes and long-term prognosis by overall survival. Ten men and 5 women, with a median age of 67.6 years, were enrolled in the study. The mortality rate was 20%, and the median APACHE II score was 15. The 11 patients who survived had significantly lower APACHE II scores than the 4 fatal cases (P = 0.02). Excluding the patient with stage IV cancer, the median overall survival was 18.9 months. Five patients (50%) had recurrence and distant metastasis. APACHE II score may be a useful predictive marker for short-term outcome and determining operative method in patients with bowel perforation caused by obstructive colorectal cancer. Perforation should be considered as a high-risk factor for cancer recurrence, most of which are peritoneal.