Perforated colonic cancer. Evolution and prognosis

The purpose of this study was to determine whether patients with perforating colonic cancer, among patients who need emergency surgery, should be considered to comprise a group with a worse prognosis.

We retrospectively revised the clinical records for 91 cases of emergency primary resection for carcinoma of the colon, of which 22 were perforating (4 Dukes A, 10 Dukes B and 8 Dukes C) and 69 were obstructive (3 Dukes A, 30 Dukes B and 36 Dukes C). For purposes of comparison we also analyzed a synchronous series of 112 patients who underwent elective surgery.

There were no recurrences or deaths among the 7 patients with Dukes A disease (follow-up from 6 to 90 months), so these patients were excluded. In the 84 remaining emergency patients, 38 showed progression of the disease (13 local recurrence, 17 liver metastases, 4 lung, 3 peritoneal and 1 bone metastases). There were 26 deaths (6 patients with perforating and 20 with obstructive disease). There was no significant difference in survival or disease progression between patients with perforating and obstructive disease.

These results do not support the classical view of considering perforating cancer as a type with an especially ominous prognosis among patients who require emergency surgery.