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Inadvertent perforation during rectal cancer resection in Norway

M T Eriksen1, A Wibe, A Syse

  • 1Department of Surgery, Buskerud Hospital, Drammen, Norway. mteriksen@start.no

The British Journal of Surgery
|February 5, 2004
PubMed
Abstract

Insights

Intraoperative perforation during rectal cancer surgery, particularly abdominoperineal resection in older patients, increases local recurrence and reduces survival. Avoiding this complication is crucial for better outcomes in rectal cancer treatment.

Area of Science:

  • Colorectal Surgery
  • Surgical Oncology
  • Patient Safety

Background:

  • Inadvertent bowel or tumor perforation is a known complication during rectal cancer resection.
  • Mesorectal excision is a standard surgical technique in Norway.

Purpose of the Study:

  • To evaluate intraoperative perforation rates after implementing mesorectal excision for rectal cancer.
  • To identify risk factors and outcomes associated with intraoperative perforation.

Main Methods:

  • Prospective national cohort study.
  • 2873 patients undergoing major rectal carcinoma resection.
  • Data collected from 54 Norwegian hospitals (November 1993 - December 1999).

Main Results:

  • Overall perforation rate was 8.1%.
  • Higher risk of perforation in abdominoperineal resection (OR 5.6) and patients aged 80+ (OR 2.0).
  • Perforation linked to increased 5-year local recurrence (28.8% vs 9.9%) and reduced survival (41.5% vs 67.1%).

Conclusions:

  • Abdominoperineal resection and advanced age (80+) are significant risk factors for intraoperative perforation.
  • Perforation is associated with poorer oncological outcomes, including higher local recurrence and lower survival rates.
  • Minimizing intraoperative perforation is essential for improving rectal cancer treatment outcomes.

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