Penetrating, obstructing, and perforating carcinomas of the colon and rectum

One third of 735 patients with colorectal cancer operated on at the Medical College of Virginia Hospitals, Richmond, between 1957 and 1972 were initially seen with a major complication of their disease (involvement of adjacent organs or structures, obstruction, or perforation). Lesions penetrating to involve adjacent organs made up 9% of the group studied; the operative mortality (9%) and five-year survival figures (41%) for those with this finding were nearly identical to those of the overall series when only resections with curative intent were examined. The operative mortalities from obstructing and perforating lesions were, respectively, two and four times the overall mortality; and crude five-year survival figures were one half and one fourth the overall survival data for the series. This poor prognosis appeared to be largely a function of the more advanced stage of disease in these groups and of sequelae from the complicated manifestations that significantly increased operative mortality. Considering only patients surviving "curative" resections, the penetrating and obstructing lesions were associated with a five-year survival that was the same as that for the curative resection group as a whole (40%), while those patients with perforating lesions had roughly half this life expectancy. Therefore, patients with these major complications of colorectal carcinoma must be treated by an aggressive surgical approach if there is no evidence of metastatic disease.