Management of Perforated Colon Cancers

Yıl 2014, Cilt: 11 Sayı: 3, - , 01.09.2014

Bünyami Ozogul Abdullah Kisaoglu Gurkan Ozturk Sabri Selcuk Atamanalp Mehmet İlhan Yıldırgan Bulent Aydinli

https://doi.org/10.15197/sabad.1.11.63

Öz

It is known that emergency surgery for colon cancer is associated with high morbidity and mortality. We retrospectively evaluated in this study our colon cancer patients admitted with perforation. The total 223 patients who had colon cancer, 74 (33%) underwent emergent colon surgery and 34 (15%) of them had perforation. Median age was 60.65±10.06 years (range:39-79 years) and 12 patients were female (35%). The most common tumor localization was in sigmoid colon (41%). Perforation site was proximal to the tumor in 26 cases (76.5%) and at the tumor site in 8 (23.5%). Peritonitis was present in 28 patients (82%). One of the major complications was anastomotic dehiscence (6 patients, 17.6%). The mortality rate was 29.4% (10 patients) and the morbidity rate was 47.1% (16 patients). The mortality of perforated colon cancer cases is high. Factors associated with mortality are left sided colon tumors (p=0.006), ASA score > 2 (p=0.01), the presence of liver metastasis (p=0.005) and the presence of >25 index according to Mannheim peritonitis index (p=0.002)

Anahtar Kelimeler

Colon cancer, perforation, management

Management of Perforated Colon Cancers

Öz

Kolon kanseri için acil cerrahi yüksek morbidite ve mortalite ile ilişkili olduğu bilinmektedir. Biz geriye dönük olarak perforasyon ile başvuran kolon kanseri hastalar değerlendirilmiştir. Kolon kanserli toplam 223 hasta çalışmaya alındı, bunların 74'üne (%33) acil kolon cerrahisi uygulandı ve bunların 34 (%15)'ünde perforasyon mevcut idi. Ortalama yaş 60.65±10.06 yıl (39-79 yaş) idi ve 12 hasta kadın (%35) idi.En sık tümör lokalizasyonu sigmoid kolonda (%41) idi. Perforasyon yeri 26 hastada (%76.5) tümörün yakınında ve 8 (% 23.5)'inde tümör sahasında idi. Peritonit 28 hastada (% 82) mevcuttu. Önemli komplikasyonlarından biri anastomoz yarılması (6 hasta, %17.6) idi. Mortalite oranı %29.4 (10 hasta) ve morbidite oranı %47.1 (16 hasta) idi. Perfore kolon kanseri vakalarının mortalitesi yüksek idi. Mortalite ile ilişkili faktörler sol taraflı kolon tümörleri (p=0.006), ASA skoru >2 (p=0.01), karaciğer metastazı varlığı (p = 0.005) ve Mannheim peritonit indeksine göre >25 (p = 0.002) idi

Anahtar Kelimeler

Kolon kanseri, perforasyon, tedavi

Kaynakça

• Jemal A, Siegel R, Ward E, et al. Cancer statistics. CA Cancer J Clin 2006;56:106–30.
• Jemal A, Thomas A, Murray T, Thun MJ. Cancer statistics of 2002. CA Cancer J Clin 2002; 52:23-47.
• American Cancer Society. Cancer facts and figures 2003. Atlanta: American Cancer Society; 2003.
• Coco C, Verbo A, Manno A et al. Impact of emergency sur- gery in the outcome of rectal and left colon carcinoma. World J Surg 2005;29:1458-64.
• Zorcolo L, Covotta L, Carlomagno N, et al. Safety of primary anastomosis in emergency colo-rectal surgery. Colorectal Dis 2003;5:262-9.
• Alvarez JA, Baldonedo RF, Bear IG, et al. Presentation, treatment and multivariate analysis of risk factors ob- structive and perforative colorectal carcinoma. Am J Surg 2005;190:376-82.
• Wong SK, Jalaludin BB, Morgan MJ, et al. Tumor pathol- ogy and long-term survival in emergency colorectal can- cer. Dis Colon Rectum 2008;51:223-30.
• Biondo S, Pares D, Marti Rague J, et al. Emergency opera- tions for nondiverticular perforation of the left colon. Am J Surg 2002;183:256-60.
• Mandava N, Kaya S, Pizzi WF, et al. Perforated colorectal carcinomas. Am J Surg 1996;172:236-8.
• Tobaruela E, Camunas J, Enrique Navascues JM, et al. Medical factors in the morbidity and mortality associated with emergency colorectal surgery. Rev Esp Enferm Dig 1997;89:13-22.
• Isbister WH. The management of colorectal perforation and peritonitis. Anz J Surg 1997;67:804-8.
• Biondo S, Jaurrieta E, Marti Rague J, et al. Role of re- section and primary anastomosis of the left colon in the presence of peritonitis. Br J Surg 2000;87:1580-4.
• Tan KK, Hong CC, Zhang J, et al. Surgery for perforated colorectal malignancy in an Asian institution’s experience over 5 years. Int J Colorectal Dis 2010;25:989-5.
• Cuffy M, Abir F, Audisio RA et al. Colorectal cancer pre- senting as surgical emergencies. Surg Oncol 2004;13:149- 57.
• Bielecki K, Kaminski P, Klukowski M. Large bowel per- foration: morbidity and mortality. Tech Coloproctol 2002;6:177-82.
• Skala K, Gervaz P, Buchs N, et al. Risk factors for mortal- ity-morbidity after emergency-urgent colorectal surgery. Int J Colorecatl Dis 2009;24:311-6.
• Carraro PG, Segala M, Orlotti C, et al. Outcome of large- bowel perforation in patients with colorectal cancer. Dis Colon Rectum 1998;41(11):1421-6.
• Anwar MA, D’Souza F, Coulter R, et al. Outcome of acute- ly perforated colorectal cancers: experience of a single district general hospital. Surg Oncol 2006;15(2):91-6.