Favourable Outcome After Resection for Contained Malignant Colorectal Perforation

Background: Perforation in colorectal cancer occurs due todirect perforation from or from proximal colon rupture. This study was aimed at documenting our experience with malignant colorectal perforation and to establish trends in presentation. Analysis of ongoing database of all patients with colorectal cancer in the KwaZulu-Natal State Hospitals established since 2000 was undertaken. The Setting was the Colorectal Unit in a tertiary centre
Patients: All patients with malignant perforation were extracted from the database and analyzed. Data collected included demographics, presentation, treatment, outcome, and follow-up. The main outcome measure was the In-hospital mortality
Results: By the end of 2012, the database was then comprised 1425 patients, of whom 48 (3.4%) were found to have malignant perforation. The Male-to-female sex ratio was 1:1, and age (mean ± SD) was 54.5± 15.6 years. Perforation occurred in 3%, 2%, 4%, and 5% of Africans, Indians, Coloureds, and Whites respectively. The disease distribution was right colon (15), descending colon (5), hepatic flexure (1), sigmoid (21), and rectum (6). Twelve patients with intestinal obstruction required emergency resection (25%). The rest underwent elective resection with the perforation discovered either at operation or at histopathologic analysis. One, 19, 23, 5 patients had Stage I, II, III, and IV respectively. There was no postoperative mortality. Only 6 patients had early disease and were deemed not to require adjunctive or palliative therapy. Patients were followed up for 14.6 ± 19 (range 1-94) months. Seven patients were lost to follow up, and two are confirmed dead. Up to now four of the 39 evaluable patients have developed metastases.
Limitation: Inadequate follow-up data
Conclusion: Malignant perforation occurs in about 3% of colorectal cancers in our geographical area of Southern Africa. The sex distribution and prevalence is the same in all population groups. Disease distribution follows general norms. Interestingly the perforation rarely leads to peritonitis. There was no postoperative mortality in this cohort.

Keywords
colorectal cancer; malignant perforation; Hartmann's procedure; emergency colectomy; South Africa