Asano Hiroshi, Kojima Kazuto, Ogino Naomi, Fukano Hiroyuki, Ohara Yasuhiro, Shinozuka Nozomi
Department of General Surgery, Saitama Medical University, 38 Morohongou, Moroyama, Irumagun, Saitama, 350-0495, Japan.
Int J Colorectal Dis. 2017 Mar;32(3):419-424. doi: 10.1007/s00384-016-2694-3. Epub 2016 Oct 30.
The common causes of colorectal perforation are benign. However, perforated colorectal cancer confers a risk of recurrence in the long term because of the malignant nature of the disease. In addition, the recurrence rate can also increase because of dissemination of cancer cells, reduced extent of lymph node dissection to prioritize saving life, and other reasons.
We evaluated the clinical features and postoperative recurrence in patients with perforated colorectal cancer who developed general peritonitis and underwent emergency surgery during a 7-year period between April 2007 and March 2014.
During the study period, 44 patients had colorectal cancer perforation. The cancer sites were the ascending colon in 6 patients, transverse colon in 1, descending colon in 4, sigmoid colon in 15, and rectum in 18. The disease stage was stage II in 18 patients, stage III in 15, and stage IV in 7. Among 22 patients who could be followed up, 8 had postoperative recurrence. The recurrence rates were 18.2% for stage II cancer and 54.5% for stage III. Postoperative recurrence was more likely to occur in the patients positive for lymph node metastasis, those with poorly differentiated adenocarcinoma, those with T4 cancer, and those who did not receive postoperative adjuvant chemotherapy.
The recurrence rate was higher in the patients with perforated colorectal cancer than in those who underwent surgery for common colorectal cancer. The prognosis can be expected to improve by performing standard surgical procedures, to the maximum extent possible, followed by postoperative adjuvant chemotherapy.
结直肠穿孔的常见病因是良性的。然而，由于疾病的恶性本质，穿孔性结直肠癌长期存在复发风险。此外，由于癌细胞播散、为优先挽救生命而减少淋巴结清扫范围等原因，复发率也可能增加。
我们评估了2007年4月至2014年3月这7年间发生弥漫性腹膜炎并接受急诊手术的穿孔性结直肠癌患者的临床特征和术后复发情况。
在研究期间，44例患者发生了结直肠癌穿孔。癌灶位于升结肠6例、横结肠1例、降结肠4例、乙状结肠15例、直肠18例。疾病分期为Ⅱ期18例、Ⅲ期15例、Ⅳ期7例。在可随访的22例患者中，8例出现术后复发。Ⅱ期癌的复发率为18.2%，Ⅲ期为54.5%。淋巴结转移阳性、低分化腺癌、T4期癌以及未接受术后辅助化疗的患者术后更易复发。
穿孔性结直肠癌患者的复发率高于接受普通结直肠癌手术的患者。通过尽可能实施标准手术程序，随后进行术后辅助化疗，有望改善预后。
