Norman Jocelynn, Moodley Yoshan
Gastrointestinal Cancer Research Group, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
J Cancer Allied Spec. 2023 Jan 13;9(1):517. doi: 10.37029/jcas.v9i1.517. eCollection 2023.
Large bowel perforation (LBP) occurs in up to 10% of colorectal cancer (CRC) patients and is a potential surgical emergency. Data on LBP in CRC patients from resource-limited countries are required to improve the management of this condition in these settings. Our study aimed to describe LBP amongst CRC patients in KwaZulu-Natal, South Africa.
This was a descriptive sub-analysis of LBP data from an ongoing CRC registry. This study explores free and contained perforations and describes LBP characteristics, surgical management, histological findings, overall survival, and CRC recurrence.
Ninety-four out of 2523 CRC patients had LBP (3.7%). The median age was 53.0 years (interquartile range: 43.0-64.0). The male-to-female ratio was 1.4:1. Thirty-three patients (35.1%) had a coexisting bowel obstruction. Tumor site perforations occurred in 87 patients (92.6%) and were mostly in the sigmoid colon (36.2%). Perforations were contained in 77 patients (81.9%). Eighty-nine patients (94.7%) underwent resection (elective resection: 76/89 patients, 85.4%). The post-operative inpatient mortality rate was 2.2%. Most patients had Stage III CRC (46 patients, 48.9%) and moderately differentiated tumors (77 patients, 81.9%). Overall survival at 12 months following CRC diagnosis was 55.4%. The early recurrence rate for CRC disease was 5.4%.
Tumor site perforations predominated, and most were contained. Patients were younger when compared with the international literature. We reaffirm that diastatic-free and contained perforations are two distinct clinical entities.
高达10%的结直肠癌（CRC）患者会发生大肠穿孔（LBP），这是一种潜在的外科急症。需要来自资源有限国家的CRC患者LBP数据，以改善这些地区对该病症的管理。我们的研究旨在描述南非夸祖鲁 - 纳塔尔省CRC患者中的LBP情况。
这是对来自一个正在进行的CRC登记处的LBP数据进行的描述性亚分析。本研究探讨了游离性穿孔和局限性穿孔，并描述了LBP的特征、手术管理、组织学发现、总生存率和CRC复发情况。
2523例CRC患者中有94例发生LBP（3.7%）。中位年龄为53.0岁（四分位间距：43.0 - 64.0）。男女比例为1.4:1。33例患者（35.1%）同时存在肠梗阻。87例患者（92.6%）发生肿瘤部位穿孔，且大多发生在乙状结肠（36.2%）。77例患者（81.9%）的穿孔为局限性穿孔。89例患者（94.7%）接受了切除术（择期切除术：76/89例患者，85.4%）。术后住院死亡率为2.2%。大多数患者患有III期CRC（46例患者，48.9%）和中度分化肿瘤（77例患者，81.9%）。CRC诊断后12个月的总生存率为55.4%。CRC疾病的早期复发率为5.4%。
肿瘤部位穿孔占主导，且大多数为局限性穿孔。与国际文献相比，患者年龄较轻。我们重申，无裂开性和局限性穿孔是两种不同的临床实体。
