Mandava N, Kumar S, Pizzi W F, Aprile I J
Department of Surgery and Oncology, Catholic Medical Center of Brooklyn & Queens, Inc, Mary Immaculate Hospital, Jamaica, USA.
Am J Surg. 1996 Sep;172(3):236-8. doi: 10.1016/s0002-9610(96)00164-x.
Colorectal carcinomas that present with perforation are stated in the literature to carry a poor prognosis. This study is to verify or refute the dismal connotation associated with perforated colorectal carcinomas (PCCs).
A retrospective analysis of 1551 patients with colorectal carcinoma revealed that 51 (3.3%) patients presented with perforation. Mary Immaculate and St. John's Queens Hospital Divisions of the Catholic Medical Center of Brooklyn and Queens chart and tumor board data were retrieved for the period 1983 through 1993.
Localized perforation with abscess formation occurred in 31 (61%) patients, and free perforation with generalized peritonitis in occurred 20 (39%) patients. Sixteen (31%) patients had distant metastasis at diagnosis with a mean survival of only 6 months. Overall operative mortality rate was 12%, and overall 5-year survival rate was 32%. By excluding 16 patients with documented Stage IV disease at diagnosis and 6 operative mortalities (3 of whom also had Stage IV disease at diagnosis), the remaining 32 patients had a mean survival of 59 months and a 5-year survival of 58%.
In view of the 58% survival in our subset of patients, aggressive management is recommended. This includes management of sepsis and radical surgical resection of adjacent involved organs. A negative attitude associated with PCC is not substantiated in this retrospective 10-year study.
文献表明，出现穿孔的结直肠癌预后较差。本研究旨在验证或反驳与穿孔性结直肠癌（PCC）相关的不良预后观点。
对1551例结直肠癌患者进行回顾性分析，发现51例（3.3%）患者出现穿孔。检索了1983年至1993年期间布鲁克林和皇后区天主教医疗中心玛丽圣母医院和圣约翰皇后医院科室的病历及肿瘤委员会数据。
31例（61%）患者发生局限性穿孔并形成脓肿，20例（39%）患者发生游离穿孔并伴有弥漫性腹膜炎。16例（31%）患者在诊断时已有远处转移，平均生存期仅6个月。总体手术死亡率为12%，总体5年生存率为32%。排除诊断时记录为IV期疾病的16例患者和6例手术死亡患者（其中3例诊断时也为IV期疾病）后，其余32例患者的平均生存期为59个月，5年生存率为58%。
鉴于我们这组患者58%的生存率，建议积极治疗。这包括控制感染和对相邻受累器官进行根治性手术切除。在这项为期10年的回顾性研究中，与PCC相关的消极态度没有得到证实。
