Curative surgery improves the survival of patients with perforating colorectal cancer

Purpose: Colorectal cancers that manifest as a perforation are generally regarded as carrying a poor prognosis. We conducted this study to assess the outcome of colorectal cancer complicated by perforation. Methods: Between 1996 and 2004, 848 patients underwent surgery for colorectal cancers in our department. We reviewed 22 (2.6%) consecutive patients who presented with perforation at one institution. Results: Fifteen (69%) patients underwent potentially curative resection. The overall operative morbidity and mortality rates were 50% and 9%. The overall 5-year survival rate was 17.4%, although by excluding patients who either had stage IV disease at diagnosis or who died during or soon after surgery (n = 7), the 5-year survival rate increased to 32% (n = 15). Furthermore, the 5-year survival rate of patients who underwent a potentially curative resection (36.9%) was significantly better than that of those who underwent a noncurative resection (0%, P = 0.0093). Conclusions: Perforating colorectal cancers are associated with high postoperative mortality and poor long-term survival. However, the intensive management of radical lymph node dissection and surgical resection are recommended to improve the long-term prognosis.