The effect of inadvertent intraoperative perforation on survival and recurrence in colorectal cancer

Abstract

Inadvertent perforation of the bowel during curative resection for colorectal cancer has serious consequences. In 174 curative resections with spillage, 5-yr survival was 29%. In 67 patients where the cancer itself was disrupted during dissection, 5-yr survival fell to 14% in the colon and to 9.3% in the rectum. Local recurrence developed in 65% of spillage cases. In Dukes'' C tumors that were perforated during surgery, local recurrence occurred in 87%. As surgeons, efforts must be directed toward preventing injury to the bowel during definitive resection of colorectal cancers. The instillation of tumoricidal solutions within the bowel lumen and the application of bowel ligatures prior to dissection may help toward preventing recurrence, should inadvertent perforation and spillage occur.