Perforated Colorectal Cancer

The majority of patients with colorectal tumors will present via the elective route. However, one-fifth of patients will present as an emergency. The most common cause of emergency presentation of colorectal cancer is obstruction followed by perforation, and in many cases, patients will present with both. We discuss the management of the patient presenting with a perforated colorectal tumor covering the acute presentation and also how to deal with consequences of a perforated tumor, namely, the management of colorectal peritoneal metastasis (CPM). CPM used to be considered a terminal condition; however, a strategy of early detection of CPM, careful patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, leads to much improved outcomes and even cure, in some patient compared with systemic chemotherapy alone.

Surgical Management Analysis of Emergency Colorectal Cancer Surgical Cases - a Retrospective Observational Study

We present an observational retrospective study which takes into consideration and analyzes the surgical management of emergency colorectal cancer cases. This analysis would contribute to a better understanding and for identification of those characteristics that are essential for reducing emergency colorectal cancer incidence and for improving the management of such cases. A number of 159 patients that underwent surgery for obstructive, bleeding or perforated colorectal cancer between January 2015 and September 2017 were selected to be included in the study. The results obtained by analyzing available data collected from the observation charts, surgery protocols, histopathological protocols were then compared with those in the literature.

CLINICOPATHOLOGICAL PROFILES OF EMERGENCY COLO-RECTAL CANCER SURGICAL CASES – PRELIMINARY REPORT OF A RETROSPECTIVE OBSERVATIONAL STUDY

We present a preliminary report of an observational retrospective study of clinical and pathological features of emergency colorectal cancer (CCR) aiming to identify specific profiles of patients according to gender, age, and residence. This analysis would contribute to better understanding surgical emergency presentation and for identification of those characteristics that are essential for both reducing emergency CCR incidence and for improving the management of such cases. A number of 159 patients that underwent surgery for obstructive, bleeding and perforated colorectal cancer between January 2015 and September 2017 were selected to be included in the study. The results obtained by analyzing available data collected from the observation charts, surgery protocols, histopathological protocols were then compared with those in the literature.

Risk of peritoneal carcinomatosis in pT4 and perforated colorectal cancer.

787 Background: Peritoneal carcinomatosis has a dismal prognosis with shorter overall survival than other isolated metastases. In selected patients, HIPEC shows encouraging results. However, early diagnosis continues to be a challenge. COLOPEC trial has been designed to determine the effectiveness of HIPEC in pT4 and perforated colon cancer expecting 25% of peritoneal carcinomatosis in the control arm. A routine second-look procedure in a pilot trial addressed to high-risk patients revealed peritoneal carcinomatosis in 13.3 % in the pT4 group and 50% in the perforation group. Methods: The aim of our study is to describe the risk of clinical/radiological peritoneal relapse in a high-risk population.This is a retrospective study. 711 patients diagnosed with colorectal cancer between 2012 and 2014 according to the hospital – based registry hospital, were reviewed. Patients with stage IV at diagnosis were excluded. 95 cases were considered as high-risk patients. We categorized different classes for pT4 (only), perforation (only) and pT4 + perforation. Results: Peritoneal carcinomatosis was identified during the follow-up in 19 (20 %) of patients initially diagnosed with pT4, perforated colorectal cancer or both. Conclusions: Whereas the risk of peritoneal carcinomatosis in patients with an only risk factor (pT4 or perforation) is 0-15%, it increases up to 33% (one in three patients) when both pT4 and perforation coexist. It is important to collect this information in the clinical record and considering it for the decision-making process. Second-look procedures should not be performed out of the setting of clinical trials. Some patients considered as high-risk patients in old series could have a good prognosis nowadays. [Table: see text]