Perforated Colorectal Cancer Research Articles

Management of Perforated Sigmoid Colon Cancer in an Incarcerated Inguinal Hernia Using a Combined Abdominal and Inguinal Approach.

The ideal management of perforated colorectal cancer in the hernia sac remains a challenge for general surgeons. We report such a case requiring a combined-incision surgical approach and two-stage operation. A male patient in his 80s presented with fatigue and a bulge in his left groin. Contrast-enhanced CT scan revealed a sigmoid colon perforation within the left inguinal hernia sac. A combination of midline abdominal and inguinal incisions was performed for the iliopubic tract repair and Hartmann procedure. Six months later, the recurrent inguinal hernia was repaired using the Kugel mesh. The treatment strategy for colonic perforation into the inguinal hernia remains nonstandardized, compared to those for nonperforated cases. Combined inguinal and midline abdominal incisions might be necessary for infected lesion removal and colon mesentery resection; using mesh to repair hernia is a rare option. Hernia repair using mesh can be performed in two stages when recurrence occurs.

Risk factors for the recurrence of stage II perforated colorectal cancer: A retrospective observational study

BackgroundPatients with perforated colorectal cancer (PCRC) experience higher recurrence rates than those with non-perforated tissue. We identified the promoting factors of stage II PCRC recurrence after R0 surgery. MethodThis retrospective observational study included patients treated for colorectal cancer at a single facility between 2007 and 2016, and compared the clinicopathological features of patients with perforating versus non-perforating stage II tumors who underwent R0 resection, while focusing on recurrences. ResultsThirty-two and 112 patients (predominantly men) with perforating and non-perforating tumors, respectively, were included. The perforated group had significantly higher proportions of T4 tumors than the non-perforated group (44% vs. 15%). The perforated group had significantly lower numbers of resected lymph nodes than the non-perforated group (6 vs. 17). Seven of 17 patients with follow-up data in the perforated group experienced recurrence (41%), versus 19 of 104 in the non-perforated group (18%). In the non-perforated group, male sex (89% vs. 60%, p = 0.030), T4 stage (32% vs. 9%, p = 0.029), and fewer resected lymph nodes (12.5 vs. 18.6, p = 0.003) were significantly associated with recurrence; however, no such influences on recurrence were observed in the perforated group. The recurrence sites in the perforated group were mostly local (6 patients, 86%). Conversely, recurrences in the non-perforated group were mostly distant; 8 of 19 patients (42%) had liver metastasis and 1 (5%) had lung metastasis. ConclusionPatients with stage II PCRC experienced higher recurrence rates regardless of clinicopathological features and had high local recurrence rates indicating possible local tumor cell dispersal owing to perforation.

Clinicopathological outcomes and risk factors for postoperative recurrent and hospital mortality in patients with perforated colorectal cancer

Clinicopathological outcomes and risk factors for postoperative recurrent and hospital mortality in patients with perforated colorectal cancer

Perforated colorectal cancers: clinical outcomes of 18 patients who underwent emergency surgery.

IntroductionAlthough colon cancer perforations are rare among acute abdominal syndromes, it is a clinical picture with high mortality that requires urgent treatment.AimIn this study, the clinical results of patients who were operated in emergency conditions due to colorectal cancer perforation were evaluated.Material and methodsThe data of 18 patients treated for colorectal cancer perforation in our clinic between February 2014 and February 2017 were retrospectively reviewed. The following data were evaluated: demographic features of the patients, location of the tumour, metastasis, stage of the tumour, number of lymph nodes dissected, survival, type, and prognosis of the surgery.ResultsEight (44%) of 18 patients with perforated colon cancers were female and 10 (56%) were male. The mean age was 65.2 (31–104) years. Four of the patients had liver metastasis only, and 5 had multiple metastases. All cases had sudden abdominal pain and acute abdominal clinical findings. Fourteen of the patients underwent full resection, and 4 of them underwent partial resection and trephine stoma (colostomy). Perioperative mortality was not observed. The long-term mortality rate in our study was 77.7% (n = 14), and the operative mortality rate was 44% (n = 8). Additional organ injuries occurred during resection in 2 patients.ConclusionsColorectal cancer perforation seen in advanced ages is one of the causes of acute abdominal syndrome, which can be fatal. The general condition of the patient and the size and localization of the perforation should be taken into consideration in the choice of treatment. Curative surgery can also be performed in perforated colorectal cancers. However, partial resection and trephine colostomy should be performed in patients with multiple metastases and poor general condition.

Postoperative Complications Predict Long-term Outcome After Curative Resection for Perforated Colorectal Cancer.

Perforation and postoperative complications have a negative effect on long-term outcomes in patients with colorectal cancer (CRC). The aim of this study was to evaluate the clinical factors with special reference to postoperative complications predicting the long-term outcome in those for whom curative resection for perforated CRC was performed. Patients who underwent curative resection for perforated CRC at stage II or III from April 2003 to March 2020 were included. Clinical factors were retrospectively analyzed. Forty-four patients met the selection criteria. The 30-day mortality rate was 4.5% and the complication rate was 47.7%. Excluding 30-day mortality, five-year recurrence-free survival (RFS) and overall survival (OS) were 62.3% and 73.6%, respectively. Multivariate analysis showed that postoperative complications (p=0.005) and pT4 pathological factor (p=0.009) were independent prognostic factors for RFS. Only postoperative complications (p=0.023) were an independent prognostic factor for OS. Postoperative complications were significantly associated with RFS and OS, and pT4 was associated with RFS. The prevention and management of postoperative adverse events may be important for perforated CRC.

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.

Differentiation between stercoral perforation and colorectal cancer perforation.

To determine the computed tomography (CT) signs associated with stercoral perforation and colorectal cancer perforation. From May 2003 to Feb. 2015, all surgically and pathologically confirmed patients with stercoral perforation (n=8, mean age 68.3 years) or colon cancer perforation (n=11, mean age 66.3 years) were retrospectively reviewed by two board-certified radiologists blinded to the proven diagnosis. The following CT findings were evaluated and recorded for each patient: wall thickness of the distal colon adjacent to perforation site, pattern of the colon wall thickening and enhancement, length of the thickened bowel wall, presence of fecaloma, degree of proximal colon dilatation, and pericolonic inflammation or presence of pericolonic abscess, and number of enlarged pericolonic lymph nodes. These findings were correlated with the pathologic diagnosis. The mean thickness of the distal colonic wall adjacent to the perforation site was 13.6 mm in patients with colorectal cancer perforation and 5.1 mm with stercoral perforation, which was statistically different. There was a significant correlation between colorectal cancer perforation and eccentric wall thickening (p<0.01). CT findings of layered enhancing wall thickening (p<0.01) and the presence of fecaloma in the proximal colon (p<0.01) were significant findings for stercoral perforation. Patients with colorectal cancer displayed more pericolonic lymph nodes (mean 2.27, p<0.05). Fecaloma in the proximal colon and layered enhancing wall thickening adjacent to perforation site are likely due to stercoral perforation. Eccentric bowel wall thickening at the distal portion of the perforation site with many enlarged pericolonic lymph nodes is most likely due to colorectal cancer perforation.

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]

Postoperative recurrence and risk factors of colorectal cancer perforation.

The common causes of colorectal perforation are benign. However, perforated colorectal cancer confers a risk of recurrence in the long term because of the malignant nature of the disease. In addition, the recurrence rate can also increase because of dissemination of cancer cells, reduced extent of lymph node dissection to prioritize saving life, and other reasons. We evaluated the clinical features and postoperative recurrence in patients with perforated colorectal cancer who developed general peritonitis and underwent emergency surgery during a 7-year period between April 2007 and March 2014. During the study period, 44 patients had colorectal cancer perforation. The cancer sites were the ascending colon in 6 patients, transverse colon in 1, descending colon in 4, sigmoid colon in 15, and rectum in 18. The disease stage was stage II in 18 patients, stage III in 15, and stage IV in 7. Among 22 patients who could be followed up, 8 had postoperative recurrence. The recurrence rates were 18.2% for stage II cancer and 54.5% for stage III. Postoperative recurrence was more likely to occur in the patients positive for lymph node metastasis, those with poorly differentiated adenocarcinoma, those with T4 cancer, and those who did not receive postoperative adjuvant chemotherapy. The recurrence rate was higher in the patients with perforated colorectal cancer than in those who underwent surgery for common colorectal cancer. The prognosis can be expected to improve by performing standard surgical procedures, to the maximum extent possible, followed by postoperative adjuvant chemotherapy.

Insufficient Lymph Node Sampling in Patients with Colorectal Cancer Perforation is Associated with an Adverse Oncological Outcome.

The impact of lymph node (LN) dissection on long-term outcomes for patients with colorectal cancer (CRC) perforation remains unclear. We aim to investigate factors associated with poor prognosis and recurrence in patients with CRC, with special reference to cancer perforation and LN dissection. The subjects comprised 550 patients who underwent colorectal surgery for CRC at Stage II or III (TNM classification) between February 2006 and November 2013. Short- and long-term outcomes of patients with or without CRC perforation were evaluated. We also sought risk factors on poor prognosis, focusing on LN dissection in patients with CRC perforation. A total of 508 underwent surgery for CRC without perforation (the non-perforation group) and 39 for CRC with perforation (the perforation group). Both overall survival and recurrence-free survival rates were significantly lower in the perforation group than in the non-perforation group (overall survival, P=0.009; recurrence-free survival, P<0.001). The relapse rates at the peritoneum (P=0.002), lung (P=0.007) and LNs (P=0.021) were significantly higher in the perforation group than in the non-perforation group. Multivariable Cox proportional hazards model revealed that CRC perforation (hazard ratio [HR] 2.55, 95% confidential interval [CI] 1.16-4.98, P=0.022), LN dissection <12 (HR 1.83, 95% CI 1.07-3.13, P=0.027), and Stage III (HR 1.79, 95% CI 1.06-3.08, P=0.031) were significant and independent risk factors for poor prognosis. Conducting <12 LN dissections independently increased the risk of reduction in overall survival for patients with CRC perforation. Thus, radical LN dissections should be performed to improve patients' survival rates, when patients' general and surgical conditions allow.

Colorectal cancer complicated by perforation. Specific features of surgical tactics

Objective: to assess the immediate results of surgical interventions for colorectal cancer complicated by perforation. Materials and methods. The immediate results of surgical treatment were retrospectively analyzed in 56 patients with colorectal cancer complicated by perforated colon cancer, who had been treated at Smolensk surgical hospitals in 2001 to 2013. Patients with diastatic perforation of the colon in the presence of decompensated obturation intestinal obstruction of tumor genesis were not included into this investigation. Results. The immediate results of uni- and multistage surgical interventions were analyzed in relation to the extent of peritonitis and the stage of colon cancer. More satisfactory immediate results were observed after multistage surgical treatment. Following these interventions, a fatal outcome of disseminated peritonitis in the presence of performed colorectal cancer was recorded in 8 (53.3 %) cases whereas after symptomatic surgery there were 11 (67.8 %) deaths. A fatal outcome was noted in 1 case (7.7 %) after multistage surgery. Discussion. The results of surgical treatment in the patients with perforated colorectal cancer are directly related to the degree of peritonitis and the choice of surgical tactics.

Perforated Colorectal Cancer. A Retrospective Analysis

Introduction The perforation of colorectal cancer (CRC) had always had a poor prognosis, regardless of whether the perforation evolved into forming an abscess or it was a free perforation into the abdominal cavity. The associated conditions as elder patients and different comorbidities seems to greatly reduce the chance of survival, as well as limit the therapeutic surgical options. AIM: The aim of this study is to review our surgical department data in order to analyze the outcomes after colorectal cancer perforation. Material and Methods A retrospective study was conducted the Department of Surgery of Prahova County Hospital. All the patients admitted for a CRC perforation were included in the study. Results During one year, 136 patients with CRC were admitted in our department. Only 7.35% (n=10) had a perforation. The median age was 70 years old. The men to women ratio was 6 to 4. The tumor was located on the right colon in 40% (n=4), on the left colon in 30% (n=3) and on the rectum in the other 30% (n=3). There were performed 4 right colectomies, 5 Hartmann resections and in one case, a colostomy. The postoperative mortality was null. A review of the literature data was also performed. Conclusions Perforated CRC is more frequent in elderly patients, with neglected cancers. The choice of surgical procedure has to be appropriate to the cancer site and patient’s comorbidities and general condition.

Management of obstructive and perforated colorectal cancer

Colorectal cancer frequently presents with obstruction or perforation at the time of diagnosis, and requires urgent surgery. Various surgical and endoscopic approaches are available that minimize the risk of complications related to emergency colorectal operations and optimize the oncological outcome for the patients. The surgeon has to make clinically and oncologically adequate decisions, ranging from diverting colostomy to partial or total colectomy in a one-stage procedure or multistage interventions. The endoscopic insertion of a self-expanding metallic stent is an option either as a definitive procedure in palliative conditions or as a bridge to safer elective surgery. In this article, we discuss the current surgical and endoscopic treatments of complicated colorectal cancer and propose an algorithm for the management of patients with obstructive tumors.

Survival Rate and Prognostic Factors in Perforated Colorectal Cancer Patients: A Case-Control Study

Purpose: Perforations are rare but serious complications in colorectal cancer. Controversy exists over whether to perform a radical operation because colorectal cancer perforation is considered as an advanced stage disease, and septic complications of peritonitis have been identified as being responsible for a poor prognosis. The aim of this study was to assess the correlation between the survival rate and the clinicopathological parameters that might be used as predictive factors of the prognosis for perforated colorectal cancer. Methods: The analysis was based on 24 cases of perforated colorectal cancer (the case group), 48 cases of matching uncomplicated colorectal cancer (the control group), and 72 cases of the case and the control groups combined together (the combined group), all of which were identified during a 10-yr period in a single institution. Results: The five-year survival rates of the perforated colorectal cancer patients and their matching controls were similar (P=0.484). No significant differences in the locations of the cancer, the pre-operative carcinoembryonic antigen (CEA) levels, the tumor sizes, the resection margins, or the numbers of the lymph nodes harvested were found between the two groups. A univariate analysis of the prognostic factors that influenced the case group revealed that adjuvant chemotherapy (P=0.004) was significantly correlated to a better five-year survival rate. A univariate analysis of the prognostic factors that influenced the five-year survival rate of the combined group revealed that the stage (P<0.001), the pre-op CEA level (P=0.018), the angio invasion (P=0.019), the perineural invasion (P=0.019), the number of harvested lymph nodes (P=0.004), and adjuvant chemotherapy (P=0.001) were significantly correlated to the five-year survival rate. The identified independent prognostic factors in the combined group were the stage (hazard ratio, 5.20), angio-invasion (hazard ratio, 2.81), and adjuvant chemotherapy (hazard ratio, 0.17). Conclusion: The clinical pathway of perforated colorectal cancer is similar to that of uncomplicated colorectal cancer. Therefore, perforated colorectal cancer patients should be recommended for treatment with the appropriate radical operation and adjuvant chemotherapy based on oncologic principles.

Multivariate Analysis of the Risk Factors Associated with Complications and Mortality after and Emergency Operation for Obstructive, Perforated Colorectal Cancer

Purpose: Despite increased effort for the detection of early colorectal cancer, advanced disease presenting as obstruction or perforation still accounts for 8 to 29% and 3-8% of all colorectal cancers, respectively. The aim of this retrospective study was to evaluate the clinical characteristics, the surgical methods, the complications, and the risk factors of obstructive or perforated colorectal cancer that may influence the outcome. Methods: A retrospective study was carried out in 60 patients with colorectal cancer, who underwent surgery due to obstruction or perforation from March 2000 to December 2005. The colorectal cancers were considered to be complicated when clinical signs of peritonitis were observed, the radiologic characteristics of the tumor did not permit preoperative mechanical bowel preparation, or perforation existed, when these observations were confirmed by operative findings. The following data were analyzed: clinical characteristics, surgical methods, complications, and risk factors. Results: Thirty-three patients (55%) had obstruction, and 27 patients (45%) had perforation. Overall, major complications occurred in 33.3% and 48.5%, respectively. The mortality rates were 6.1% and 14.8%, respectively. Risk factors for major complication were age, perforation, and transfusion whereas those for mortality were perforation and American Society of Anesthesiologists (ASA) class. Conclusion: The risk factors of complication were old age, transfusion, and perforation and those for mortality was perforation and ASA class. Earlier diagnosis and prompt, intensive, careful management should be attempted in these high-risk patients.

Gastrointestinal perforation in metastatic carcinoma: A complication of bevacizumab therapy

Bevacizumab (Avastin , Genentech, Inc.) is a humanised monoclonal antibody directed against Vascular Endothelial Growth Factor (VEGF). Developed by Napoleone Ferrara and colleagues, it was the first commercially available antiangiogenesis therapy to demonstrate efficacy and improved survival in patients with metastatic colorectal carcinoma. Bevacizumab is relatively new to clinical usage. It is FDA approved since 2004, and is generally well tolerated. As the glycoprotein VEGF is produced by normal tissues, antiVEGF therapy has been associated with notable adverse effects including hypertension, haemorrhage, arterial thrombosis and poor wound healing. Anecdotally, increased frequency of gastrointestinal perforation has been reported. Recent randomised trials evaluating Bevacizumab in combination with 5-FU based chemotherapy have demonstrated GI perforation rates of up to 3.6%. Much more data is needed to elucidate this issue owing to confounding factors. For example, the reported incidence of perforated colorectal cancer varies between 2.6 and 9%, therefore, in patients treated with bevacizumab, are these perforations simply a reflection of the natural history of the cancer due to improved survival following therapy? This is unlikely, as GI perforation not only occurs at the tumour site but also at remote anatomical locations. In addition, data regarding whether the primary tumour is intact is not reported in over 50% of the available trials.

Gangrène gazeuse extensive révélant une pathologie digestive : 7 observations

Objective Gas gangrene of the abdominal wall is a rare clinical occurrence with high rates of morbidity and mortality. The primary source of the infection is often unknown. To analyze the primary underlying intestinal etiologies and diagnostic approaches of gas gangrene of the abdominal wall, and to highlight specific treatment problems, particularly that of constructing a colostomy exteriorized through a massively infected abdominal wall. Patients and methods Seven cases of abdominal wall gas gangrene due to a gastrointestinal etiology were identified. (Cases arising from proctologic sources or related to recent abdominal surgery were excluded.) During the same period, 39 other patients presenting with abdominal wall gangrene from non-intestinal sources were treated. Results The etiologies were: perforated sigmoid diverticulitis (n=2), perforated appendicitis (n=1), acute pancreatitis with associated cecal perforation (n=1), and perforated colorectal cancer (n=3). Four of the seven patients died despite treatment (mortality of 57%). Conclusion The clinical presentations of these seven cases demonstrate that a GI source must be suspected whenever a patient presents with abdominal wall gas gangrene, even when there are no specific GI symptoms. Imaging, particularly with CT scan, is essential both to visualize the extent of tissue necrosis and to reveal underlying primary GI pathology. This optimizes the surgical approach both by allowing for complete debridement and drainage of infected tissue, and by focussing the intervention on correction of the underlying primary GI source of infection.

The survival rate and prognostic factors in 26 perforated colorectal cancer patients

The treatment for perforated colorectal cancer is not easy and the prognosis for this disease is not so predictable. There are some controversies about performing radical operations because colorectal cancer perforation was considered as an advanced stage disease due to the possibility of tumor cell dissemination through the perforation site. We selected and enrolled 26 patients with perforated colorectal cancers among the 1,227 patients who underwent operation for colorectal cancer. These cases were retrospectively analyzed by using their medical records and clinicopathological data. Twenty-eight cases (2.3%) with perforated colorectal cancers were studied and the overall operative mortality rate was 11%. The overall 5-year survival rate was 57.8% when excluding the operative mortality. The overall 5-year cancer-free survival rate was 52.8%. There were significant differences in the survival rate and the cancer-free survival rate between the stages (p=0.008 and p<0.001, respectively). A univariate analysis of the prognostic factors revealed that the number of the metastatic lymph nodes (p=0.018) and the perforation proximal to the cancer (p=0.005) were significantly correlated to worse survival, and the higher number of the metastatic lymph nodes was correlated to a poorer cancer-free survival rate (p<0.001). For the perforated colorectal cancers, the stage, the perforation proximal to the cancer, and the number of the metastatic lymph nodes were correlated, with the survival and the cancer-free survival as factors of a poor prognosis. The surgical approach selected for perforated colorectal cancer should be in line with the principles of an appropriate cancer operation because the clinical pathway of perforated colorectal cancer is similar to that of uncomplicated colorectal cancer.

Outcome of acutely perforated colorectal cancers: Experience of a single district general hospital

Perforation of colorectal cancer (CRC) is rare and is associated with a significantly high mortality and morbidity. The aim of the current study was to evaluate various factors influencing the outcome in these patients. A retrospective analysis of 42 patients with perforated CRC between 1999 and 2003 was performed. A number of variables including age, sex, site of perforation, presence of faecal peritonitis, grade of surgeon, presence of metastasis, stage of tumour, type of surgery, ASA grade and CR POSSUM score were analysed for their influence on the outcome in these patients using MS Excel, MS Access and Stata. Of the 42 patients 19 were female and 23 were male. The mean age of the patients was 70.5 (range 44-96yr). Thirty patients had perforation at the tumour, 10 proximal to the tumour, and one distal to the primary tumour. The perforation was localised in 25 patients. However, 17 patients had free perforation with frank faecal peritonitis. Twenty-one patients had resection and anastomosis, 18 patients had resection without restoration of bowel continuity and 3 had palliative colostomy. The in-hospital mortality (within 30d) was 40.5% (n=17) with only 15 patients being alive at the end of 2yr with an overall mortality of 64.3% (n=27). The outcome was not altered by variables such as sex, surgeon's grade, surgical procedure, Dukes' staging or the site of perforation (p>0.5). Univariate analysis showed that advanced age (p<0.01), higher ASA grade (p<0.001), higher CR POSSUM score (p<0.001) and degree of peritonitis (p<0.01) were strongly associated with adverse outcomes. However, in stepwise multivariate logistic regression analysis ASA grade (p=0.01) and CR POSSUM score (p=0.01) were the only significant predictors of in-hospital mortality. The outcome of perforated colonic cancer continues to be poor. ASA score and CR POSSUM score are good predictors of the short-term outcome.