Patient outcomes and prognostic factors associated with colonic perforation surgery: a retrospective study

다국어 초록 (Multilingual Abstract)

Background: Despite advances in surgery and intensive perioperative care, fecal peritonitis secondary to colonic perforation is associated with high rates of morbidity and mortality. This study was performed to review the outcomes of patients who underwent colonic perforation surgery and to evaluate the prognostic factors associated with mortality. Methods: A retrospective analysis was performed on 224 consecutive patients who underwent emergency colonic perforation surgery between January 2008 and May 2019. We divided the patients into survivor and non-survivor groups and compared their surgical outcomes. Results: The most common cause of colon perforation was malignancy in 54 patients (24.1%), followed by iatrogenic perforation in 41 (18.3%), stercoral perforation in 39 (17.4%), and diverticulitis in 37 (16.5%). The sigmoid colon (n=124, 55.4%) was the most common location of perforation, followed by the ascending colon, rectum, and cecum. Forty-five patients (20.1%) died within 1 month after surgery. Comparing the 179 survivors with the 45 non-survivors, the patient characteristics associated with mortality were advanced age, low systolic blood pressure, tachycardia, organ failure, high C-reactive protein, high creatinine, prolonged prothrombin time, and high lactate level. The presence of free or feculent fluid, diffuse peritonitis, and right-sided perforation were associated with mortality. In multivariate analysis, advanced age, organ failure, right-sided perforation, and diffuse peritonitis independently predicted mortality within 1 month after surgery. Conclusion: Age and organ failure were prognostic factors for mortality associated with colon perforation. Furthermore, right-sided perforation and diffuse peritonitis demonstrated a significant association with patient mortality.

참고문헌 (Reference)

1 Cirocchi R, "Treatment of Hinchey stage III-IV diverticulitis : a systematic review and meta-analysis" 28 : 447-457, 2013

2 Lee IK, "The survival rate and prognostic factors in 26 perforated colorectal cancer patients" 22 : 467-473, 2007

3 Strobel O, "Surgical therapy of peritonitis" 82 : 242-248, 2011

4 Richards CH, "Surgical outcome in patients undergoing reversal of Hartmann’s procedures : a multicentre study" 17 : 242-249, 2015

5 Tan KK, "Surgery for perforated colorectal malignancy in an Asian population : an institution’s experience over 5 years" 25 : 989-995, 2010

6 Nakamura F, "Study of the prognostic factor of the colon perforation case with the pan-peritonitis that needed emergency surgery : a single-center observational study" 6 : 379-384, 2019

7 Jobin SP, "Role of serial lactate measurement to predict 28-day mortality in patients undergoing emergency laparotomy for perforation peritonitis : prospective observational study" 7 : 58-, 2019

8 Horesh N, "Reversal of Hartmann’s procedure : still a complicated operation" 22 : 81-87, 2018

9 Kriwanek S, "Prognostic factors for survival in colonic perforation" 9 : 158-162, 1994

10 Biondo S, "Prognostic factors for mortality in left colonic peritonitis : a new scoring system" 191 : 635-642, 2000

11 Komatsu S, "Prognostic factors and scoring system for survival in colonic perforation" 52 : 761-764, 2005

12 주일석 ; 이유진 ; 유태영 ; 김정빈 ; 박인석 ; 곽금희 ; 조현진 ; 양근호 ; 김기환 ; 배병노, "Prognostic Factors and Management for Left Colonic Perforation: Can Hartmann’s Procedure Be Preventable?" 대한대장항문학회 36 (36): 178-185, 2020

13 Halim H, "Primary resection anastomosis versus Hartmann’s procedure in Hinchey III and IV diverticulitis" 14 : 32-, 2019

14 Tridente A, "Patients with faecal peritonitis admitted to European intensive care units : an epidemiological survey of the GenOSept cohort" 40 : 202-210, 2014

15 Alvarez JA, "Outcome and prognostic factors of morbidity and mortality in perforated sigmoid diverticulitis" 94 : 240-248, 2009

16 우리나 ; 계봉현 ; 김건 ; 김형진 ; 조현민, "Mortality risk factor analysis in colonic perforation: would retroperitoneal contamination increase mortality in colonic perforation?" 대한외과학회 93 (93): 203-208, 2017

17 Bielecki K, "Large bowel perforation : morbidity and mortality" 6 : 177-182, 2002

18 Shinkawa H, "Factors affecting the early mortality of patients with nontraumatic colorectal perforation" 33 : 13-17, 2003

19 Horiuchi A, "Evaluation of prognostic factors and scoring system in colonic perforation" 13 : 3228-3231, 2007

20 Biondo S, "Differences in patient postoperative and long-term outcomes between obstructive and perforated colonic cancer" 195 : 427-432, 2008

21 Tridente A, "Derivation and validation of a prognostic model for postoperative risk stratification of critically ill patients with faecal peritonitis" 7 : 96-, 2017

22 Otani K, "Colon cancer with perforation" 49 : 15-20, 2019

23 Dindo D, "Classification of surgical complications : a new proposal with evaluation in a cohort of 6336 patients and results of a survey" 240 : 205-213, 2004

24 Vermeulen J, "Avoiding or reversing Hartmann’s procedure provides improved quality of life after perforated diverticulitis" 14 : 651-657, 2010

25 Sugimoto K, "Analysis of the efficacy of direct hemoperfusion with polymyxin B-immobilized fiber(PMX-DHP)according to the prognostic factors in patients with colorectal perforation" 43 : 1031-1038, 2013