Prognostic significance of surgical perforation of the rectum during abdominoperineal resection for rectal carcinoma.

Two hundred fifty patients were followed up after resection for carcinoma of the rectum. Sixty-four (25.6 percent) had a surgical perforation in the resected rectum. Perforation did not affect the long term outcome in patients with Dukes' A or D tumors, but in patients with Dukes' B and C cancers the surgical defect was associated with an increased incidence of recurrent tumor (57 versus 34 percent) and a decreased 5 year survival rate (31 versus 46 percent). The local recurrence rate was significantly higher in patients with Dukes' B rectal cancer who had an iatrogenic perforation (25.9 percent) than in those without a perforation (8.1 percent). This increased local recurrence rate was as high as the local recurrence rate in patients with Dukes' C cancers (23 percent) with or without a perforation. Patients with Dukes' B or C cancers who had incomplete resection had survival patterns similar to those in patients with Dukes' D cancers. Failure to remove all gross tumor and failure to avoid rectal perforation during abdominoperineal resection increases the risk of recurrence and decreases the chance of long-term survival.