Impact Of Rectal Perforation On Recurrence During Rectal Cancer Surgery In A National Population Registry

Background Incidental perforation in rectal cancer surgery is considered a risk factor for poorer oncological outcome. Most studies emanate from the era before total mesorectal excision when staging, neoadjuvant treatment and surgical technique were suboptimal. This study assessed the impact of incidental perforation on oncological outcome in a cohort of patients with optimized management.Methods Data from the Swedish Colorectal Cancer Registry for patients undergoing R0 abdominal surgery for TNM stage I-III rectal cancer between 2007 and 2012, with 5-year follow-up, were analysed. Multivariable analysis was performed.Results In total, 6176 patients were analysed (208 with and 5968 without perforation). The local recurrence rate was increased after perforation (7 center dot 2 per cent (15 of 208) versus 3 center dot 2 per cent (188 of 5968); P = 0 center dot 001), but there were no differences in rates of distant metastasis (16 center dot 3 per cent (34 of 208) versus 19 center dot 8 per cent (1183 of 5968); P = 0 center dot 215) and overall recurrence (20 center dot 7 per cent (43 of 208) versus 21 center dot 0 per cent (1256 of 5968); P = 0 center dot 897). The 5-year overall survival rate was lower after perforation (66 center dot 4 versus 75 center dot 5 per cent; P = 0 center dot 002), but the 5-year relative survival rate was no different (79 center dot 9 versus 88 center dot 2 per cent; P = 0 center dot 083). In multivariable analysis, perforation was a risk factor for local recurrence (hazard ratio 2 center dot 10, 95 per cent c.i. 1 center dot 19 to 3 center dot 72; P = 0 center dot 011), but not for the other outcomes.Conclusion Incidental perforation remains a significant risk factor for LR, even with optimized management of rectal cancer. This must be considered when discussing adjuvant treatment and follow-up.