PERFORATIVE cancer of the large bowel, by obstruction of fecal flow or direct erosion of the bowel wall, results in more serious bacterial infections than any other human malignancy. This dual threat of death from either peritonitis or cancer forces upon surgeons a natural indecisiveness. We traditionally drain and retreat from pus, yet we radically attack cancer.
This 20-year study of patients with large bowel cancers and intraperitoneal infections has helped us to resolve, at least in part, this dilemma of retreat or attack. Prompt surgical removal of the cancer, when possible, appears to protect the patients from both (1) early death from infection and (2) late death from malignancy. When infections occur following resection of colon cancers, early surgical drainage or fecal diversion (with or without drainage) offers the best chance of survival.
We have also noted, from this study, a significant increase in five-year survival of patients who