Perforative carcinoma of colon and rectum.

As further statistical evidence accumulates it is becoming evident that a major factor in the differing patient salvage between perforative and uncomplicated cancer of the colon and rectum is the element of infection. The absence of abdominal sepsis is undoubtedly responsible for the lessened morbidity and mortality found in the treatment of established fistulas. Surgical attention should therefore be directed first to the eradication of the primary source of infection, the perforated tumor. The safety with which an intestinal anastomosis may be made in the presence of edema and inflammation is a matter of mature judgement on the part of the operating surgeon. Postoperative suture line leakage should be avoidable. Extirpative surgery with or without anastomosis, coupled with the judicious drainage of the peritoneal cavity, antibiotic coverage, and blood volume support should continue to give improved results in the management of this distressing complication of cancer of the colon and rectum.