Survival after intestinal perforation: Can it be predicted?

Objective: Intestinal perforation is associated with high morbidity and mortality in gynecologic oncology patients. We investigated potential factors associated with survival after perforation which may influence treatment recommendations. Methods: A retrospective review of all gynecologic oncology patients experiencing intestinal perforation between 1993 and 2007 was performed. Demographics, cancer history, presenting symptoms, vital signs, laboratory values, and management of perforation were collected, and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores were calculated for each patient. Factors affecting survival from the time of perforation were analyzed using Kaplan-Meier method and univariate and multivariate Cox proportional hazard models. Student's t-test and χ² analysis were also utilized to evaluate potential associations. Results: Fifty-three patients met the inclusion criteria. No difference in survival was found based on disease site, history of radiation therapy, presenting symptoms, smoking history, or presence of bowel procedures performed during the most recent abdominal surgery prior to perforation. APACHE II score, disease status, body mass index, and treatment method of perforation were found to be significant prognostic factors for survival. After multivariate Cox regression analysis, only APACHE II scores remained significantly associated with an increased risk of death. Median survival of patients with APACHE II scores < 15 was 28.13 months compared to 2.90 months in patients with scores ≥ 15 (P < 0.0001). Conclusion: Many factors must be examined when determining the management of intestinal perforation in gynecologic oncology patients. Clinicians should consider the APACHE II score in their assessment to assist risk stratification and treatment planning of these patients.