A previous study undertaken by this department showed follow-up to be of little value in tracing curable recurrences in patients with colorectal cancer who had curative operations. The aim of the present investigation was to determine if more intensified follow-up would result in earlier diagnosis of recurrences and thus lead to earlier and more effective treatment. Altogether 599 patients with colorectal cancer were treated between 1973 and 1977. The 363 (61 per cent) patients who were operated upon for cure entered the study and were followed up until December 1979. The same incidence of recurrence was seen in both series, but, with the more detailed protocol, they were more frequently detected before symptoms developed. However, the rate of curative reoperation for recurrence was not changed and only few patients survived after such reoperations. The conclusion is that the previous protocol is as efficient as the detailed one while no effective treatment of disseminated disease exists.

In an unselected series of 207 consecutive patients with Crohn's disease diagnosed between 1958 and 1974, 170 underwent a resection of all the macroscopically involved bowel ('radically' resected). Two patients died during the first postoperative month. The crude recurrence rate for the surviving 168 patients was 49%. The cumulative recurrence rate, calculated by the actuarial method, was 53% at 15 years. Age, sex, length of preoperative disease history, localization of the lesions in the bowel, and primary surgical procedures performed had no influence on the recurrence rate. However, the histopathological appearance of the resection margins seemed to influence the prognosis, since the presence of ulcers and/or granulomas was correlated with a significantly increased recurrence rate.

The progress of 139 patients operated upon for cure of colorectal carcinoma, was followed postoperatively with a standardized protocol. A CEA test was performed for comparison with other parameters. Median observation time was four years. When an upper limit for CEA of 7.5 micrograms/1 was allowed, sensitivity was found to be 78 per cent, specificity 91 per cent, and predictive value of an elevated CEA concentration, 83 per cent. In general, CEA measurement traced recurrence six months before clinical diagnosis. In only a few cases was recurrence first heralded by an abnormality in other blood chemistry test results. CEA may thus be used in postoperative screening for recurrence even though most recurrences, when detected, are not curable.

A prospective study was performed on 196 consecutive patients undergoing elective colonic surgery to evaluate the prophylactic effect of a single dose of doxycycline. The patients were randomized into four groups: group I 200 mg i.v. preoperatively, group III 600 mg i.v. preoperatively, group III 600 mg i.v. postoperatively, and group IV 200 mg i.v. preoperatively and 200 mg i.v. daily 3 days postoperatively. The rate of septic complications for the different groups were: I 13 per cent, II 7 per cent, III 20 per cent, and IV 19 per cent. There was no statistically significant difference in occurrence of septic complications between the groups. The degree of bacterial contamination during operation was estimated by culture from wound irrigation fluid and from cotton swabs. Bacteria were recovered from the irrigation fluid in 97 per cent, while culture from cotton swabs proved to be much less sensitive. A high number of bacteria in the irrigation fluid was significantly correlated to a high complication rate. It is suggested that direct plating from irrigation fluid can be used for defining a high risk group of patients in colonic surgery.

The frequency of metachronous colorectal tumours in a prospective 20‐year series of patients with colorectal cancer is reported. Thirty‐one patients, that Is 2.1% of the patients operated on for cure, had metachronous carcinomas, and 5.4% had metachronous polyps. One‐third of the metachronous carcinomas were diagnosed at scheduled postoperative control examinations, and the others because of their symptoms or at autopsy. The reported metachronous carcinomas are considered to represent failures of follow‐up only and not to indicate their true incidence, since their natural course has been arrested by removal of adenomas whenever found. Several of the metachronous tumours were judged to be overlooked synchronous ones, and therefore a thorough postoperative examination of the remaining large bowel is advocated. The finding of subsequent tumours in this series indicates that continuous follow‐up is worthwhile.