Data on 709 patients who had a resection for colorectal carcinoma at Concord Hospital between 1971 and 1980 were studied to determine the independent effects on survival of several patient characteristics and pathological variables using the Cox regression model. Clinicopathological stage had the strongest association. Other variables ranked according to their relative importance independent of stage were: histological grade, level of direct spread, the presence of venous invasion, age and sex of the patient and the presence of obstruction.

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A clinicopathologic staging method for colorectal carcinoma was applied prospectively to 503 patients treated by surgical resection over a period of 7 1/2 years. The method grouped separately those patients known to be incurable at the time of resection and allowed for an anatomically precise definition of the extent of tumor spread. Survival studies showed that prognosis did not significantly deteriorate with spread of tumor beyond the bowel wall unless there were demonstrable metastases, infiltration of a free serosal surface, or if local resection was incomplete. Highly significant decrements in survival occurred when lymph node metastases were demonstrable and when unresected tumor was known to be present. The staging system from which these observations were made formed an improved guide to prognosis when compared with the original Dukes' method. Patients with histologically high-grade tumors had a poorer survival rate than those with low or average tumors with the same extent of spread.

Three hundred ten predominantly male patients who were 75 years of age or older and had surgery for colorectal carcinoma had a hospital mortality rate of 9 percent and a cancer-related five-year survival of 50 percent. These results and a detailed analysis of the causes of complications and mortality were compared with the outcome of 710 patients who were treated concurrently and who were younger than 75 years. Tumors in older patients had a tendency to occur on the right side and were more locally advanced. Increased mortality was particularly attributable to sepsis and cardiovascular causes. Increased morbidity was due principally to respiratory and urinary problems. There were no significant differences, however, in wound or anastomotic complications, nor was therapy for the older patients more costly. The indications for surgical resection for colorectal cancer in patients aged 75 years and older should be the same as those for any younger group.