Outcome in colorectal adenocarcinoma: two seven-year studies of a population.

Abstract

Objective-To record every patient with proved colorectal adenocarcinoma presenting from a defined population over two years in 1968-9 and during 1980-2, and to compare treatment and outcome over seven years. Design-Retrospective in 1968-9 and prospective in 1980-2. Setting-Aberdeen general hospitals.Subjects-Every patient presenting to the four general surgical units with histological proof of colorectal adenocarcinoma.Main findings-On average, one new patient presented each week per 100000 population. The proportion of patients aged 65 and over rose from 67% to 71%. An operation was performed on 385 patients in 1968-9 and on 399 during 1980-2. At laparotomy the proportion of patients who seemed to be curable and had a radical operation rose slightly, from 56% to 61%, and operative mortality fell from 9% to 5%. In all there were 421 survivors of curative surgery, and seven years later three quarters were either alive (51%) or had died without recurrence (25%). In both studies some 40% of patients were considered incurable when they presented, but the number who had a palliative resection rose from 59% to 85%.Conclusions-The contribution of radical surgery to the treatment of colorectal adenocarcinoma is substantial, with three quarters ofpatients so treated showing no evidence ofrecurrence after seven years. Operative mortality in an elderly population is now low, and improvement in late outcome is more likely to come from developments in adjuvant therapy than in operative technique. A continuing problem is that 40% of patients are not curable when they present, although palliative resection can now be offered to over 80%. IntroductionCarcinoma of the large bowel is the neoplasm most often treated by general surgeons. Its management is now receiving much attention, with reports opening with the statement that over 20000 people die each year in Britain from this cause and that five year survival is less than 30%.' These figures very properly attract attention, but two surveys of the population of northeastem Scotland suggest that, for several reasons, they need careful interpretation.More than half of the patients who now present are 70 or more years of age, so causes of death natural to an elderly population will account for considerable late mortality. Secondly, results are seriously affected by the fact that 40% of patients are beyond hope of cure when they present, and virtually all die within three years. Finally, although radical surgery is often successful in patients who seem to be curable at the time of operation, follow up reveals that occult local or distant spread was already present in one

Influence of Age on Colorectal Cancer’s 5-Year Survival

“…The operative mortality was relatively low in this study and is comparable with other reports [8,15,19]. In fact, it is probable that with an ageing population this figure is unlike ly to fall much lower.…”

“…Reports throughout the world confirm that up to 40% of all colorectal cancer patients are beyond a definitive cure because the cancer has already metastasized either locally or distally at the time of diagnosis [7,15,16]. The 5-year survival rate for Dukes stage A has been reported to be 90-100%, for Dukes B patients approximately 50%, for Dukes C patients 20%, and for Dukes D patients<5% [17], At present, only 10% of all excised colorectal cancers belong to Dukes stage A [ 18], It follows that the earlier the can cer is discovered, the greater the chance for a cure.…”

“…In fact, it is probable that with an ageing population this figure is unlike ly to fall much lower. Since the mortality for radical surgery is 5-6% generally today, de velopments in the operative technique are un likely to improve the survival rate in colorec tal cancer [15], Patients with ulcerative colitis remain among the most important risk groups of colo rectal cancer and should be regularly screened, as has been previously proposed [19]. This study included, however, only 2 patients with a 25-year history of ulcerative colitis, and they both had a metastasized can cer at the time of diagnosis.…”

Morbidity and Mortality Rounds in Liver Transplantation

“…The incidence of adverse events among hospitalized patients who undergo an operation is 3.0%, again with half of the cases being preventable [13]. In the United Kingdom, an acceptable mortality rate lies within 5-10% for major operations with a complication rate of 20-25% [15]. Mortality decreases as the number of surgeries performed per center and individual surgeon increases [16,17].…”

Is Colonoscopic Screening of a Low-Risk (Normal) Population Ethically Justifiable?

“…5% of people will develop colorectal cancer and 40% of this population will die of the disease [2,3]. The incidence of colorectal cancer tends to increase at about 40 years of age and is most prevalent between the ages of 60 and 75.…”