Colorectal cancer: A continuing problem

Outcome in 645 patients presenting with colorectal cancer between 1974-9 and a subsequent cohort of 483 patients presenting between 1980-4 was compared, During both periods studied, approximately one third of patients presented as emergencies, over one third had clinical evidence of local tumour fixity at the time of initial presentation and approximately one quarter had distant metastases. Approximately 80% of patients presenting electively underwent resection; postoperative mortality was approximately 10%. Resection rates were lower and postoperative mortality higher in the elderly and those presenting as emergencies, Overall survival at five years was 31% for patients undergoing elective surgery and 12% for those presenting as emergencies.

Despite the improvements in surgery and peri-operative care, no significant differences in outcome were noted between the two periods studied. This is probably a reflection of the high proportion of patients who present as emergencies and the advanced stage of the disease at the time of initial presentation.