COLORECTAL-CANCER IN PATIENTS WITH PREVIOUS SPINAL-CORD INJURY

BACKGROUND: The optimum management of large-bowel cancer in patients w ith previous spinal cord injury (SCI) is uncertain. PURPOSE: The aim i s to determine the outcome of patients with SCI who are undergoing col ectomy or proctectomy for cancer. METHODS: A population-based study of patients receiving care at hospitals in the Department of Veterans Af fairs system from 1987 to 1991 was performed. Patients with ICD-9 code s for SCI and colon and rectal cancer were identified. Patients with p revious SCI who underwent colectomy or proctectomy for their cancer co mprised the study population. Data were compiled from national compute rized Veterans Affairs datasets, supplemented by individual operative reports and discharge summaries. RESULTS: Forty-four patients were eva luable. Mean age was 65 (range, 40-80) years, and mean time since SCI was 24 (range, 1-50) years. Mean follow-up was 4.6 years after resecti on. Distribution of tumors was 39 percent right-sided, 43 percent left -sided, and 18 percent rectal. All 32 patients with colonic tumors und erwent resection; 26 of 32 patients (81 percent) had an anastomosis. S even of eight (88 percent) rectal lesions were treated by abdominoperi neal resection. Twenty-six of 44 patients (59 percent) presented with Stage III or IV disease. Twelve of 44 (27 percent) died, 8 of 12 from cancer. Overall 30-day mortality rate was 4.5 percent (2/44). In-hospi tal morbidity rate (pulmonary, cutaneous, and urinary tract only) was 34 percent. Among those who received postoperative chemotherapy, 80 pe rcent completed treatment. CONCLUSIONS: Patients with previous SCI tol erate resection well. Tumor distribution and stage are similar to thos e of neurally intact patients. Morbidity is commonly related to pre-ex isting complications of SCI. Adjuvant therapy is well tolerated.