HAVE THE STAGE AT THE TIME OF DIAGNOSIS A ND THE SURGICAL-MANAGEMENT OF COLONIC CANCERS CHANGED OVER THE LAST 10 YEARS - REPORT OF A SERIESOF 303 PATIENTS

The major prognostic factors in colonic cancer are parietal invasion, lymph node spread and distant metastasis, as summarized in the Dukes c lassification. The aims of this study were to find any variation of th ese parameters between patients operated in 1981 and those operated in 1991 and wheter the mortality and morbidity rate were modified. One h undred and twenty seven patients in 1981 and 176 in 1991 were consider ed. Age, sex, clinical features, tumor staging and histologic data wer e reviewed. Mortality and morbidity rates were established. Mean age w as 67 (+/- 14) in 1981 and 69 (+/- 15) in 199 1. Obstructing carcinoma s were present in 8 cases (7 %) in 1981 and 20 (13 %) in 1991. At lapa rotomy, metastases were found in 16 cases (13 %) in 1981 and 25 (14 %) in 1991. Tumors were resectable in 22 patients (17 %) in 1981 and in 23 (14 %) in 199 1. Tumor staging showed in 105 specimens in 1981 : 24 Dukes' A (23 %), 39 Dukes' B (37 %), 26 Dukes' C (25 %) and 16 Dukes' D (15 %). In 1991, the study of 153 specimens found 23 Dukes' A (15 % ), 52 Dukes' B (35 %), 54 Dukes' C (36 %) and 24 Dukes' D (16 %). None of the differences were statistically significant. Overall mortality rate in 1981 was 4.3 % (5 patients including two anastomotic leaks) an d 6 (5.2 %) patients were operated for surgical complications includin g 5 anastomotic leaks. In 1991, 3 patients (1.7 %) were operated and o nly one for an anastomotic leak. There were no deaths. Mortality and m orbidity rates were significantly different (p < 0.05) between 1981 an d 1991. As-far as Dukes classification is concerned, the prognostic va riables of colonic cancers have not changed over this ten -year period . On the other hand, the progress in surgical management allows curati ve resection without mortality.