OUTCOME IN COLORECTAL ADENOCARCINOMA - 2 7-YEAR STUDIES OF A POPULATION

Objective-To record every patient with proved colorectal adenocarcinom a presenting from a defined population over two years in 1968-9 and du ring 1980-2, and to compare treatment and outcome over seven years. De sign-Retrospective in 1968-9 and prospective in 1980-2. Setting-Aberde en general hospitals. Subjects-Every patient presenting to the four ge neral surgical units with histological proof of colorectal adenocarcin oma. Main findings-On average, one new patient presented each week per 100000 population. The proportion of patients aged 65 and over rose f rom 67% to 71%. An operation was performed on 385 patients in 1968-9 a nd on 399 during 1980-2. At laparotomy the proportion of patients who seemed to be curable and had a radical operation rose slightly, from 5 6% to 61%, and operative mortality fell from 9% to 5%. In all there we re 421 survivors of curative surgery, and seven years later three quar ters 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 treatm ent of colorectal adenocarcinoma is substantial, with three quarters o f patients so treated showing no evidence of recurrence after seven ye ars. Operative mortality in an elderly population is now low, and impr ovement in late outcome is more likely to come from developments in ad juvant therapy than in operative technique. A continuing problem is th at 40% of patients are not curable when they present, although palliat ive resection can now be offered to over 80%.