Adenocarcinoma of the colon and rectum: some reflections on the immediate and long-term results of surgery

Colorectal cancer continues to be a major public health problem in western countries. Although some studies have reported an improvement in disease-fr ee and overall survival, few of the diagnostic and therapeutic procedures p roposed have found unanimous consent. We report some reflections on both th e immediate and the long-term results of colorectal cancer surgery on the b asis of our experience, represented by 1164 patients with histologically pr oven colorectal carcinoma, admitted to the Institute of General Surgery of Parma University between 1976 and 1993 and operated on by the same surgical team, in order To provide data for scientific discussion. A curative resec tion was possible in 67.9 % of the cases. Our experience shows that many co lorectal cancer patients will be cured with aggressive surgery although, in recent years, adjuvant therapy for colorectal cancer has advanced consider ably Statistical analyses reveal that an unfavourable prognosis is correlat ed with variables indicative of advanced disease. Concerning the problem of local recurrences, our results demonstrate that surgery is the only therap eutic option providing tangible results, and that intense follow-up leads t o a greater number of resections carried out for local recurrence and to im proved 5-year survival. Comparison of studies and scientific discussions ca rt prove useful, above all regarding secondary prevention and, in particula r the identification of patients at risk who should undergo screening for e arly diagnosis and early surgical treatment.