MANAGEMENT OF COLORECTAL-CANCER IN 3 SOUTH THAMES DISTRICT HEALTH AUTHORITIES

This study describes the management of colorectal cancer, diagnosed in 1988, of residents in three South Thames Districts. Of the 328 cases identified as having being diagnosed in 1988, case notes were retrieve d on 263 (80%) including 62 registered by death certificate only. Ther e were 159 cases (61%) of colon cancer and 104 cases (39%) of rectal c ancer. Of these, 172 cases (68%) were admitted electively and 90 (32%) as emergencies. Patients subsequently diagnosed with colon cancer had a relative risk of being admitted through emergency (relative to rect al cancer patients) of 1.39 (95% C.I.: 1.16, 1.67). Elective admission s varied significantly by district of residence (P < 0.0001) ranging f rom 36-65% for colon cancers and from 63-92% for rectal cancers across the three districts. Dukes' stage was recorded in only 143 (54%) sets of case notes, with significant variation by district of residence in the proportion of elective patients for whom a Dukes' stage was indic ated (P < 0.01) Two-hundred and thirty-six (90%) cases received treatm ent. Of the treated cases, 233 patients received surgery with 29 cases of colon cancer (18%) and 32 cases of rectal cancer (31%) receiving a djuvant therapy. The proportions of anterior resection, AP resection a nd colostomies given, varied by district. Patients presenting for elec tive surgery were more likely to be treated by a consultant than patie nts presenting on emergency: the relative risks were 2.58 (95% C.I.: 1 .74, 3.82) for colon cancer patients and 4.93 (95% C.I.: 2.20, 11.06) for rectal cancer patients. In 44 (26%) colon cancer cases and 21 (22% ) rectal cancer cases it was explicitly stated that the tumour had not been fully resected. For colon tumours the five year relative surviva l rates were 35% (95% C.I.: 21%, 50%), 52% (95% C.I.: 34%, 70%), and 1 4% (95% C.I.: -2%, 30%) in districts A, B and C respectively. The corr esponding figures for rectal tumours were 45% (95% C.I.: 27%, 64%), 62 % (95% C.I.: 41%, 83%) and 24% (95% C.I.: -1%, 50%). There were wide v ariations in the representation, management of and survival from color ectal cancers across the three districts. Differences were significant at the level of district of residence, mode of presentation and surgi cal grade. More assiduous recording of Dukes' stage is imperative if c onsensus is to be achieved on effective management. Further work is al so warranted on district differences in diagnostic and referral protoc ols.