Colorectal cancers--experience at a regional cancer centre in India

The incidence of colorectal cancer (CRC) shows a wide geographic variation and India along with other Asian and African countries has a low incidence. Most patients present with advanced disease and no uniform treatment guidelines are followed at present.

An audit of 91 patients treated as per IRCH protocol between June 1994 and Jun 2000 in a single surgical unit was performed.

The mean age of patients was 45.3 years (18-90 years) and there was a predominance of rectal cancer patients (Rectal vs Colon = 76% vs 24%). Majority of the rectal cancers were low rectal cancers (67%) and abdominoperineal resection was the commonest surgical procedure performed(40). The inoperability rate was 24% and sphincter salvage rate was 13%. Seventy nine percent of patients had adenocarcinoma and 90% of CRC patients belonged to Astler-Collers stage B2 and C. A total of 37 patients also received adjuvant radiotherapy and only 39 out of 60 patients planned for adjuvant chemotherapy could complete the treatment. The operative mortality was 2.2% and morbidity was 18%. A total of 13 (14%) patients had relapse of disease (local 5, regional 3, distant 5).

A significant number of CRC patients in India present with advanced stage of disease and probably due to referral bias majority had low rectal cancers. By advocating multimodality protocols a good locoregional and systemic control can be achieved despite the advanced stage of presentation.