Carcinoma of the caecum

This study presents a review of 519 of 553 unselected patients with carcinoma of the caecum presenting in the Plymouth Health District between 1975 and 1987. A large proportion of the patients were elderly and the median age increased throughout the study period to 76 years. One third of cases presented as an emergency and a small number was discovered at autopsy. Bowel obstruction accounted for over half the emergencies and chronic anaemia for half the elective cases. At presentation many tumours were advanced and only 5% were Dukes' A. One quarter of patients had synchronous tumours. Resection was performed in most cases, and this was attempted even in the presence of local invasion and liver metastases. Morbidity following resection was low and only six anastomotic leaks were clinically apparent. The mortality rate following resection was 2.6% and was higher for emergency procedures. The age-adjusted 5-year survival rate was 37% and rose to 64% for those undergoing 'curative' surgery. These results suggest that future improvements in the management of right colon cancer may lie with early referral and diagnosis. This study further highlights the importance of good perioperative care in the increasingly elderly patient.