Adenocarcinoma of the colon and rectum: a report on 624 cases

A total of 624 patients with adenocarcinoma of the large bowel and operated between 1958 and 1978 were retrospectively studied. According to the period of operation, patients were divided into group A (1958 to 1968, n = 259) and group B (1969 to 1978, n = 365). Symptoms were closely related to tumour location. Blood loss and change in bowel habits were most frequent in patients with left-sided cancer, while anaemia, loss of body weight and abdominal pain turned out to be the predominant symptoms in patients with right-sided cancer. Patients with cancer of the transverse colon or splenic flexure showed a high incidence of ileus (19%). Resection of the primary tumour was possible in 86% of the cases. The overall morbidity was 48% and the postoperative mortality was 8%. Anastomotic dehiscence occurred in 4% of our patients. There was no significant difference in postoperative mortality between the two patient groups. The mortality is closely related to the Dukes stage (Dukes A 4%, Dukes D 19%). The overall crude survival was 45%, the corrected survival 57%. Patients with cancer of the descending colon or (recto)sigmoid had a higher corrected 5-year survival when compared to patients with cancers in other tumour sites (65% versus 52%, p less than 0.01). Dukes stage, ileus as primary symptom were also correlated with survival, while sex distribution, age and duration of symptoms were not.