[Risk-related surgical treatment of colorectal tumors]

By long-time follow-up studies the authors maintain that the prognosis of colonic cancer is determined by distant metastases whereas the prognosis of rectal cancer after surgery for cure is essentially dependent on local recurrences. From that the consideration is derived to improve the prognosis of colonic cancer by an adjuvant chemotherapy, and of rectal cancer by increasing locoregional radicality which can only be attained by preoperative and/or postoperative irradiation. The individual risk of recurrence should be the indicator for an adjuvant therapy in addition to surgery. Some histological signs (grading of the tumour, cellular stromal reaction on the tumour site) correlate with prognosis and risk of recurrence. In this way it seems to be possible to define the high risk cases which may be improved by an adjuvant therapy.