Colorectal carcinoma. A survey of 1345 cases 1950-1984

A 35-year (1950-1984) experience of colorectal carcinoma is surveyed. Intendedly curative resection was performed in 941 (70%) of the 1345 patients, this proportion being constant throughout the study. The operative mortality was 4.6%, falling from 12% in the early 1950s to less than 1%. Five-year survival, calculated for 1066 patients seen in 1950-1979, was 35% overall and 49% after surgery with curative intent. Improved survival rates were mainly due to decline in operative mortality. In Dukes' stages A, B and C the respective 5-year rates were 83, 48 and 22%. Retention of the original Dukes' system is advocated. Further improvement in results probably cannot be achieved via surgical management. Intensive follow-up routines have not revealed significant numbers of curable recurrences, and adjuvant treatment has been disappointing. To improve the long-term prospects, earlier diagnosis seems to be essential. Screening for fecal occult blood may be valuable, but proof awaits the results of randomized clinical trials.