Palliative operative management in rectal carcinoma

The results of palliative operative management of 338 patients with rectal carcinoma managed by one of the authors are presented. Postoperative mortality was higher for patients undergoing palliative resection (11.7 per cent) than colostomy bypass (5.3 per cent) or diagnostic laparotomy (6.8 per cent). Cancer specific survival following palliative resection was significantly (P less than 0.001) longer than that following colostomy bypass or diagnostic laparotomy for tumor Stages D1 (local visceral involvement) and D2 (distant metastases). However, in patients with liver or peritoneal metastases alone, cancer specific survival did not differ significantly after the operations of resection or colostomy bypass. The failure to demonstrate improved survival after resection of the primary tumor in these latter two groups with distant metastases indicates the dominant role of volume of tumor tissue present in these situations. The results suggest that longer survival following palliative resection reflects a bias of patient selection towards more favorable cases.