Reassessment of intraoperative decisions: why operations for cancer of the large bowel fail

A program developed for the intraoperative judgement decisions commonly faced in cancer of the colon and rectum has been published and has been found to correlate frequently with the management carried out in a cancer hospital and on the ward services of university programs in city/county and Veterans Administration hospitals. Those patients whose management varies with the recommendations of the program are subject to statistically significant excess risk of dying in the hospital and excess risk of failure of ultimate control of their malignant process. It is our opinion that this program is not only useful in demonstrating the explicit nature of surgical judgement but is also useful to the operating surgeon as an indication for the need for consultation or reassessment of his obwervations.