Colorectal cancer surgery in a district general hospital

The purpose of our study was to audit colorectal cancer surgery in a large district hospital, compare our results with other series and highlight any areas in patient management where improvements could be made. A comprehensive audit was undertaken of all patients undergoing surgery for colorectal adenocarcinoma over a 2-year period (December 1989 to November 1991). Two hundred and twenty-two patients were studied. General practitioner referrals were seen within 8 weeks in 140 (96%) of 149 cases. Delay to diagnosis was associated with barium enema examination. A consultant or senior registrar was present at 187 (84.2%) of operations, and only two (0.9%) were undertaken between 24.00 and 08.00 hours. For rectal tumours the ratio of anterior resection to abdomino-perineal excision was 2:1. Eight of nine anastomotic leaks followed low anterior resection. All required re-operation and three died. The overall in-hospital mortality was 17 (7.7%). Although our results compare favourably with other published series, several areas for potential improvement in management have been identified.