Controversies in the treatment of colorectal cancer

Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum

Pelvic and perineal recurrences of cancer after rectal amputation are frequent, often isolated, and thus directly responsible for a fatal outcome by local decompression accidents or infection. This study explores the patterns of recurrence after "curative" operation for rectal cancers. One hundred thirteen patients who underwent abdominoperineal resection are reviewed: there were 36 local recurrences, i.e., an incidence of 31.8 percent. About 70 percent of these recurrences occurred within two years after surgical treatment. Low level of tumor in the rectum, local spread into perirectal fat or serosa, lymph node involvement, and histologic grade of malignancy were the only factors that were statistically related to local recurrence. The strategy for careful follow-up of patients at risk is outlined and a plea is made for a controlled trial of postoperative radiotherapy.

Prognostic significance of surgical perforation of the rectum during abdominoperineal resection for rectal carcinoma

Two hundred fifty patients were followed up after resection for carcinoma of the rectum. Sixty-four (25.6 percent) had a surgical perforation in the resected rectum. Perforation did not affect the long term outcome in patients with Dukes' A or D tumors, but in patients with Dukes' B and C cancers the surgical defect was associated with an increased incidence of recurrent tumor (57 versus 34 percent) and a decreased 5 year survival rate (31 versus 46 percent). The local recurrence rate was significantly higher in patients with Dukes' B rectal cancer who had an iatrogenic perforation (25.9 percent) than in those without a perforation (8.1 percent). This increased local recurrence rate was as high as the local recurrence rate in patients with Dukes' C cancers (23 percent) with or without a perforation. Patients with Dukes' B or C cancers who had incomplete resection had survival patterns similar to those in patients with Dukes' D cancers. Failure to remove all gross tumor and failure to avoid rectal perforation during abdominoperineal resection increases the risk of recurrence and decreases the chance of long-term survival.

Adenocarcinoma of the colon and rectum: a review of surgical treatment in 302 patients

A retrospective study of 302 patients who underwent surgical treatment for colorectal carcinoma from 1952 to 1971 is presented. Resectability rate was 93.7 per cent. Operative mortality rate was 5 per cent. Complications were recorded in 12 per cent of cases. Recurrence at the anastomotic line occurred in 3.31 per cent. The actuarial five-year survival rate was 44.2 per cent for all types of cancer. The "no-touch" technique utilized after 1968 resulted in increased survival of patients who had Dukes' B and C cancers.