ABSTRACT
INTRODUCTION: The surgical and oncological treatment of colorectal cancer has undergone steady evolution over the last 20 years, however nationally derived survival figures have been disappointingly slow to improve. This study is an analysis of prospectively collected data (taken over a 6-year period) on the outcome of colorectal cancer management from a single university surgical unit in New Zealand. METHODS: A comprehensive dataset was prospectively collected on all patients seen with colorectal cancer by a single surgical team, and complete follow-up was obtained. Details of surgical and oncology treatment of the primary lesion and of any subsequent disease and treatment were recorded. Survival was analysed by clinical and pathological variables. RESULTS: Over 6 years, 244 new patients with a total of 263 primary colorectal cancers were seen.; 97% of these patients had an operation and 95% had the primary tumour resected. The mortality after elective operation was 0.5% (1/197) and 8% (3/39) after urgent or emergency surgery. After a median follow-up of 32 months, recurrence in the pelvis was apparent in 1 of 72 patients after curative resection of rectal cancer and 4 of 18 after palliative resection, thus giving a total pelvic recurrence rate of 6% at 30 months. The 5-year survival rate of all new patients seen with a rectal cancer was 58% and 56.5 % for patients with a colon cancer. CONCLUSIONS: A combination of low operative mortality rates, low local recurrence rates in rectal cancer, the increasing use of adjuvant therapies, and careful follow up to detect (and where possible resect) metastatic disease at an early stage is associated with good cancer-specific survival figures. However further improvement in survival will need a shift to earlier stage at diagnosis and more effective chemotherapy (both in the adjuvant setting and for advanced disease) if significant gains in survival are to be made.
