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The earlier diagnosis of adenocarcinoma of the large intestine. A report of 1,884 cases, including 5‐year follow‐up survival data, results of surgery for the disease, and effect on survival prognosis of treatment earlier in the development of the disease
Author(s) -
Gilbertsen Victor A.
Publication year - 1971
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(197101)27:1<143::aid-cncr2820270122>3.0.co;2-w
Subject(s) - medicine , rectum , adenocarcinoma , surgery , sigmoid colon , lymph node , survival rate , splenic flexure , large intestine , colorectal cancer , cancer , gastroenterology , colonoscopy
From 1940 to 1963, 1,884 patients with adenocarcinomas of the large intestine (including colon and rectum) were seen at the University of Minnesota Medical Center. Patients with lesions of the rectum comprised 53.2% of the group and numbered 1,002, including 693 (36.8%) with cancers of the rectal ampulla and 309 (16.4%) with tumors of the rectosigmoid. The remaining patients had adenocarcinomas primary in the colon, including 18.0% of the sigmoid, 16.2% of the right colon, and 12.6% of the other portions of the bowel. The overall absolute 5‐year survival rate was 30.7%. The least favorable overall survival for any bowel area (except splenic flexure) was noted for patients with cancer of the rectum. Curative resections were performed for 62.6% of patients with rectal cancers, and 12.4% had resections for palliation. One hundred fifty patients (15.3%) had palliative colostomies without resections, and only 2.5% of the series were deemed inoperable. Analysis of survival results for patients with cancers of the rectum revealed a substantial increase in the proportion of earlier cancers in patients seen during the more recent years: percentage of patients without evident lymph node involvement rose from 32.1% for the 1940–1950 group to 46.4% for the 1958–1963 group. Five‐year survival for the earlier cases, however, declined from 62.8% for 1940–1950 to 43.5% for 1958–1963. Associated with the fall in survival rates for earlier cases were substantial increases in operative mortality for patients who underwent resections for cure. Overall 5‐year survival rate for rectal cancer patients was nearly identical for the patients more recently seen (1958–1963) compared to that for the 1940–1950 group. A similar marked increase in the proportion of patients without evident lymph node involvement was observed for the patients with cancers primary in the colon: 30.4% for 1940–1950; 42.3% for 1951–1958; and 46.9% for those seen 1958–1963. Increases in operative mortality rates were of a smaller degree than were those associated with operations for rectal cancers. The overall absolute 5‐year survival rate for colon cancer patients rose from 32.6% for 1940–1950, to 35.2% for 1951–1958, to 39.0% for 1958–1963. It is concluded that these substantial increases may well be anticipated to be associated with significant betterment in overall survival as circumstances permit the reduction of rates of operative mortality to 5% or less.