Premium
Trends in short‐term outcomes after resection of colorectal cancer: 1971–2013
Author(s) -
Dent Owen F.,
Bokey Les,
Chapuis Pierre H.,
Chan Charles,
Newland Ronald C.
Publication year - 2016
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.13772
Subject(s) - medicine , colorectal cancer , total mesorectal excision , asymptomatic , surgery , radiation therapy , statistical significance , prospective cohort study , colorectal surgery , rectum , anastomosis , cancer , abdominal surgery
Background The aim of this study was to describe temporal trends in presentation, surgical management and immediate postoperative outcomes in patients recorded in a registry of colorectal cancer resections that was initiated at Concord Hospital, Sydney, Australia, in 1971. A companion paper describes tumour pathology and long‐term recurrence and survival. Methods This report is based on 5217 consecutive resections up to 2013, with no exclusions. Categories in variables examined were expressed as percentages over annual totals of relevant patients or annual mean values. The statistical significance of trends was examined by least squares regression. Results The percentage of asymptomatic patients increased over time, whereas urgent presentations declined. Tumour size declined. The percentage of rectal cancers fell but the percentage of low rectal tumours rose. Initially, restorative rectal resections increased rapidly but later remained stable. There was no trend in medical complications, whereas surgical complications declined. Anastomotic leakage after restorative rectal resections declined but it was low and stable for colonic tumours. The rate of early reoperation remained stable, whereas 30‐day mortality declined. Neoadjuvant radiotherapy for rectal cancer and adjuvant chemotherapy for stages B and C were introduced in 1992 and applied increasingly thereafter. Conclusion Our findings, based on a 43‐year prospective study, indicate sustained trends towards the earlier diagnosis of colorectal cancer and favourable short‐term outcomes following bowel resection.