Audit of definitive colorectal surgery in patients with early and advanced colorectal cancer

Abstract

The role of surgery in patients with advanced colorectal cancer may be questioned in the era of specialized intensive palliative care. Should patients with advanced disease be advised against surgery because of the risks of the surgery itself? In this study, the perioperative outcomes in patients undergoing definitive surgery for early (Dukes' stages A, B and C) and advanced colorectal cancer (stage D) were examined. All patients undergoing definitive surgery for colorectal cancer during a 15-year period were identified. Details of tumour site and stage, surgery performed, perioperative complications and postoperative mortality were compared. A total of 374 patients underwent definitive surgery. There were 193 men, a male : female ratio of 1:0.9. Seventy-one patients had advanced disease. There were no differences between the early and advanced groups in perioperative requirements for either blood or total parenteral nutrition. In the advanced group, more operations were performed as emergencies than in the early group (32.4 vs 17.5%; P < 0.01) and more patients presented with bowel obstruction in the advanced group (23.9 vs 10.2%; P < 0.01). There were no site differences between the early and advanced groups and no differences between the operations performed except that endo-anal destruction was not performed in advanced patients. There were no differences in perioperative morbidity or mortality in the groups studied. Resection rates, operation type and postoperative morbidity and mortality were similar in patients with both early and advanced colorectal cancers. In terms of perioperative outcome, the presence of advanced cancer, per se, should not, therefore, be a justification to decline surgery.