Adenocarcinoma of the colon and rectum: some reflections on the immediate and long-term results of surgery.

Colorectal cancer continues to be a major public health problem in western countries. Although some studies have reported an improvement in disease-free and overall survival, few of the diagnostic and therapeutic procedures proposed have found unanimous consent. We report some reflections on both the immediate and the long-term results of colorectal cancer surgery on the basis of our experience, represented by 1164 patients with histologically proven colorectal carcinoma, admitted to the Institute of General Surgery of Parma University between 1976 and 1993 and operated on by the same surgical team, in order to provide data for scientific discussion. A curative resection was possible in 67.9% of the cases. Our experience shows that many colorectal cancer patients will be cured with aggressive surgery, although, in recent years, adjuvant therapy for colorectal cancer has advanced considerably. Statistical analyses reveal that an unfavourable prognosis is correlated with variables indicative of advanced disease. Concerning the problem of local recurrences, our results demonstrate that surgery is the only therapeutic option providing tangible results, and that intense follow-up leads to a greater number of resections carried out for local recurrence and to improved 5-year survival. Comparison of studies and scientific discussions can prove useful, above all regarding secondary prevention and, in particular, the identification of patients at risk who should undergo screening for early diagnosis and early surgical treatment.