Obstruction and perforation complicating colorectal carcinoma. An epidemiologic and clinical study with special reference to incidence and survival.

Comparisons were made between all patients who underwent emergency surgery for complicated colorectal carcinoma in Finland in 1975 and all who were electively operated on for the disease in the same period. The overall incidence of tumour complications was 18% (29% in colon and 7% in rectum). Obstruction alone was present in 15% and perforation with or without obstruction in 4%. The mean age in the "emergency group", 69.5 years, was 4 years higher than in the "elective group". Resectability for cure was 47% and 66% in the respective groups. The 21% mortality associated with emergency surgery was four times the rate after elective surgery. The observed 5-year survival rates were 18% and 35%. Relative 5-year survival, excluding surgical mortality, was 31% vs. 48%, overall and 54% vs. 68% after resection for cure. The excess mortality in the emergency compared with the elective group accrued only in the first 6 postoperative months. In complicated colorectal cancer, intensive treatment is necessary even after the immediate postoperative period. Early diagnosis should be sought even in elderly patients, as the prospects are better after elective than after emergency surgery.