[Did the stage of diagnosis and the surgical management of colonic cancers change over the last ten years? Apropos of 303 patients].

The major prognostic factors in colonic cancer are parietal invasion, lymph node spread and distant metastasis, as summarized in the Dukes classification. The aims of this study were to find any variation of these parameters between patients operated in 1981 and those operated in 1991 and whether the mortality and morbidity rate were modified. One hundred and twenty seven patients in 1981 and 176 in 1991 were considered. Age, sex, clinical features, tumor staging and histologic data were reviewed. Mortality and morbidity rates were established. Mean age was 67 (+/- 14) in 1981 and 69 (+/- 15) in 1991. Obstructing carcinomas were present in 8 cases (7%) in 1981 and 20 (13%) in 1991. At laparotomy, metastases were found in 16 cases (13%) in 1981 and 25 (14%) in 1991. Tumors were resectable in 22 patients (17%) in 1981 and in 23 (14%) in 1991. Tumor staging showed in 105 specimens in 1981: 24 Dukes' A (23%), 39 Dukes' B (37%), 26 Dukes' C (25%) and 16 Dukes' D (15%). In 1991, the study of 153 specimens found 23 Dukes' A (15%), 52 Dukes' B (35%), 54 Dukes' C (36%) and 24 Dukes' D (16%). None of the differences were statistically significant. Overall mortality rate in 1981 was 4.3% (5 patients including two anastomotic leaks) and 6 (5.2%) patients were operated for surgical complications including 5 anastomotic leaks. In 1991, 3 patients (1.7%) were operated and only one for an anastomotic leak. There were no deaths. Mortality and morbidity rates were significantly different (p < 0.05) between 1981 and 1991. As far as Dukes classification is concerned, the prognostic variables of colonic cancers have not changed over this ten-year period. On the other hand, the progress in surgical management allows curative resection without mortality.