Results of the treatment of colorectal cancer complicated by obstruction.

654 patients with colorectal cancer were operated on during the period 1982-1993. Acute surgical intervention was performed in 232 cases because of large bowel obstruction, whereby the obstruction tumor was localized in the colon in 160 patients and in the rectum in the remaining 72 patients. 53 of the patients were designated as stage T3,4N-M0 stage, 97 as T3,4N+M0 and 82 as T3,4N+/-M1. Histologically, well- and moderately-differentiated adenocarcinoma was diagnosed in 69%, poorly differentiated and mucinous adenocarcinoma in 29% and squamous cancer in 2% of the cases. The patients were distributed in 4 groups according to the clinical presentation of the obstruction: acute (n = 60), subacute (n = 52), recurring (n = 42) and chronic (n = 78) forms. 122 radical and 110 palliative operations were performed. 34% of the patients had postoperative complications. The overall postoperative mortality was 25% AND it was highest in one-stage operation with a primary anastomosis (p < 0.05). The 5-year survival in patients with obstructive colon and rectal tumours was 32% and 27%, respectively (p = 0.631). The patients with differentiated adenocarcinoma have a better prognosis, as well as those without regional lymph node metastases (p < 0.05). The patients without obstruction operated on during the same period, had a higher 5-year survival for both colon (p < 0.01) and rectal (p < 0.0019) cancer.