The prognosis after surgical treatment for carcinoma of the rectum

Abstract

Abstract The results of surgical treatment of 550 cases of carcinoma of the rectum presenting to the Professorial Surgical Unit of the General Infirmary, Leeds, from 1955 to 1968 have been analysed. Operation of some kind was undertaken in 98.5 per cent of the cases and rectal excision in 90.5 per cent. The operative mortality for all the cases undergoing rectal excision was 10.6 per cent, for those having anterior resection 6.8 per cent and for those submitted to combined abdominoperineal excision 12.5 per cent. The commonest causes of death were various forms of sepsis and cardiothoracic complications. The corrected 5-year survival rate for all the immediate survivors of rectal excision was found to be 56. 0 per cent. For cases having Dukes' A lesions it was 91.9 per cent, for those with B lesions 71.3 per cent and for those with C lesions 37.7 per cent. For patients treated by sphincter-saving resection it was 68.3 per cent and for those submitted to combined excision 47.2 per cent. The 5-year survival rate was also found to be adversely affected by, among other factors, extensive circumferential spread of the primary growth in the bowel wall, fixity of the lesion, involvement of the overlying or adjacent peritoneum and the presence of hepatic metastases, but the prognosis with these developments was sometimes better than might have been anticipated.