Primacy of surgery for colorectal cancer

BackgroundThe optimal technique for curative resection of colonic cancer includes high ligation of the mesenteric vessels, wide excision of the colonic mesentery and prevention of tumour cell spillage. This article reports results from the authors' institution for patients in whom complete mesocolic excision was performed long before the term was coined. MethodsPatients operated on for cure for primary adenocarcinoma of the colon between January 1994 and December 2004 were identified from a prospectively maintained, institutional review board-approved, colorectal cancer registry. Medical records and operation notes were reviewed. The primary outcomes were recurrence (local and distal) and age-adjusted 5-year survival. ResultsSome 1013 patients (560 men and 453 women) were identified, with a median age of 69 (range 21-96) years. The most common location of the cancer was the sigmoid colon (329 per cent), followed by the caecum (267 per cent) and ascending colon (170 per cent). Operations were performed laparoscopically in 134 patients (132 per cent). Median duration of hospital stay was 7 (range 1-64, mean 82) days. Overall morbidity and mortality rates were 135 and 22 per cent respectively; there were 20 anastomotic leaks (20 per cent). Some 282 patients (278 per cent) had stage I, 386 (381 per cent) stage II and 345 (341 per cent) stage III disease. Median lymph node yield was 283 (range 0-241, mean 283), and 12 or more nodes were examined in 881 per cent of patients. Adjuvant chemotherapy was administered to 277 patients (803 per cent) with stage III disease. Overall local and distant recurrence rates at 5years were 51 and 171 per cent respectively. The 5-year local recurrence rate was 22, 53 and 77 per cent for American Joint Committee on Cancer stages I, II and III respectively. Corresponding distant recurrence rates were 40, 147 and 305 per cent. The 5-year overall cancer-free age-standardized survival rate was 853 per cent. Five-year age standardized survival rates for patients with disease stages I, II and III were 977, 908 and 698 per cent respectively. ConclusionThese data define modern results of surgery for colonic cancer with conservative use of chemotherapy. Excellent results before complete mesocolic excision was coined