Skip to main content
SpringerLink
Log in

Surgical Technique and Survival in Patients Having a Curative Resection for Colon Cancer

  • Published:
Diseases of the Colon & Rectum

Abstract

PURPOSE: This study was performed to determine whether the adoption of a standardized technique for resection of colon cancer, based on mobilization along anatomic planes, resulted in improved survival after adjustment for other known prognostic factors. METHODS: Patients undergoing a potentially curative, elective colonic resection at Concord Hospital from 1971 to 1995 were included. None received adjuvant therapy. Data were recorded prospectively. Overall survival and colon-cancer–specific survival were examined by the Kaplan-Meier method and proportional-hazards regression in relation to patient and tumor characteristics and the introduction of a standardized surgical technique in 1980. RESULTS: Overall five-year survival rose from 48.1 percent before 1980 to 63.7 percent after 1980 (P < 0.0001); cancer-specific survival rose from 66.4 percent to 76.6 percent (P = 0.002). Factors that did not change significantly before and after 1980 were patient age and gender, tumor site, stage, grade, serosal surface involvement, and apical node metastases. The proportion of tumors ≥5 cm in diameter decreased after 1980 (61.9 to 49.2 percent, P = 0.001) but survival was unrelated to size. Venous invasion rose after 1980 (9 to 15.8 percent, P = 0.014). Multiple regression with adjustment for age, stage, grade, venous invasion, serosal surface involvement, and apical node metastases showed significantly shorter overall survival before the introduction of the standardized technique (hazard ratio, 1.5; 95 percent confidence interval, 1.2–1.8) and significantly shorter colon-cancer–specific survival (hazard ratio, 1.7; 95 percent confidence interval, 1.3–2.2). The proportion of patients having a noncurative operation because of residual tumor in a line of resection (excluded from the survival analyses) fell from 10.6 percent (confidence interval, 7–15.3 percent) before 1980 to 3.2 percent (confidence interval, 2–4.9 percent) after 1980. CONCLUSION: As in rectal cancer surgery, mobilization of the colon along anatomic planes is an important principle that influences outcome and needs to be emphasized.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  2. D Hoffmann J Moore D Roder (1997) ArticleTitleTrends in survival from colonic cancer Aust N Z J Surg 67 842–845

    Google Scholar 

  3. Y Koyama K Kotake (1997) ArticleTitleOverview of colorectal cancer in Japan Dis Colon Rectum 40 2–9

    Google Scholar 

  4. I Arveux MC Boutron T El Mrini et al. (1997) ArticleTitleColon cancer in the elderly Br J Cancer 76 963–967

    Google Scholar 

  6. P Blomqvist A Ekbom O Nyren U Krusemo R Bergstrom HO Adami (1997) ArticleTitleSurvival after colon cancer 1973–1990 in Sweden. Convergence between catchment areas Ann Surg 225 208–216

    Google Scholar 

  7. PH Chapuis OF Dent EL Bokey RC Newland G Sinclair (1999) ArticleTitlePrise en charge du cancer colo-rectal dans un hôpital australien Ann Chir 1 9–18

    Google Scholar 

  8. P Prior CB Woodman S Collins (1998) ArticleTitleInternational differences in survival from colon cancer Br J Surg 85 101–104

    Google Scholar 

  9. JE Frazer RH Robbins (1916) ArticleTitleOn the factors concerned in causing rotation of the intestine in man J Anat Physiol 50 75–110

    Google Scholar 

  11. IP Bissett KY Chau GL Hill (2000) ArticleTitleExtrafascial excision of the rectum Dis Colon Rectum 43 903–910

    Google Scholar 

  12. H Fritsch (1994) ArticleTitleTopography and subdivisions of the pelvic connective tissue in human foetuses and in the adult Surg Radiol Anat 16 259–265

    Google Scholar 

  14. RC Newland OF Dent PH Chapuis EL Bokey (1993) ArticleTitleClinicopathologically diagnosed residual tumor after resection for colorectal cancer. A 20-year prospective study Cancer 72 1536–1542

    Google Scholar 

  15. WB Gabriel CE Dukes HJ Bussey (1935) ArticleTitleLymphatic spread in cancer of the rectum Br J Surg 23 395–413

    Google Scholar 

  16. RK Phillips R Hittinger L Blesovsky JS Fry LP Fielding (1984) ArticleTitleLocal recurrence following ‘curative’ surgery for large bowel cancer Br J Surg 71 17–20

    Google Scholar 

  17. EL Bokey PH Chapuis OF Dent et al. (1997) ArticleTitleFactors affecting survival after excision of the rectum for cancer Dis Colon Rectum 40 3–10

    Google Scholar 

  18. GA Porter CL Soskolne WW Yakimets SC Newman (1998) ArticleTitleSurgeon-related factors and outcome in rectal cancer Ann Surg 227 157–167

    Google Scholar 

  19. H Kessler P Hermanek (1998) ArticleTitleOutcomes in rectal cancer surgery are directly related to technical factors Semin Colon Rectal Surg 9 247–253

    Google Scholar 

  20. IP Bissett GS McKay BR Parry GL Hill (2000) ArticleTitleResults of extrafascial excision and conventional surgery for rectal cancer at Auckland Hospital Aust N Z J Surg 70 704–709

    Google Scholar 

  21. CS McArdle D Hole (1991) ArticleTitleImpact of variability among surgeons on postoperative morbidity and mortality and ultimate survival BMJ 302 1501–1505

    Google Scholar 

  22. M Killingback P Barron OF Dent (2001) ArticleTitleLocal recurrence after curative resection rectum without total mesorectal excision Dis Colon Rectum 44 473–486

    Google Scholar 

  23. H Kessler U Mansmann P Hermanek SuffixJr ST Riedl D Staimmer P Hermanek (1998) ArticleTitleDoes the surgeon affect outcome in colon carcinoma? Semin Colon Rectal Surg 9 233–240

    Google Scholar 

  24. M Jagoditsch PH Lisborg GR Jatzko et al. (2000) ArticleTitleLong-term prognosis for colon cancer related to consistent radical surgery World J Surg 24 1264–1270

    Google Scholar 

  25. EL Bokey B Öjerskog PH Chapuis OF Dent RC Newland G Sinclair (1999) ArticleTitleLocal recurrence after curative excision of the rectum for cancer without adjuvant therapy Br J Surg 86 1164–1170

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Colorectal Surgery, The University of Sydney at Concord Hospital, Sydney, New South Wales, Australia, the School of Social Sciences, The Faculties, The Australian National University, Canberra, Australian Capital Territory, Australia, and the Division of Anatomical Pathology, Concord Hospital, Sydney, New South Wales, Australia

    E. L. Bokey M.S., P. H. Chapuis D.S., O. F. Dent Ph.D., B. J. Mander M.D., I. P. Bissett M.D. & R. C. Newland M.D.

Authors
  1. E. L. Bokey M.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. H. Chapuis D.S.
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. F. Dent Ph.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. J. Mander M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. I. P. Bissett M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. R. C. Newland M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

About this article

Cite this article

Bokey, E.L., Chapuis, P.H., Dent, O.F. et al. Surgical Technique and Survival in Patients Having a Curative Resection for Colon Cancer. Dis Colon Rectum 46, 860–866 (2003). https://doi.org/10.1007/s10350-004-6673-3

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10350-004-6673-3

Keywords

Search

Navigation