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Query: UMLS:C0009402 (colorectal cancer)
 53,228 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A retrospective study of three hundred patients with colorectal cancer seen during a five-year period at Wellington Hospital is presented. The age incidence, anatomical distribution, tumour stage and incidence of intestinal obstruction differ from those reported in most other series. There is no correlation between delay in presentation and Dukes stage. It is suggested that colorectal cancer is a more aggressive disease in New Zealand than it is elsewhere in the world. The dangers of translating disease satistics from one country to another are emphasized.
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PMID:Colorectal cancer in New Zealand: a Wellington study. 28 29

Colorectal cancer is the leading cause of large bowel obstruction in Chile. The aim of this work was to assess the immediate results and long term survival of the surgical treatment of this complication. The clinical features of 113 patients (48 male and 65 female) with a mean age of 65 years, operated in a period of 10 years, were reviewed. The follow up was made by clinic appointments or home visits. The tumor was localized in the right colon in 30 cases, transverse colon in 20, splenic angle in 14, left colon in 39 and rectum in 10. Operative mortality was 34% for tumors of the right colon and 14% form tumors of the left colon. The follow up of the 89 survivors was accomplished in 97% with a mean follow up of 54 months (range 6 months-10 years). The principal prognostic factor was the initial stage of the tumor; survival was 87% for Dukes-Turnbull stage A, 70% for stage B and 32% for stage C1. The maximal survival period for stages D was 28 months. Patients subjected to an initial resective surgical procedure fared better, although not significantly, than colostomized patients. Present tendency is to perform one surgical procedure, avoiding colostomies that worsen patients quality of life and require a second intervention that increases surgical morbidity.
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PMID:[Colon and rectum cancer complicated with obstruction: immediate results and long-term follow-up]. 134 71

Intestinal obstruction owing to colonic carcinoma is a relatively frequent cause of acute abdominal pain. The aim of this prospective study is to evaluate the prognostic factors that may influence the final outcome of those patients operated upon for an intestinal obstruction (OG) as opposed to those electively operated upon (EG). From September 1984 to March 1988, a total of 188 patients with colorectal cancer have been included in the study. One hundred thirty-five were EG, while 53 (28.1 percent) were OG. The mean ages were similar in both groups. Sex, morbidity, and mortality rates were equally distributed. Curative resection rate was significantly higher in the EG group (P = 0.029). Tumor staging tended to be significantly more advanced in OG patients (chi-square = 9.054; df = 3; P = 0.026). Multivariate analysis (proportional hazards model) showed that the only independent prognostic factor was tumor staging (P = 0.0000). Obstruction itself disappears as a predictive variable when tumor staging is introduced in the model. We conclude that obstructing colon carcinomas tend to be more locally advanced, that probably being the only reason for a worse long-term prognosis.
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PMID:Obstructing colorectal carcinomas. Prospective study. 191 40

Acute large bowel obstruction can be the result of mechanical causes (such as colorectal cancer) or motility disturbances, the latter being termed colonic pseudo-obstruction. Whatever the aetiology, the pathophysiology of large bowel obstruction has clinical significance. Changes in motility augmented by increased colonic blood flow may play a role in dissemination of tumour cells and/or bacteria. Intravascular fluid depletion, especially shortly after intestinal decompression, has important haemodynamic implications. The diagnosis is often confirmed on plain abdominal X-ray, but water-soluble contrast studies are important in distinguishing a mechanical obstruction (which almost always requires an operation) from a pseudo-obstruction (which can usually be managed without surgery). Mortality and morbidity may be reduced by optimization of the patient's condition both before and after the operation using intensive care facilities and by careful timing of surgery. The surgical management of malignant large bowel obstruction is best directed by a senior surgeon. For tumours up to and including the splenic flexure, an extended right hemicolectomy is advisable since it offers adequate removal of the tumour and allows an immediate safe ileocolic anastomosis. More distal tumours should be resected if possible, and there is much to recommend on-table irrigation and immediate anastomosis, although a colostomy with a mucous fistula or Hartmann's procedure still have a place. Endoscopic diagnosis and decompression enables definitive surgery to be undertaken electively and several techniques are being evaluated. Non-operative reduction of sigmoid volvulus by rigid or flexible endoscopy is achieved with high success rates, but is not recommended for caecal volvulus. Resection is usually necessary in both to prevent recurrence. Mortality of colonic volvulus is closely related to bowel viability. Uncomplicated colonic pseudo-obstruction may be managed medically or by endoscopic decompression. It often occurs in association with systemic medical conditions, which need to be treated vigorously. Surgery is indicated if there are signs of impending or frank perforation, or if non-operative measures fail.
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PMID:True and false large bowel obstruction. 193 30

The data for 77 patients with colorectal cancer who underwent emergency surgery for acute intestinal obstruction (57 patients) or perforation (20 patients) within 24 h of admission were evaluated. The patients were older and had more advanced disease than patients undergoing elective surgery for colorectal cancer. Emergency surgery for carcinoma of the right colon consisted of primary resection in 95 per cent of cases and was followed by a 28 per cent mortality rate. Perforated tumours of the left colon and rectum were managed by primary resection in 82 per cent of cases with a 22 per cent mortality rate. In contrast, obstructing tumours of the left colon and rectum were treated by primary resection in 38 per cent of cases with a 6 per cent mortality rate, and by primary decompression in 62 per cent of cases with a 25 per cent mortality rate. The overall postoperative mortality rate was 23 per cent and increased with advanced tumour disease, perforation and peritonitis. Cardiac decompensation and intraabdominal sepsis were the major causes of death. Although the long-term survival rate following emergency surgery was worse than after elective surgery, improvements in outcome should be achieved by better management of the initial emergency situation.
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PMID:Outcome after emergency surgery for cancer of the large intestine. 201 67

The etiology of intestinal obstruction (I.O.) has changed markedly since the beginning of this century. In this series, the authors studied 121 cases of I.O. treated surgically; adhesions were the commonest cause of high intestinal obstruction, accounting for 43.03 percent in a total of 79 patients, with hernia being the obstruction lesion in 16.45 percent. Colo-rectal cancer were the commonest cause of low intestinal obstruction accounted for 73.81 percent, with volvulus of the sigmoid colon in 14.28 percent. Complications occurred in 15.7 percent of patients following operative intervention; wound infection was the most common postoperative complication. The overall operative mortality was 9.09 percent.
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PMID:[Surgical treatment of intestinal obstruction]. 213 92

The mechanism of bowel obstruction in colorectal cancer is likely to involve interactions between tumour cells, host fibroblasts and the extracellular matrix. The role of fibroblast-mediated matrix reorganisation in malignant structures of the large bowel was examined in an in vitro collagen matrix model in which tumour cells and fibroblasts were cultured under serum-free conditions. Colon cancer cells secreted a factor(s) which enhanced the ability of colon fibroblasts to contrast a collagen matrix without an associated mitogenic response by the fibroblasts. Within uncontracted collagen gels marked elongation of fibroblast cell processes was observed in the presence of the tumour-derived factor(s). We propose that matrix reorganisation by host fibroblasts in the wall of the human colon is responsible, at least in part, for malignant large bowel obstruction.
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PMID:The role of colon fibroblasts in malignant large bowel obstruction--an experimental in vitro model. 222 73

Over a 20-year period, 168 cases of colorectal cancer were treated in a 50-bed rural hospital by 1 surgeon. The majority of the patients were older than 70 years of age. The stage of disease was comparatively advanced, with 71% of the patients having nodal or distant metastases, 19% with bowel obstruction, and 8% with perforation. The operability and resectability rates were 100% and 96%, respectively. The crude 5-year survival was 50% for the entire series. The 5-year survival after curative operations in which there was no gross residual tumor at the end of the operation was 63%, and the 5-year survival for resection of localized node-negative disease was 81%. The wound infection rate was 2%, and the operative mortality rate was 1% for combined elective and emergency operations. The results of treatment of colorectal cancer in small rural hospitals are infrequently reported, and this series may be compared with the published results from large teaching institutions.
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PMID:Colorectal cancer in a small rural hospital. 230 33

The records of 51 patients diagnosed with enterovesical fistulas at Virginia Mason Medical Center from 1974 to 1988 were reviewed. Diverticulitis (41%), Crohn's disease (17%), and colorectal cancer (16%) were the major causes. In 50 of 51 patients, the diagnosis was made on the basis of the clinical history and the urine culture. Radiologic and endoscopic studies failed to identify the fistula in 20%, though all were confirmed at operation or autopsy. In four of eight patients with fistulas secondary to colorectal cancer, malignancy was not diagnosed preoperatively. Operation was performed in 84% of the patients. One-stage resection of the bowel was performed in 66% of patients with the intent of removing the fistula. The complication rate was 8% with no deaths. All multi-stage procedures were performed for fistulas complicated by abscess or bowel obstruction. There were two postoperative deaths in patients with metastatic cancer undergoing palliative diversion. All eight patients treated by diverting colostomy had persistent fistulas and urinary sepsis. All eight patients treated with antibiotics but without operation were free of complications of the fistula until death from other causes. Enterovesical fistula is a clinical diagnosis. Preoperative studies should be used to delineate the bowel disease and search for malignancy rather than to see the fistula, which is clinically apparent. One-stage resection of the involved bowel is the procedure of choice in the absence of abscess or bowel obstruction. When resection is not feasible, medical management with antibiotics is preferable to colostomy.
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PMID:Management of enterovesical fistulas. 233 17

Prospectively collected information on 2524 patients who had undergone "curative" resection for colorectal cancer was analysed to establish the rank-order of importance of both clinical and pathological factors affecting outcome. The patients were divided into two groups. In the first, a statistical weighting was established for each prognostic factor and those that influenced long-term survival were, in order of importance, lymph node status, tumour mobility, number of lymph nodes positive for tumour, presence of bowel obstruction, and depth of primary tumour penetration. Factors that influenced in-hospital mortality were cardiopulmonary complications, intraabdominal sepsis (without anastomotic leak), presence of bowel obstruction, and age. In the second group these mathematical weightings were applied, and the predicted and observed outcomes were in close agreement. Statistical techniques of this kind will be of value in prognosis and in analysis of the results of new treatment regimens.
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PMID:Prediction of outcome after curative resection for large bowel cancer. 287 36


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