Abstract
Background
Recent reports based on registry data have shown that survival after surgery for colorectal cancer is improving in the UK. It is not clear whether these improvements are due to earlier presentation or more effective treatment.
Methods
Outcome for 645 patients with colorectal cancer admitted to Glasgow Royal Infirmary between 1974 and 1979 was compared with that for 354 patients admitted between 1991 and 1994.
Results
More patients in the later period had Dukes' A or B tumours and fewer had evidence of metastatic spread (P < 0ยท001); more underwent potentially curative resection (57ยท6 versus 49ยท9 per cent; P < 0ยท001) and fewer underwent palliative diversion. The overall postoperative mortality rate fell from 14ยท1 to 8ยท5 per cent (P = 0ยท017). Overall and cancer-specific 5-year survival after potentially curative resection increased from 40ยท1 to 60ยท5 per cent and from 47ยท3 to 71ยท7 per cent respectively (both P < 0ยท001). Compared with the earlier period, the adjusted hazard ratio for cancer-specific survival following potentially curative resection was 0ยท452 (95 per cent confidence interval 0ยท329 to 0ยท622; P < 0ยท001).
Conclusion
The observed improvement in survival was mainly due to improvements in the quality of surgery and in perioperative care rather than earlier presentation.