Obstructing carcinomas of the colon

Abstract

A series of 908 cases of colonic carcinoma has been analysed to elucidate reasons for the poor prognosis in obstructing colonic cancer. Complete obstruction was present in 148 cases (16·3 per cent), 280 cases (30·8 per cent) had partial obstruction and 480 (52·8 per cent) presented without obstruction. There were fewer Dukes' A tumours in those with complete obstruction (P <0·005) and greater numbers of advanced tumours (P <0·0005) compared with those without obstruction. This is reflected in a lower curative resection rate of 50·7 per cent in those with obstruction compared with 70·6 per cent in those without obstruction (P <0·001). However, after curative resection there was no significant difference in the distribution of tumour stage. Patients with complete obstruction showed a higher incidence of recurrence (P <0·01) after curative resection, consequent to an increased incidence of local recurrence (P <0·02). Five-year cancer-specific survival for the total series was decreased from 59·1 per cent in patients without obstruction to 31·8 per cent in those with complete obstruction (P <0·001). After curative resection there was also a significant reduction in survival (P <0·001). It is concluded that completely obstructing colonic cancers are more aggressive than other colonic cancers.