ABSTRACT
Background: Clinical predictors of death and survival in
surgical treatment of colon cancer are
easily confounded by the modern adjuvant and neo-adjuvant
chemotherapy. This study focuses on lethality and survival during
implementation of ultra-radical surgery for colonic cancer prior to multimodal
therapy. Methods: Retrospective observational follow-up study of 824
consecutive, unselected patients resected for Stage I, II, III and IV colon
cancer from 1990 until 2000 at one tertiary centre, with a median follow-up of
45 months (0 - 202 months). Predictors for death were assessed by Cox
regression analyses and log-rank test. The cause of death was obtained from the
Norwegian Cause of Death Registry. Results: The relative survival rates
were 86.3%, 71.9%, 50.3% and 6.6% in Stage I, II, III and IV, respectively. In
28.7% of the patients, the cause of death
was other than colorectal cancer recurrence. The adjusted Cox regression model showed that higher age (1.04 (95% CI: 1.03; 1.05)), male gender (1.37 (1.14; 1.66)), emergency surgery (1.52 (1.21; 1.93)), left vs. right hemicolectomy (1.39 (1.03;
1.87)), and perioperative blood transfusion (1.25 (1.01; 1.55)) were
predictors of reduced survival. Health without known comorbidity (0.71 (0.58;
0.88)), D2 versus D1 lymph node dissection (0.66 (0.53; 0.83)) and tumour Stage
I, II, III versus Stage IV 0.10 (0.06; 0.16), 0.14 (0.11; 0.19), 0.23 (0.18;
0.30) were associated with prolonged survival. Conclusions: In 28.7% of
the patients, the cause of death was other than colorectal cancer recurrence.
Age, sex, comorbidity, emergency resection,
lack of lymph node dissection, tumour stage, and preoperative blood transfusions are all significant predictors for reduced survival after
surgery for colon cancer.