Management and survival of patients with adenocarcinoma of the colon and rectum: A national survey of the commission on cancer

BACKGROUND: The Commission on Cancer (COC) of The American College of Surgeons periodically reviews criteria for evaluation of the care of patients with cancer related to diagnosis, treatment, rehabilitation, and follow-up. The COC annually performs a national survey of practices for several cancer sites. STUDY DESIGN: Data collection forms for carcinoma of the colon and rectum were field-tested and then forwarded to participating hospitals. The study included a long-term survey to permit evaluation of five-year survival rates and a short-term survey to review current practices and time trends. Specific questions were asked concerning disease presentation, preoperative evaluation, surgical treatment, postoperative care, use of adjuvant therapy, and disease status at the last follow-up examination. RESULTS: A total of 39,502 reports from 943 hospitals were analyzed, including 12,682 patients with carcinoma of the colon diagnosed in 1983, 16,527 patients with carcinoma of the colon diagnosed in 1988, 4,597 patients with carcinoma of the rectum diagnosed in 1983; and 5,696 patients with carcinoma of the rectum diagnosed in 1988. Patterns of care, including changes in presentation, diagnostic and therapeutic management, and survival rates, are presented. Specific data showing results for various ethnic groups are also included. CONCLUSIONS: The distribution of cases by anatomic site was consistent with a hypothesis of rightward migration of colon carcinoma. Colon and rectal carcinomas in African-Americans were reported in more advanced stages and with corresponding decreases in survival rates. Some patterns of nonoptimal diagnostic use were noted. The increasing use of sphincter-sparing surgical alternatives for carcinoma of the rectum was evident. Adjuvant therapy was not widely used during this period. This study suggests evolving patterns of evaluation, increased preservation of continence, and improved but varying survival among ethnic groups. It further suggests that survival as measured across these 943 hospitals may be lower than that attained at some individual centers.