[Cancer of the rectum: clinical and therapeutic aspects. What changes occurred during the last 2 decades?].
This retrospective study of 440 cases of cancer of rectum was done over a period of 2 decades (1970-1993) which was divided in 3 periods (1970-79, 1980-89, 1990-93) and a comparative analysis was done with respect to clinical features, histo-pathology, treatment and results. At least one predisposing lesion (polyp, villous tumour) was noted in 26.7%, 41.5% and 41.5% respectively. The topographic distribution was unchanged in all three periods. The Dukes staging showed increase in stage A with 1.9%, 9.8% and 10% respectively and decrease in stage D with 26.1%, 20.2% and 16% respectively. The operability rate was 92.3%, 94% and 96.5% respectively, resectability rate was 80%, 91.3%, 94% and 96.5% respectively, resectability rate was 80%, 91.3% and 95.9% and curative resection rate was 83.3%, 86% and 88.2% respectively. Amongst the operations done, abdomino-perineal resection was done in 55.8%, 39.5% and 7.2%; anterior resection was done in 5.5%, 36.6% and 81.4%; thus these two curves crossed in 1985. Hartmann's procedure was done in 11%, 8.7% and 4.1%. The radiotherapy was given in 6.9%, 23.9% and 75.8% respectively. Overall hospital mortality rate was 5.8% which showed progressive decrease in the 3 groups with 13.8%, 1.24% and 2% respectively. The principal factors influencing the mortality rate were the emergency presentation the type and the palliative type of operation. Overall early complication rate was 42% which showed progressive decrease in the 3 groups with 64.8%, 37% and 21% respectively. Rate of local recurrence was 17.2% which was related to the topography of the tumour, Dukes staging, type of operation, margin of resection and preoperative radiotherapy. 5 year survival rate was 43% which in relation to the curative or palliative nature of the operation and the Dukes staging. The expected progress in terms of survival depended on surgery in early stages of disease and use of radiotherapy and chemotherapy.