title: Changes in outcome following surgery for colorectal cancer: one surgeon's experience.
abstract: BACKGROUND
  Colorectal cancer (CRC) has the second highest mortality rate of all cancers in Ireland. Developments in imaging, surgical technique, and perioperative care in the last two decades have altered management.
  
  
  OBJECTIVE
  To determine whether outcome following surgery for CRC in the mid-west has changed over a 22-year period.
  
  
  METHODS
  Four hundred and twenty-two patients were divided into two time periods: Group A (1980-1991, n = 203) and Group B (1992-2002, n = 219) and demographic, inpatient, and survival data were reviewed.
  
  
  RESULTS
  The mean age was 67 years, 59% were male. Group B patients had less advanced disease at presentation (Dukes' stage D 14% vs 22%, p < 0.05), fewer perioperative complications (13% vs 23%, p < 0.05), and fewer local recurrences (6.8% vs 11.8%, p < 0.05) than Group A. No difference in 30-day mortality rate or survival was detected.
  
  
  CONCLUSIONS
  Although perioperative CRC management has improved, methods of earlier diagnosis and improvements in adjuvant therapy should be explored to improve survival.
authors.affiliation: Dept of Surgery, Midwestern Regional Hospital, Dooradoyle, Limerick. eamonkav@indigo.ie
authors.forename: J M
authors.initials: JM
authors.lastname: Kiely
authors.forename: E G
authors.initials: EG
authors.lastname: Kavanagh
authors.forename: A M
authors.initials: AM
authors.lastname: Guiney
authors.forename: C
authors.initials: C
authors.lastname: Fiuza-Castineira
authors.forename: P V
authors.initials: PV
authors.lastname: Delaney
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000379:methods; D001707:Biopsy, Needle; D002423:Cause of Death; D015331:Cohort Studies; D003082:Colectomy / Q000009:adverse effects / Q000379:methods*; D003113:Colonoscopy / Q000379:methods; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D015994:Incidence; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality*; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D016019:Survival Analysis