title: Survival, surgical management and perioperative mortality of colorectal cancer in the 21-year experience of a specialised registry.
abstract: OBJECTIVE
  A general improvement of colorectal cancer prognosis has been observed. Reasons of this more favourable trend are diffusion of screening, advancements in molecular biology, new developments in chemotherapy and surgical techniques. Through the data of a colorectal cancer registry, we purposed to evaluate changes in surgical procedures for colorectal neoplasms and to analyse trends of perioperative mortality.
  
  
  METHODS
  Patients with colorectal cancer were registered from 1984 to 2004. The main surgical procedures were recorded and classified. Perioperative mortality was defined as death of patients within 1 month since the operation.
  
  
  RESULTS
  Regression analysis showed an increase over time of right and left hemicolectomy. Both colectomy and endoscopic polypectomy showed significant rise over time. In contrast, abdominoperineal operations dropped during the study period. A similar decrease was observed for palliative surgery. Perioperative mortality declined from 7-11% to 3-6% of all operations; main factors associated with perioperative mortality were presence of comorbidities, increasing age and advanced stage.
  
  
  CONCLUSIONS
  The better prognosis of patients with colorectal cancer was associated with changes of surgical techniques, with a tendency to prefer large operations over limited resections. Perioperative mortality showed a gradual decrease and is at present in the order of 3% to 6% of all operations.
authors.affiliation: Dipartimento di Medicina Interna, Università di Modena e Reggio Emilia, Policlinico, Modena, Italy. deleon@unimore.it
authors.forename: Maurizio Ponz
authors.initials: MP
authors.lastname: de Leon
authors.forename: Annalisa
authors.initials: A
authors.lastname: Pezzi
authors.forename: Piero
authors.initials: P
authors.lastname: Benatti
authors.forename: Antonio
authors.initials: A
authors.lastname: Manenti
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Rossi
authors.forename: Carmela
authors.initials: C
authors.lastname: di Gregorio
authors.forename: Luca
authors.initials: L
authors.lastname: Roncucci
mesh_terms: D000328:Adult; D002423:Cause of Death; D003082:Colectomy; D015179:Colorectal Neoplasms / Q000401:mortality* / Q000601:surgery*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D010166:Palliative Care; D019990:Perioperative Care; D012042:Registries; D016019:Survival Analysis