title: Trends in demographics and management of obstructing colorectal cancer.
abstract: BACKGROUND
  Obstructing colorectal cancer (CRC) has an aggressive clinical course and poorer prognosis. With the increasing incidence and differing clinical and pathologic spectrum of CRC among Black patients, as well as a paucity of African studies, regional analysis is required. Our aim was to describe the demographics and management of obstructing CRC among the different racial groups in South Africa and to compare these parameters with international standards.
  
  
  METHODS
  Patients referred to Inkosi Albert Luthuli Central Hospital, Durban, South Africa, with CRC between 2000 and 2012 were followed prospectively. Demographic information, site of obstruction, and management of patients who underwent emergency surgery for malignant large bowel obstruction were analyzed separately.
  
  
  RESULTS
  CRC was diagnosed in 1,425 patients. A total of 203 three patients (14.3 %) required emergent treatment for acute large bowel obstruction. The mean age at presentation with obstructing CRC was 59 years. Black patients presented significantly younger (50 years) than White (64), Indian (60), or Colored (61) patients (p < 0.001). The most common sites of obstruction were the sigmoid colon and rectum. A total of 58 patients (29 %) had concomitant metastatic disease. No difference was found between race, sex, and sex per race in patients with concurrent metastatic disease (p = 0.227, p = 0.415, p = 0.798, respectively). Of the 203 patients, 128 (63 %) were managed by resection, 37 (18 %) by colonic stenting, 35 (17 %) by colostomy, and 3 (2 %) by colonic bypass. Stenting was unsuccessful in six patients.
  
  
  CONCLUSIONS
  Tumor location of patients presenting with obstruction is comparable to that cited in international literature; however, the age of presentation among Black patients is more than a decade earlier than in other ethnic groups. Surgical management should be individualized. Stenting remains a reliable alternative in select cases.
authors.affiliation: Department of Surgery, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Private Bag X7, Congella, Durban, KwaZulu-Natal, 4013, South Africa, drzmoolla@hotmail.co.za.
authors.forename: Zaheer
authors.initials: Z
authors.lastname: Moolla
authors.forename: Thandinkosi E
authors.initials: TE
authors.lastname: Madiba
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D044383:Black People; D015179:Colorectal Neoplasms / Q000150:complications / Q000208:ethnology* / Q000601:surgery*; D003125:Colostomy; D003710:Demography / Q000639:trends; D005260:Female; D006801:Humans; D007194:India / Q000208:ethnology; D007415:Intestinal Obstruction / Q000208:ethnology* / Q000209:etiology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012737:Sex Factors; D013019:South Africa; D015607:Stents; D044465:White People