title: Trends in short-term outcomes after resection of colorectal cancer: 1971-2013.
abstract: BACKGROUND
  The aim of this study was to describe temporal trends in presentation, surgical management and immediate postoperative outcomes in patients recorded in a registry of colorectal cancer resections that was initiated at Concord Hospital, Sydney, Australia, in 1971. A companion paper describes tumour pathology and long-term recurrence and survival.
  
  
  METHODS
  This report is based on 5217 consecutive resections up to 2013, with no exclusions. Categories in variables examined were expressed as percentages over annual totals of relevant patients or annual mean values. The statistical significance of trends was examined by least squares regression.
  
  
  RESULTS
  The percentage of asymptomatic patients increased over time, whereas urgent presentations declined. Tumour size declined. The percentage of rectal cancers fell but the percentage of low rectal tumours rose. Initially, restorative rectal resections increased rapidly but later remained stable. There was no trend in medical complications, whereas surgical complications declined. Anastomotic leakage after restorative rectal resections declined but it was low and stable for colonic tumours. The rate of early reoperation remained stable, whereas 30-day mortality declined. Neoadjuvant radiotherapy for rectal cancer and adjuvant chemotherapy for stages B and C were introduced in 1992 and applied increasingly thereafter.
  
  
  CONCLUSIONS
  Our findings, based on a 43-year prospective study, indicate sustained trends towards the earlier diagnosis of colorectal cancer and favourable short-term outcomes following bowel resection.
authors.affiliation: Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.|School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
authors.forename: Owen F
authors.initials: OF
authors.lastname: Dent
authors.affiliation: Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.|School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
authors.forename: Les
authors.initials: L
authors.lastname: Bokey
authors.affiliation: Department of Colorectal Surgery, Concord Hospital, Sydney, New South Wales, Australia.|Discipline of Surgery, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.|Department of Colorectal Surgery, Liverpool Hospital, Sydney, New South Wales, Australia.|School of Medicine, Western Sydney University, Sydney, New South Wales, Australia.
authors.forename: Pierre H
authors.initials: PH
authors.lastname: Chapuis
authors.affiliation: Division of Anatomical Pathology, Concord Hospital, Sydney, New South Wales, Australia.|Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Charles
authors.initials: C
authors.lastname: Chan
authors.affiliation: Division of Anatomical Pathology, Concord Hospital, Sydney, New South Wales, Australia.|Discipline of Pathology, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Ronald C
authors.initials: RC
authors.lastname: Newland
mesh_terms: D003082:Colectomy; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D005544:Forecasting; D006801:Humans; D015994:Incidence; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology*; D009367:Neoplasm Staging; D009517:New South Wales / Q000453:epidemiology; D011446:Prospective Studies; D012042:Registries; D015996:Survival Rate / Q000639:trends
keywords: colorectal cancer; pathology; resection; short-term outcomes; time trend