Primary treatment—does the surgeon matter?

The dominant factor contributing to the relatively poor prognosis for colorectal cancer is the advanced stage of the disease at the time of initial presentation: up to a third of patients have locally advanced or metastatic disease, which precludes surgical cure. Even in the patients who undergo apparently curative resection, almost half die within five years.

In the west of Scotland, for example, about a third of 1842 patients presenting with colorectal cancer to seven hospitals between 1991 and 1994 presented as emergencies. Potentially curative resection was achieved in about 70% of patients presenting electively; the curative resection rate was lower in those presenting as emergencies. Five per cent of patients admitted for elective surgery and 13% of those admitted as emergencies died. Almost 60% of elective patients survived two years, compared with 44% of patients admitted as emergencies. These results are typical of population based studies in the United Kingdom.