Forty‐five patients with obstructing carcinoma of the colon and rectum were compared with 176 patients with nonobstructing tumor diagnosed over a 10‐year period. The age and sex distribution did not differ between the two groups. The site of greatest risk for obstruction was the splenic flexure and descending colon (50%); median survival in these patients was one‐half that for other sites. In the obstructed group no patient had Dukes' stage A vs. 9.6% in the nonobstructed patients, and 22% of the obstructed patients had Dukes' D vs. 14% of the nonobstructed patients. The 5‐year survival in Dukes' A was 82%, while no survivors were found for Dukes' D. The crude 5‐year survival rate was 22.4% in the obstructed patients and 49.1% in the nonobstructed patients; in‐hospital mortality was 22.4% and 6.8%, respectively, and the adjusted actuarial survival was 39% vs. 64%, respectively. Curative resection was performed in 68% of the obstructed and 83% of the nonobstructed patients. The adjusted actuarial 5‐year survival rates for these patients were 53% and 76%, respectively. The criteria for the tumor grade tested in this study, which included differentiation of the tumor cells, size, and the presence of perforation, did not influence the survival. Twenty‐one patients underwent primary resection, 15 had stage resection, and 9 had diversion procedures. The in‐hospital mortality rates were 35% for primary resection and diversion procedures and 7% for stage resection. The crude 5‐year survival was 32% for primary resection, 42% for stage resection (not statistically significant), and 0 for diversion procedures. The poor prognosis for the obstructed patients in our study was mainly related to 1) high in‐hospital mortality, 2) the lower rate of curative resection, 3) unequal distribution of the tumor site, and 4) to a small extent, the difference in Dukes' stage.
- obstructing carcinoma