The treatment outcome of colorectal cancer in Veterans General Hospital-Taipei

Colorectal cancer (CRC) is the third most common cause of cancer-related death in Taiwan. During the past 20 years, several advances have improved treatment outcome and quality of life of CRC patients.

Based on the computerized database of Taipei Veterans General Hospital, between January 1981 and December 2000, 5474 CRC patients were identified and divided into 2 groups based on the date of treatment (1981–1990 and 1991-2000).  

Since 1990, two important changes have been occurred in our hospital. The first was complete mobilization of the rectum down to the pelvic floor with transaction of the rectum at anorectal junction has been practiced for the middle and lower rectal cancers. The second was a more aggressive attitude of chemotherapy for the stage III and stage IV cancers.

The 5-year overall survival was better in the 1990s group (56%) than in the 1980s group (50%, P=0.001). The patients in 1990s who received chemotherapy (either in stage III or in stage IV tumors) were significant more than those in 1980s. In the 1990s group, the benefit of chemotherapy was significant. In stage III patients, the 5-year overall survival was 57% with chemotherapy and 45% without chemotherapy, while in stage IV patients, the 1-year overall survival was 65% with chemotherapy and only 32% without chemotherapy.

 For rectal cancer patients, the local recurrence rate was lower in the 1990s group (6%) than in the 1980s group (10%, P<0.01). Of the rectal cancer patients, 37% received an exstirpation (abdominoperineal resection or Hartmann operation) and 63% received anterior resection with reconstruction in the 1980s group as compared to 21% and 79% in the 1990s group (p<0.001)

The results of the treatment of CRC has improved during the past twenty years. More accurate staging, improved surgical technique in rectal surgery and more aggressive attitude of chemotherapy were the most important contributive factors.