Surgical Treatment for Dukes D Colorectal Cancer
A retrospective study of the strategy of treatment for Dukes D colorectal cancer was made by comparing survival rates in relation to the factors of the disease. From among the 974 cases of colorectal cancers for which surgery was performed during the last 20 years, we studied 183 cases of Dukes D, classifying them according to four factors of the disease (liver metastasis : 106 cases, peritoneal dissemination : 40 cases, distant lymph node metastasis : 25 cases, and lung metastasis : 12 cases). There were some cases with involvement of more than one factor, however, we categorized them according to which factor was most significant to avoid repetition. The three-year and five-year survival rates with regard to the factors were as follows, respectively; peritoneal dissemination: 28.0%, 14.0%, lung metastasis : 10.7%, 0%, liver metastasis: 8.2%, 4.9%, and distant lymph node metastasis : 4.4%, 4.4%. No significant difference was revealed in either three or five years survival rate between lung metastasis and the other factors. However, better results were achieved in cases with peritoneal dissemination than either cases with liver metastasis or distant lymph node metastasis cases (p<0.05). Also better prognosis (p<0.05) was recognized in cases with liver metastasis than that in cases with distant lymph node metastasis. There were some five-year survivors among patients who underwent combined resection of the primary tumor and the metastatic lesion. Therefore, in spite of the patients with Dukes D stage, aggressive surgery and multidisciplinary treatment should be indicated to improve surgical results for advanced colorectal cancer.