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Background: The aim of the present study is to provide local data for the management of colorectal cancers in the south-western Sydney health area from 1997 to 2001. Methods: The data were collected prospectively. Follow up was conducted in late 2001 and early 2002. Data were cross-validated with hospital and area databases and with data from the New South Wales Registry of Births, Deaths and Marriages. Results: This was an unselected series of 1293 patients from 36 surgeons; 16.5% of patients presented as emergencies. Only 3% presented as a result of bowel cancer screening. Of the 1293 patients, 1270 received an operation. There were 598 elective colonic resections with the mortality rate of 1.2%, reoperation rate of 2.7% and anastomotic leak rate of 0.8%. For the 410 elective rectal resections, the rates were 2.9%, 2.7% and 1.2%, respectively. For the 290 emergency operations, the rates were much worse at 7.7%, 6.6% and 4.8%, respectively. The corrected overall 3-year survival rate was 64%. For Dukes’ A, B, C and D, the figures were 94%, 87%, 61% and 7%, respectively. Conclusions: Colorectal cancer is a major cause of mortality and morbidity in our community. Very few bowel cancers were discovered at the asymptomatic stage. This paper strongly supports community bowel cancer screening and early diagnosis. The local database has provided a rich source of information to benchmark management and outcomes of bowel cancer patients treated in the South Western Sydney Area Health Service. An area-wide computer network with online data input facilities at individual workplaces will improve data integrity and data collection efficiency.

Four hundred and five patients with colorectal adenocarcinoma were seen over a five year period in the Department of Surgery, University of Hong Kong. These patients were divided into two concurrent groups according to the age of 40. Thirty patients (7.4%) were below age of 40 at the time of presentation. This young group of patients had both a higher combined proportion of C and D tumours (76.6% to 50%) and a higher proportion of poorly differentiated tumours (20% to 5.5%). The curative and palliative resections rates were similar. Life tables of patients who underwent curative resections showed young patients to have a significantly poorer overall disease-free interval as well as overall determinant survival. In comparing only the Dukes C patients, the young patients still showed a higher recurrence rate.

A case is reported of the reconstruction of a continent anus after an abdominoperineal resection for a patient who presented with a Dukes B adenocarcinoma at 4.5 cm from the anal verge. After a radical excision, the perineal colostomy was sited orthotopically. The right gracilis muscle, completely detached from the thigh except for the neurovascular pedicle, was wrapped around the neorectum at the original level of the levator ani, in an alpha loop configuration. The free ends of the alpha loop pointing anteriorly were sutured to the public bone. Thus the 80 degrees ano-rectal angle was reconstructed. A temporary transverse colostomy was also performed. After closure of the colostomy at eight weeks, the patient was immediately continent of soft stools without a learning period. Pressure studies of the new sphincter are also reported.