Improvement of colo-rectal cancer surgery following introduction of endoscopical approach

In the period 1968-1993, we treated 399 patients for colorectal cancer. Up to 1980, preceding large scale use of endoscopy, 217 patients, out of the group of 399, were submitted to surgery; at time of diagnosis all patients had symptoms of advanced colonic tumor (intestinal obstruction; palpable mass; significant rectal bleeding); none of the lesions detected was in Dukes A or B1 groups; 56 patients were in Dukes B2 and stages C1 + C2 + D were detected in 161 cases. In period 1981-1993 we treated 182 patients; in all cases the diagnosis consisted of endoscopical examinations. Out of this group 69 patients underwent endoscopic resection of polyps with focal neoplastic degeneration: 44 did not require surgery according to Haggitt criteria. In the group of 138 patients who underwent surgery, 89 were in Dukes A + B1 + B2 groups and 49 were in Dukes C1 + C2 + D groups. In our experience endoscopy is not essential in the clear cut colonic neoplasms, however it is an invaluable screening test in early stages, in poor symptomatic population, in elderly patients (>50 y.o.) and in patients with non specific symptoms. We wish to emphasize how endoscopy has improved the results of colonic cancer surgery.