Large bowel multiple tumours.

The medical records of all patients with colorectal cancer seen at the "G. Marinaccio" Department of Surgery in Bari between 1997 and 2004 were examined. Cases included in the study met the criteria advocated by Warren and Gates and Moertel et al. Over such period we operated on 103 patients with colon neoplasms, mostly males (64 patients) and aged over 65 (64 patients). Both palliative and radical operations were performed either as elective treatment or as emergency surgery; in some of the latter cases the diagnosis of neoplasm was made casually following the final histological test on the operative specimen. Ten cases of multiple malignant tumours were recorded, corresponding to 9.7%; in particular 1 synchronous-metachronous tumour (0.97%), 3 synchronous tumours (2.7%) and 6 metachronous tumours (5.8%) were observed; two of the metachronous tumours were detected in the same patient and one in a patient that had previously been operated on for a synchronous carcinoma, thus making a total of 8 patients in all. It is concluded that full examination of the colon in all patients presenting with primary colorectal cancer is mandatory and that, in the light of this experience and recent reports in the literature, this should be done by pre- or perioperative colonoscopy. Colonoscopy not only provides accurate detection of lesions, but also allows the surgeon to perform polypectomies, thereby obviating the need for extending surgery at the time of resection of the coexisting cancer. In conclusion, we recommend preoperative colonoscopy for all patients who present non-obstructive colorectal neoplasms.