Objective The authors assessed the relative value of Dukes' staging and Doppler perfusion index (DPI) as prognostic indices of early death in patients with colorectal cancer who have had apparently curative surgery. Summary Background Data Dukes' classification is recognized as the gold standard against which other prognostic factors should be compared; however, its discriminatory power is limited. No established method exists for accurately identifying patients who, despite having undergone an apparently curative resection for colorectal carcinoma, are at high risk. Methods Eighty consecutive patients undergoing apparently curative surgery for colorectal cancer were staged using Dukes' classification. In addition, DPI (ratio of hepatic arterial to total liver blood flow) was measured before surgery by means of a duplex/color Doppler sonography. Results On the basis of 2-year follow-up data, Dukes' classification failed to define clearly those patients who died or who developed recurrent disease. In contrast, DPI clearly identified two groups of patients: 78% of patients with an abnormally elevated DPI value developed recurrent disease or died, whereas 97% of patients with a normal DPI value survived. Conclusion This technique can identify patients at high risk for colorectal cancer, after having undergone apparently curative resection, who would be suitable for adjuvant therapy.
