The prognosis after surgical treatment for carcinoma of the rectum.

The results of surgical treatment of 550 cases of carcinoma of the rectum presenting to the Professorial Surgical Unit of the General Infirmary, Leeds, from 1955 to 1968 have been analysed.     

Lymphatic distribution of the colon and rectum

We may state that the lymphatic ducts of the appendix, cecum, ascending colon, right colic flexure, and right two-thirds of the transverse colon follow in general the distribution of the superior mesenteric artery and end in the superior mesenteric lymph nodes, whence the lymph passes through the gastrointestinal (common intestinal) trunk to the cisterna chyli. Lymph from at least a portion of the left flexure of the colon passes to the superior mesenteric lymph glands and to the lymph glands of the hilum of the spleen. The lymph drainage of the descending colon, pelvic colon, and most of the rectum is through the inferior mesenteric and iliac glands and thence to the left lumbar glands. Lymph from the lower part of the anal canal passes by way of vessels which terminate in the superficial inguinal lymph nodes.     

The role of lymphadenectomy in the surgical treatment of cancer of the left colon and rectum

The study of 89 cases of left colon and rectum cancer treated with oncology lymphectomy of II and III level, permits to confirm the main role of this surgical practice for a right tumoral stadiation. It's also confirmed the therapeutic role of lymphectomy with a 5 years follow-up, with a rescue of C1 cases, without a significative advantage of the extension to the III level.     

Surgical experience with carcinoma of the colon and rectum.

From September 1925 through December 1978 at Vanderbilt University Hospital, 1,279 patients with adenocarcinoma of the colon and rectum underwent operations. Reports of this cumulative series have been published previously; the last report in 1970 included 1,022 patients. The current report examines the progress made in our recognition and management of colorectal cancer. During this 54-year period, there has been a relative decrease in the incidence of carcinoma of the rectum and a relative increase in carcinomas elsewhere in large bowel. Resectability rate has steadily increased, culminating in a rate of 98.4% in the recent period (1969-1978). The operative mortality rate fell to 4.3% (1956-1960) but has shown a slight rise to 5.4% in the recent period (1969-1978). This reflects the increased number of patients in the eighth to the tenth decades of life. Five-year survival rates in 99% of 1,218 patients were computed. Absolute five-year survival for the recent period was 43.7%, compared with 17% for the initial period. Five-year survival rates for patients in the recent decade with Dukes A, B, and C lesions were 67%, 58.6%, and 33.3%, respectively. Comparison of survival data in the last two decades shows little improvement. However, in the last 20 years, 78 to 80% of patients had more advanced lesions.     

Intraoperative colon irrigation in emergency surgical treatment of lesions of the left colon and rectum]

The Authors propose the use of intraoperative colon irrigation in emergency surgery of left-sided lesions of the colon. This technique allows the colon to be decompressed and cleaned at the same time with the possibility of performing a resection or hemicolectomy without having to resort to protective colostomy and its related problems of morbidity.     

Mixed adenoneuroendocrine carcinoma of the colon and rectum

Mixed adenoneuroendocrine carcinoma (MANEC) are rare cancers of the gastrointestinal (GI) and pancreatobiliary tract. They are characterized by the presence of a combination of epithelial and neuroendocrine elements, where each component represents at least 30% of the tumour. Review of literature and consolidation of clinicopathological data. Sixty-one cases of colorectal MANEC have been reported in literature and one seen in this centre. The median age of the patients affected was 61.9?±?12.4 years (20–94 years). Male to female ratio is 1.0:1.2. Presentations were similar to other colorectal malignancies. 58.0% of colorectal MANECs were found in the right colon, 8.1% cases in the transverse, 16.1% in the left colon, 16.1% in the rectum. These tumours appeared invasiveness 79.1% were T3–T4. Over 90% of cases were presented with metastatic disease. The majority of patient underwent surgical resection of the primary cancer (96.6%). Of these, 10 operations (17.9%) were emergency operations due to obstruction, perforation, or bleeding. Three patients received first line palliative care. In eight cases (13.8%), patients underwent adjuvant chemotherapy. The median overall survival after diagnosis was 10?±?2.4 months (95% CI: 5.37–14.64 months). MANECs are rare but aggressive colorectal cancers. Surgical resection of localized disease with adjuvant chemotherapy appears to significantly improve survival in small case series. Further understanding through the sharing of experiences is required.     

Carcinoma of the colon and rectum. A review of results of surgical treatment in 164 patients.

This report is a retrospective review of the authors' experience with colonic and rectal carcinoma in 164 patients from 1954 to 1968 with a five-year follow-up. The operative approach utilized principles of early vascular isolation, wied-colon and mesenteric reseciton, and minimal tumor manipulation in curative operations; palliative procedures were aggressively employed. Of the 164 patients, 104 with lesions almost equally divided between colon and rectum had resections with curative intent. The overall five-year survival rate after curative resection was 55%, and included eight hospital deaths that were usually related to cardiopulmonary complications. Lymph node involvement appreciably decreased the survival rate from 72% without node involvement to 39% with node involvement. Patients with rectal lesions experienced more favorable results than those with colonic lesions. Palliative procedures in 46 patients enhanced comfort, but few patients survived longer than one year. Wound and anastomotic complications were infrequent.     

Hartmann's procedure for carcinoma of the rectum and sigmoid colon.

A review of the Hartmann's operation for patients with rectal and sigmoid cancer over an 18 year period is presented. There were 1063 patients who had a resection for carcinoma of the rectum or sigmoid colon and 4.4% of these had a Hartmann's procedure. This operation was particularly useful in the management of patients who presented with a proximal obstruction or perforation at the tumour site. It was also effective in the elective treatment of elderly unfit patients who had locally advanced tumours or those with distant metastases. Re-anastomosis is recommended in those patients who are relatively fit and have had a potentially curative resection.