Harry E. Bacon

Cancer of the colon, rectum and anal canal: Surgical approach with rates of five- and ten-year survival

Site The purpose of this report is to record our experiences in a series of 1,663 patients with cancer of the coIon, rectum and ana canal, covering the sixteen year, four month period from September I, 1940 to December 31, 1956. A review of my records discIoses that of the 1,663 patients with cancer of the Iarge bowe1, I ,so I were subjected to some type of operation, i.e., resection, coIostomy, coIotomy and polypectomy, or ceIiotomy (open and cIosed). Resection, either for “cure” or paIIiation, was performed in 1,371 patients brought to the operating room, a resectabiIity rate of g I .2 per cent. (TabIes I and II.)

Influence of lateral spread of cancer of the rectum on radicability of operation and prognosis

T HE purpose of this presentation is to 65.4 per cent rate when above the peritoneal caII attention to the importance of the reffexion. Decisive evidence of the importance Iateral spread of cancer of the rectum of the IeveI of the lesion was presented aIso becuase, in our opinion, this probIem has not by Waugh and KirkIin32 and by SunderIand.2x been given adequate consideration. In this (TabIes II and III.)

Leiomyosarcoma of the rectum

SummaryA case of leiomyosarcoma of the rectum is described. Medical literature was reviewed and 96 cases were encountered. Increased constipation, localized rectal pain and rectal bleding are the most constant symptoms. The tumor was discovered by digital examination in 84 per cent of the cases. Local excision was followed by a recurrence rate of 86 per cent. On the basis of this experience, we believe that leiomyosarcoma of the rectum is best treated by radical surgical removal.

The rationale of re-resection for recurrent cancer of the colon and rectum.

RECURRENCE is a complication potentially inherent in all cancer surgery. While many reports are available on the incidence of recurrence, a review of the world medical l i terature reveals that there is a paucity of publications on the snrgical management of recurrent cancer. In part, this may be due to a general acceptance o~ the hopelessness of the situation in the erroneous belief that recurrence is synonymous with inoperabil i ty or unresectability, or both. Abandonment of the pat ient to terminal medical pall iat ion too frequently has been accepted philosophically by both pat ient and physician, often based solely on one lone possibi l i tythe hopelessness of recurrence. Patients so condemned linger miserably or die as forfeits before the court of surgical judgment. Yet some recurrences may have been resectable locally or, as many of us may recall from observations made at postmortem examination, the lesion may have been a benign process or an entirely new growth. This defeatist at t i tude toward recurrence no longer can be held tenable. Both todays patient, who is more cognizant of scientific progress, and the qualified surgeon are assuming more flexible attitudes in philosophical concepts of recurrence and the management of mal ignant disease. Re-resection, the theme of this presentation, is not to be confused with the unresectability of lesions of patients who have been sent home to die. On the other hand,

Multiple primary malignant tumors involving the colon and rectum; report of ninety-four cases.

Abstract 1. 1. Multiple primary malignant neoplasms are not a rarity and are probably more frequent than the reported statistics indicate. 2. 2. One malignancy apparently does not confer an immunity against another malignancy in the same individual, at least not an immunity that can be determined clinically. In fact, a person who has had one malignant neoplasm is more likely to have another than a person who never has had a malignant tumor. 3. 3. A series of 1,112 consecutive cases of cancer of the colon, rectum and anal canal in which there is an incidence of multiple primary malignancy of 7.5 per cent are presented. 4. 4. Various contributing factors are enumerated which probably influence the progressively rising reported rate of multiple primary malignant neoplasms. 5. 5. Two cases of adenocarcinoma of the sigmoid and rectum with coexisting sarcoma are added to the literature. 6. 6. Because of the frequency with which carcinoma of the female genital organs is encountered concurrently with malignancy of the rectum and colon, the authors recommend castration of female patients forty or more years of age at the time of resection.

Primary multiple malignancy of the colon and rectum

Summary and ConclusionsA series of 2,508 patients with malignancy of the large intestine has been reviewed to determine the incidence of primary multiple neoplasms, which proved to be 9.1 per cent. Attention is directed to the frequency of involvement of the colon, rectum and other organs. It is recommended that prior to performing surgical operations on the colon, the various systems be thoroughly evaluated; that during the operation, meticulous exploration be performed and colonoscopy be utilized. After surgery, all patients should be checked clinically and radiologically at regular intervals.

Tuberculosis of the anal canal

TUBERCULOSIS was one of the first diseases to receive recognition and intelligent treatment. Hippocrates, in the fifth century BC, recorded that he was familiar with the various forms of tuberculosisA In the nineteenth century, Villemin 11 deduced through a series of experiments, the contagious character of this entity. He inoculated many species of animals with sputum and other products from tuberculous lesions in man and cattle, and tuberculosis developed in all. In 1882, Koch 6 isolated the specific bacillus, grew it in pure culture, and demonstrated its pathogenicity.

Malignancy of the anus, rectum and sigmoid colon in the young

Abstract 1. 1. A case of early carcinoma of the rectum in a male 4 years and 7 months of age is reported. 2. 2. The literature has been reviewed, citing 123 authentic cases of primary malignancy of the anus, rectum or sigmoid colon below the age of 20.

Present status of the pull-through sphincter-preserving procedure†

The pull‐through operation, which is performed for, rectal carcinoma situated between 7 and 12 cm from the anal verge, is a sound surgical procedure and its radicality is in no way compromised by preservation of the anal sphincters. The mortality, survival, and recurrence rates compare favorably with those of abdominoperineal excision (the Miles operation). In some respects, the pull‐through operation is superior to the Miles operation. The perineal wound heals in a shorter time and the patient is able to return to work sooner. Aside from the physiologic advantage of having the transplanted colon in the anal canal, continence for practical purposes is retained.

Prevention of recurrent carcinoma of the colon and rectum: Report on 236 patients

Summary and ConclusionsAttention has been drawn to the limitations of surgical management of carcinoma of the colon and rectum and to methods that show promise of improving five-, ten-and 15-year salvage rates. More extensive use of new and existing methods of cancer detection, by both physician and patient, should be undertaken.Thus far, the results from the use of XCB appear to be encouraging and no untoward effects have been encountered in its use. The problem of recurrence by implantation still prevents a survival rate proportionate to the surgeon’s efforts. In our series, sufficient time has not yet elapsed for a representative statistical report. Smears taken for cell study and chemical tissue reactions are being evaluated. More time and similar studies by other interested investigators will be required to justify more significant conclusions.It is not our purpose to champion the use of a specific drug or operative procedure, but rather to present a preliminary report on a method encompassing many factors directed primarily at lessening the incidence of local recurrence and implantation of malignant cells in the anastomosis.