Harry W. Southwick

Recurrence at the suture line following resection for carcinoma of the colon

Abstract In previous studies we have noted an incidence of suture line recurrence following resection for cancer of the colon in approximately 10 per cent of patients. Prophylactic measures consisting of preliminary ligation of the lumen of the bowel several centimeters proximal and distal to the tumor, excision of the tissue crushed by the clamps, and irrigation of the bowel before performance of the anastomosis, have been employed in 101 patients over a five year period. In this group of patients, all of whom have been followed up for at least one year, we have been unable to find a single incidence of recurrence of disease at the suture line.

Radiation-associated head and neck tumors

It is a signal honor, which I accepted with sincere humility, to join the distinguished group of my predecessors to present the Hayes Martin lecture. Charles Harrold [I], in presenting the first Hayes Martin lectureship award, noted that many considered Doctor Martin’s most outstanding achievement to be his “continued demonstration that patients with advanced and extensive head and neck cancer might have a surgical cure and a functional rehabilitation.” Although a surgeon by training, Doctor Martin had wide experience in radiation therapy and, as William MacComb, the first Hayes Martin lecturer, noted, Doctor Martin enthusiastically supported Coutard’s fractionated radiation technic in the early 1930s [2]. The limitations in controlling head and neck cancer even with this modality soon became apparent however. In addition, the morbidity of intense radiotherapy with necrosis, fistulas, and hemorrhage, to mention only a few, stimulated Doctor Martin to develop other technics for the management of these problems. He was first and foremost a surgeon and it was logical that he would apply his great fund of knowledge in this area to the treatment of head and neck tumors. Many of you may not be aware of how general a surgeon Doctor Martin was. One of his earliest publications, written in collaboration with the great internist, Soma Weiss, was on “The Use of Prostigmine in Abdominal Distention” published in 1925 [3]. To say the least, this was an aggressive approach to abdominal distention from multiple causes. Perhaps it was the lack of enthusiastic acceptance of this regime, but for whatever reason, his surgical career soon became confined to working with patients with neoplastic disease primarily presenting above the clavicles. His contributions in this area are innumerable and well known to most of us here.

Malignant melanomas of the skin of the head and neck

Abstract 1. 1. Fifty-eight patients with malignant melanoma of the head and neck are presented; thirty-eight patients formed the definitive group. 2. 2. Over-all survival five years free of disease was 39.5 per cent. 3. 3. The salvage was not significantly different whether the treatment was (a) adequate local excision generally accompanied by skin graft, (b) adequate excision and elective regional node dissection, or (c) therapeutic node dissection when the primary tumor was controlled. 4. 4. No patient survived who had a recurrent primary tumor and clinical evidence of regional node disease. 5. 5. Heroic surgery for primary or metastatic disease was unsuccessful both as to salvage or significant palliation. 6. 6. Primary treatment suggested is adequate local excision if the neck is clinically negative. 7. 7. Elective neck dissections are reserved for patients in whom such dissection can be performed in valid continuity or when the primary tumor is recurrent.

Neck mass caused by thrombus in the external jugular vein

Three cases of lateral neck tumors caused by thrombosis of the external jugular vein have been presented. Microscopic examination of the excised thrombosed veins revealed all of them to have a dilated architecture with somewhat degenerated vessel walls much like an aneurysm. Such a dilatation would cause some stasis and eddy currents and make the vessels more susceptible to thrombus formation. The final factor which induced these thrombi remains unknown. Indeed, when the interrelation of the factors discussed previously is considered, multiple etiologic factors appear most likely. Some form of minor trauma, although not documented, would still seem the most likely cause of thrombosis of a vein in a patient with no previous symptoms. In case III, trauma of inflammatory changes in a mass already noted to be present for some time could have induced thrombosis within the dilated vessel. Thrombosis of the external jugular vein is yet another lesion in the extensive differential diagnosis of a mass in the lateral neck.

Prophylactic measures in the spread of carcinoma of the colon and rectum.

ANY mSCUSStON of prophylactic measures in the prevention of spread of carcinoma should be preceded by a brief statement of the mechanisms of spread of the disease. There are four major mechanisms concerned in this spread. They may be summarized as follows: 1. by lymphatics, 2. by contiguity through tissue planes, 3. by implantation, and 4. by vascular channels. Efforts to prevent spread must be directed towards these various mechanisms of dissemination. The first two have been discussed in detail in the medical literature,a, is, 39 Samson Hanley was the pioneer in the study of spread by lymphatics. The medical profession has been aware of the spread by implantation and venous emboli, but in our opinion too little attention has been paid to these mechanisms by the surgeon.

Cancer of the gastrointestinal tract.

SummaryThere has been in the past quarter-century a definite, though perhaps not spectacular, improvement in the outlook for the patient with gastrointestinal tract cancer. Cancer of the esophagus, particularly of the lower third, is no longer universally fatal. Cancer of the stomach, colon, and rectum also have an improved outlook.It is an unpleasant fact, however, that even with cancer of the colon (where the results are best) almost 75 per cent of the patients succumb.One of the most encouraging facts of recent years is the renewed interest in the natural history of the disease process. Operations are extended or modified for pathologically valid reasons and not merely because patients will tolerate them.Finally, the entire field of the prophylactic approach to the treatment of cancer is receiving renewed interest. Herein lies one of the greatest potentialities for the immediate future.