P. H. Chapuis

The relationship of survival to staging and grading of colorectal carcinoma: a prospective study of 503 cases.

A clinicopathologic staging method for colorectal carcinoma was applied prospectively to 503 patients treated by surgical resection over a period of 71/2 years. The method grouped separately those patients known to be incurable at the time of resection and allowed for an anatomically precise definition of the extent of tumor spread. Survival studies showed that prognosis did not significantly deteriorate with spread of tumor beyond the bowel wall unless there were demonstrable metastases, infiltration of a free serosal surface, or if local resection was incomplete. Highly significant decrements in survival occurred when lymph node metastases were demonstrable and when unresected tumor was known to be present. The staging system from which these observations were made formed an improved guide to prognosis when compared with the original Dukes method. Patients with histologically high‐grade tumors had a poorer survival rate than those with low or average grade tumors with the same extent of spread.

The prognostic value of substaging colorectal carcinoma: a prospective study of 1117 cases with standardized pathology

This study further assesses a previously reported clinicopathologic staging system for colorectal carcinoma. By using carefully defined anatomic criteria, various substages of tumor spread have been examined prospectively for their prognostic significance in a group of 1117 patients accessioned over 14 years and documented by the same pathologist. Spread from the muscularis propria into surrounding tissues was not associated with a significant deterioration in prognosis if the lines of resection were clear of tumor and there were no known metastases or free mesothelial surface invasion. Free mesothelial surface invasion by potentially curable tumors was associated with a significant reduction in patient survival. Patients with potentially curable tumors but with lymph node metastases had a significantly poorer probability of survival if the apical lymph node was involved. Among those with incurable tumors, there was no significant difference in survival depending on whether incurability was due to distant metastases or surgical transection of tumor. Substaging offers a means of refining the ability to predict tumor behavior.

Surgery for large bowel cancer in people aged 75 years and older

Three hundred ten predominantly male patients who were 75 years of age or older and had surgery for colorectal carcinoma had a hospital mortality rate of 9 percent and a cancer-related five-year survival of 50 percent. These results and a detailed analysis of the causes of complications and mortality were compared with the outcome of 710 patients who were treated concurrently and who were younger than 75 years. Tumors in older patients had a tendency to occur on the right side and were more locally advanced. Increased mortality was particularly attributable to sepsis and cardiovascular causes. Increased morbidity was due principally to respiratory and urinary problems. There were no significant differences, however, in wound or anastomotic complications, nor was therapy for the older patients more costly. The indications for surgical resection for colorectal cancer in patients aged 75 years and older should be the same as those for any younger group.

Elective resection for diverticular disease and carcinoma

A retrospective comparison was made of 47 patients who underwent elective surgical resection for diverticular disease and 106 patients who had sigmoid colectomy or left hemicolectomy for carcinoma over an eight and one-half-year period. There was higher morbidity and mortality in those patients with diverticular disease.

Bladder dysfunction following anterior resection for carcinoma of the rectum

A retrospective study was made of 190 patients who had anterior resections of the rectum for carcinoma at Concord Hospital between 1971 and 1981. Urinary tract infection occurred in 25 percent of patients. Bladder dysfunction occurred in 22 percent of patients, and was more frequent in those in whom the tumor was less than 10 cm from the anal verge. The patients were compared with 122 patients who had undergone abdominoperineal excisions of the rectum for carcinoma. Although the overall incidence of bladder dysfunction was the same in both groups, there was a significantly higher incidence of permanent bladder dysfunction in patients undergoing abdominoperineal excision (P=0.00034).

Duodenocolic fistula: An unusual complication of duodenal diverticulum

SummaryThe management of two patients with benign duodenocolic fistula is reported. In both patients, laparotomy clearly demonstrated the origin of a fitulous tract arising from a duodenal diverticulum. Microscopic examination of the diverticula failed to disclose the presence of either gastric or pancreatic tissue.