Roger Grace

Five-year follow-up study of the fat clearance technique in colorectal carcinoma

PURPOSE: The aim of our study was to determine the five-year survival of patients with colorectal carcinoma whose Dukes classification had changed following fat clearance of the mesocolon or mesorectum. METHODS: One hundred three patients with colorectal carcinoma were followed up at a special clinic for at least five years after surgery. The tumors from these patients had previously been given a Dukes classification before and after fat clearance. RESULTS: Four of the five patients whose Dukes status changed from B to C as a result of fat clearance died of malignant disease during the five-year follow-up period. After fat clearance it was apparent that Dukes B patients survived, on average, 11 months longer than Dukes C patients. A significantly increased mean number of positive nodes was found after fat clearance in Dukes C cases, both in those who were alive at five years and those who died of their malignant disease. CONCLUSIONS: The fat clearance technique is a useful aid to improving the accuracy of the Dukes classification and has prognostic significance. It should be used in specimens of colorectal carcinoma, which on initial examination appear to be Dukes B cases.

The treatment of perianal and anal condylomata acuminata: a new operative technique.

Seventy-five patients have been treated for condylomata acuminata by means of a new operative approach which results in the preservation of the maximum amount of normal tissue. The technique has proved to be simple to perform, it has minimal complications and causes the patient little in the way of discomfort. Three out of 4 patients treated have no significant recurrent wart formation.

Effect of anorectal eversion on long-term clinical outcome of restorative proctocolectomy.

Eversion of the rectum during restorative proctocolectomy with stapled ileal pouch-anal anastomosis (IPAA) remains a controversial surgical manoeuvre because of concern that it may impair anal sphincter function and adversely affect outcome. We have reviewed the long-term results in 41 patients whose operation included formation of a 20 cm J-pouch with stapled IPAA by the technique of rectal eversion. At median follow-up of 4 years (range 1–6 years), 4 pouches (10%) had been removed (2 for pelvic sepsis, 1 for rectovaginal fistula and 1 for Crohns disease). In 34 patients with functioning pouches in situ, median stool frequency was 5 per 24 h (range 2–10). 11 patients (33%) regularly had to evacuate their pouch at night and 4 (12%) used antidiarrhoeal medication. No patients reported major incontinence; 2 (6%) had minor leakage, and in another 2 minor leakage had now ceased. 4 patients had had episodes of pouchitis. These favourable results offer no support for the contention that rectal eversion substantially worsens the long-term results of restorative proctocolectomy.

Faecal Incontinence after Childbirth

Faecal incontinence after childbirth has been a hidden problem for many years because it was an area that aroused feelings of shame or inadequacy in many women. 1 Coincident with more openness in society has come wider availability ofmethods of investigating faecal incontinence in which the advent of endoanal ultrasound has been particularly important. These developments have uncovered a higher incidence of incontinence than was previously perceived.f

Surgeon-related variance: how much longer for its recognition?

We read with interest the paper by Morris et al , which looked at 30-day postoperative mortality after colorectal cancer surgery in England.1 In 1978, using the data from the large bowel cancer (LBC) project2 we made the case for looking at ‘surgeon’ as a highly significant variable in the context of randomised control trials. Each surgeon was given a random number independent of their institution to protect their confidentiality The results in the LBC project showed a wide variance in 30-day mortality between 0% and 5% up to 21% and for clinical anastomotic leak, the …

Problems of minor anal surgery: a review.

Anal surgery is important because the problems are common and because the results of correct management are good; it is therefore surprising that controversy surrounds the choice of correct management for some of these problems. There is no better example of this than that relating to the commonest of all anal conditions haemorrhoids while there is no consensus on the management of anorectal abscesses and perianal warts.