Wendell S. Sharpe

Anterior versus abdominoperineal resection. Resection for rectal and rectosigmoid carcinoma.

Abstract Anterior resection of the colon for carcinoma involving the middle and upper rectum, rectosigmoid, and sigmoid is the operation of choice (lesions 7 to 9 cm. above the anal verge or at the peritoneal reflection and above). This restores functional colonic continuity without the need for colostomy and provides the patient with an equally good chance for a five year survival rate as compared to a Miles abdominoperineal resection. This sphinctersaving procedure is an adequate operation for cancer providing dissection includes adequate normal colon above and below these lesions with removal of associated tissues that include the regional lymphatics. Our data showed the morbidity rate to be lower and the five year survival rate to be better than those for the Miles operation in comparable lesions in the areas of the colon described herein. Sphincter-saving operative procedures for cancer of the colon, when properly performed, can be as adequate an operation for cancer as the Miles abdominoperineal resection for lesions at the peritoneal reflection and above

Distal Antrectomy With Vagectomy for Duodenal Ulcer: Results in 611 Cases

Distal antrectomy (25% or less) resection of the distal stomach with bilateral vagectomy, Billroth II, antecolic, Polya or Hofmeister gastrojejunostomy, continues to be our operation of choice for chronic duodenal ulcer. This is based upon our experience in 611 operations and as a result of careful complete repeat in-patient followup studies conducted since our original operation which was devised and performed in July 1953. This procedure controls or eliminates the two major gastric acid stimulatory phases responsible in the pathogenesis and chronicity of a duodenal ulcer: neurogenic (cephalic phase) via the vagal gastric pathways, and the humoral (gastrin) phase via antral stimulation. Even though part of the antrum may remain in the gastric remnant in some patients, antral control is maintained because the antrum remains in the gastric acid stream, there is no stasis, and it is vagectomized. The ulcer diathesis is controlled with a minimal disturbance in gastric physiology, in function, and in gastric reservoir capacity; the procedure will almost eliminate all of the undesirable postoperative gastrointestinal sequelae associated with other operations for duodenal ulcer. It insures the least chance for marginal, gastric, or recurrent ulcer formation, and a low morbidity rate.

CANCER OF THE COLON AND RECTUM; ANALYSIS OF 300 CASES.

Summary A survey of our experience with the surgical treatment of cancer of the colon in 300 patients treated during a fifteen year period ending in 1963 is presented. A curative procedure was performed in 7 per cent of the patients with a postoperative mortality of 3.5 per cent from all causes. A palliative procedure was performed in 23 per cent with a mortality of 4.4 per cent. At the completion of this fifteen year study, 52 per cent of the patients had died as a result of their disease. The longest periods of survival and the greatest number of survivors were among patients with lesions in the sigmoid, rectosigmoid, rectum, or descending colon. Fifty-seven per cent of the lesions occurred in the sigmoid, rectosigmoid, and rectum. In 14 per cent the lesion was located in the cecum. The most common cell type was adenocarcinoma. The average survival time was thirty-one months, with the longest survivals occurring in patients with lesions of the upper part of the rectum. At the end of five years, 25 per cent of the patients were living and free from their disease. The higher the lesion was in the rectum, rectosigmoid, or sigmoid, the longer was the survival period and the higher were the percentages of survivals.