ISSN:0007-1323    

DOI:10.1002/bjs.1800720802

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800720803

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe introduction of new techniques has enabled more patients with low rectal carcinoma to undergo sphincter‐saving resection (SSR). This policy, however, has provoked controversy concerning the adequacy of excision and fear of increased rates of recurrence compared with abdominoperineal resection (APER). We have therefore compared our results of SSR for low and mid‐rectal cancers performed between 1978 and mid 1982 with those obtained with APER before this period. One hundred and fifty‐nine patients presented with tumours between 3 and 12 cm from the anal verge; 153 (96 per cent) underwent resection, of whom 46 (30 per cent) had disseminated disease. One hundred (68 per cent) underwent SSR, 33 (22 per cent) had an APER and 16 (10 per cent) had a local procedure. Operative mortality was 4 per cent following APER and 7 per cent after SSR (n.s.). Patients were followed for a mean of 4·6 years (range 2–6 years), only four (2·5 per cent) being lost to follow‐up. The incidence of recurrence after radical SSR (n = 74) was compared with the historical control group which underwent radical APER, the two groups being matched for Dukes' stage and height of the lesion. After 2 years, local recurrence cumulative rates were 13·6 per cent after SSR and 18·8 per cent after APER. Distant recurrence rates were 14·5 and 20 per cent respectively. Ten patients (13·5 per cent) died of their disease within 2 years of a radical SSR, 15 (15 per cent) after radical APER. Corrected 5‐year survival and recurrence rates were similar. Thus, SSR does not appear to carry an increased risk of recurrent disease compared with APER after an equivalent

ISSN:0007-1323    

DOI:10.1002/bjs.1800720804

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractAt St Mark's Hospital survival after radical surgery for cancer of the rectum has not changed significantly over the past 30 years. The technique of extended abdomino‐iliac lymphadenectomy was developed in an attempt to improve prognosis in patients considered to have particularly unfavourable tumours. Between 1960 and 1981 the technique was used in 75 patients with a single adenocarcinoma of the rectum. Two patients died postoperatively and 52 patients developed complications; a mortality and morbidity similar to those seen after conventional surgery at this hospital. Five‐year survival rate showed no improvement over that achieved by conventional techniques; disappointingly this was also the case for patients with Dukes' C1tumours. The results of this study suggest that an improvement in survival in patients with cancer of the rectum is unlikely to be achieved by any extension of conventional radical surg

ISSN:0007-1323    

DOI:10.1002/bjs.1800720805

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

ISSN:0007-1323    

DOI:10.1002/bjs.1800720806

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractOne hundred and eighteen patients undergoing low colorectal anastomoses were randomly allocated to reconstitution by either single layer interrupted extramucosal sutures or circular staple gun. In the 60 patients undergoing sutured anastomosis there were 2 (3 per cent) clinical leaks and 4 (7 per cent) radiological leaks, and no failures of the 58 patients who underwent stapled anastomosis there were 4 failures, 7 (12 per cent) clinical leaks, 14 (24 per cent) radiological leaks and 1 death. Stapled anastomoses were more than ten times as expensive as sutured anastomoses and there were no savings in time or numbers of associated colostomies. An interrupted extramucosal suture technique remains the ultimate standard for low colorectal anastomosis.

ISSN:0007-1323    

DOI:10.1002/bjs.1800720807

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractUsing a Clark oxygen electrode and a133Xe clearance technique, tissue oxygen tension (To2) and blood flow have been determined in the small and large bowel of a rabbit experimental model. The predictive value of perianastomotic To2in colonic anastomoses was determined, healing being assessed by leakage rate, tensile strength and hydroxyproline content. The effect of suture technique on colonic perianastomotic To2has also been studied. Colonic and small intestinal To2correlated with blood flow (r = 0·93). Basal colonic blood flow and oxygen tension were significantly lower than in the small intestine (P<0·01). Interrupted and continuous suture techniques decreased colonic perianastomotic To2, although mean To2in the continuous group was significantly lower than in the interrupted group (P<0·01). The leakage rate was 10 per cent (1/10) for anastomoses constructed with a perianastomotic To2above 55 mmHg compared with 100 per cent (10/10) if less than 25 mmHg (P<0·001). Perianastomotic To2correlated with breaking energy (P<0·001), breaking strength (P<0·01) and hydroxyproline content (P<

ISSN:0007-1323    

DOI:10.1002/bjs.1800720808

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractAcral melanoma occurs in the volar surface of the hands, feet, fingers, toes and subungual sites. Recently it has been recognized as a distinct entity with characteristic clinical and pathological features. Of our 340 patients with malignant melanoma, 24 (7 per cent) had acral melanoma. Sixteen were in the plantar skin, two in the palms and six in the nailbed. The delay in diagnosis was 6 months to 5 years and most of the patients presented with large neglected tumours. Fourteen lesions had histological features consistent with acral lentiginous melanoma — a unique pattern to this area. Fourteen patients were in clinical stage I at diagnosis, seven in stage II and three had distant metastases (stage III). The treatment was mainly surgical. Palmar—plantar lesions were widely excised. One patient underwent below‐knee amputation. Lesions of the digits were treated by amputation of the affected toe. Fourteen of the patients underwent either prophylactic or therapeutic lymph node dissection. In 9 of them, regional metastases were found. In patients with advanced disease chemotherapy was added. Three patients had isolated limb perfusion. Fourteen patients died of metastatic disease within 1–5 years. Four are alive but have metastatic spread. Six patients are disease‐free, one to 4·5 years following

ISSN:0007-1323    

DOI:10.1002/bjs.1800720809

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractThe purpose of this study was to determine the value of staging and serial follow‐up investigations in newly diagnosed patients with completely excised primary cutaneous malignant melanoma. We reviewed the records of the 393 patients with completely excised primary malignant melanoma who were referred to the Ontario Cancer Institute and the Toronto‐Bayview Regional Cancer Centre between 1 January 1978 and 31 March 1982. Initial investigations included history and physical examination in all 393 patients, complete blood count (199 patients), liver function tests (198 patients), urinary melanins (159 patients), chest X‐rays (345 patients), whole lung tomography (182 patients), radionuclide liver‐spleen scans (207 patients), and bone scans (116 patients), bipedal lymphangiograms (78 patients), CT scans of the chest (59 patients), and CT brain scans (51 patients). The clinical stage of ten patients was changed as a result of history and physical examination or lymphangiogram. All other investigations failed to detect metastatic melanoma. Follow‐up investigations included history and physical examinations, complete blood counts, liver function tests, radionuclide liver spleen and bone scans. History and physical examinations, chest X‐rays and patients' awareness of abnormalities were responsible for detection of subsequent melanoma recurrences. All other tests failed to identify metastatic melanoma at the time of its occurrence. Therefore, we recommend that initial staging investigations be limited to history and physical examination with clinical photographs, and baseline chest X‐ray. We recommend that subsequent follow‐up include only history and physical examinations a

ISSN:0007-1323    

DOI:10.1002/bjs.1800720810

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY

摘要:

AbstractA matched case control study has been conducted in order to determine whether an association exists between gastric surgery and the subsequent development of colorectal carcinoma. Two hundred and eighty‐nine patients (151 women and 138 men) presenting with large bowel cancer have been studied. Case controls were matched according to age, sex and date of admission. The case notes of each patient in the study were reviewed to determine the prevalence of peptic ulceration and gastric surgery. Significantly more patients with colorectal carcinoma had undergone gastric surgery P<0·05, although the prevalence of peptic ulceration was similar in both groups. Colorectal carcinoma is more common in patients who have undergone gastric surgery for benign peptic ulcer disease than in the general populati

ISSN:0007-1323    

DOI:10.1002/bjs.1800720811

出版商:John Wiley&Sons, Ltd.    

年代:1985

数据来源: WILEY