[Surgical treatment of synchronous hepatic metastases of colorectal cancers. Simultaneous or delayed resection?]. / Le traitement chirurgical des métastases hépatiques synchrones des cancers colo-rectaux. Résection simultanée ou résection différée?

The surgical strategy for resectable synchronous hepatic metastases of colorectal cancer remains controversial. The retrospective analysis of our series of resectable synchronous hepatic metastases focused on the percentage of simultaneous resections, the circumstances, the indications and the results of the one-step procedure compared to the two-step strategy. From January 1, 1982 to December 31, 1995, 129 patients were operated on for resection of hepatic metastases of colorectal cancer. Forty one patients (32%) presented with synchronous hepatic metastases, 20 of whom (49%) underwent simultaneous resection of the primary tumor and the hepatic metastases (simultaneous resection group: SR). For the other 21 patients (51%), the hepatic resection was delayed for a mean interval of 5.2 +/- 4.2 months (delayed resection group: DR). The mean age of the 2 groups was not significantly different (54 years versus 58 years). When the primary tumor was located on the ascending colon, the hepatic excision was performed simultaneously in 9 out of ten cases. The need for blood transfusion and the volume required were not significantly different between the two groups. The length of each surgical operation was comparable between the two groups (331 +/- 76 minutes SR vs 330 +/- 88 minutes DR). Postoperative complications were observed in 20% of patients in the SR group and 10% of patients in the DR group (no significative difference). There was no postoperative mortality in either group. Survival was 83%, 44% and 37% at 1, 2 and 3 years respectively in the SR group and 79%, 59% and 49% in the DR group, with no significant difference between the groups. These results show that simultaneous resection of the primary tumor and the hepatic metastases did not increase either morbidity or mortality in our study, and that it should be proposed especially to patients presenting with a primary tumor of the ascending colon with metastases resectable by means of a minor hepatectomy.

An historical cohort study of mortality among salaried research and development workers of the Allied Corporation.

An historical cohort mortality study of research and development personnel (primarily chemists) actively employed on Dec 31, 1961, with at least 1 year of service with the Allied Corporation was carried out. These employees experienced lower mortality for all causes of death combined and all cancer causes combined than would be expected on the basis of the general US population. The degree of deficit in all causes of death combined was below the healthy worker effect usually associated with occupational mortality studies of production workers. There was one statistically significant excess, that for cancer of the prostate among research laboratory personnel who worked during the period 1945 to 1955, a period during which researchers may have been exposed to insecticides or fluorine derivatives. Substantial deficits were observed for causes of death known to be related to life-style, suggesting that mortality among Allied's salaried employees, including research and development workers, may have been influenced more by these factors than by occupational factors.