Construction of an omental envelope as a method of excluding the small intestine from the field of postoperative irradiation to the pelvis.

A technique for excluding the small intestine from the true pelvis in order to permit high dose radiotherapy is described herein. The procedure is done postoperatively after incomplete resection for carcinoma of the colon and rectum.

Elective postoperative radiotherapy after incomplete resection of colorectal cancer.

It is known that patients with incompletely resected epithelial cancers are at high risk of local recurrence. A prospective study to determine whether elective postoperative radiotherapy can decrease the incidence of local recurrence and thus improve survival of those patients with an incompletely resected tumor was made of 125 irradiated patients with locally advanced colorectal cancer (B2, C1, C2) 78 patients had rectosigmoid tumors and 47 had colonic cancers. Complete resection (R0) was performed in 94 patients (75 per cent). Thirteen (10 per cent) had microscopic (R1) and 18 (14 per cent) had gross residual disease (R2). Local control and survival (average follow-up, 38 months) of patients with microscopic residual cancer (RI) were 84 per cent (11/13) and 77 per cent (10/13) respectively. These results were identical to those obtained in patients without residual disease (R0). Patients with gross residual disease (R2) had a local control of 50 per cent (9/18) and a survival of 39 per cent (7/18). Radiation complication occurred in seven of 125 patients (6 per cent). One patient died, of radiation enteritis. One patient required a nephrostomy. The remaining five patients were treated conservatively. Elective postoperative radiotherapy given to patients who had incomplete resection of a colorectal cancer prevented local recurrence in the majority and may have increased survival.

The treatment of locally advanced carcinoma of the colon and rectum by a surgical procedure and radiotherapy postoperatively.

Following resection of locally advanced carcinomas of the rectum and colon, 95 patients received moderate dose elective radiotherapy either to an inverted T field or the entire abdomen. In 27 instances, carcinomas invaded adjacent structures and were incompletely resected. Fifty-seven patients had tumors of the rectosigmoid and had either an abdominoperineal or an anterior resection. Thirty-five patients had a mean follow-up period of 26 months. Three of 35 carcinomas recurred locally, 26 of 35 patients are alive without disease. Thirty-eight patients had carcinomas of the colon and had either a partial or hemicolectomy. Thirty-one had a mean follow-up period of 24 months. Five of 31 carcinomas recurred locally. Seventeen of 31 patients are alive, without disease. Sixty-six of 95 patients have survived two years free of disease. One death occurred from radiation enteritis. Radiotherapy postoperatively for patients at a high risk of failure resulted in a low incidence of local recurrence.

Elective postoperative radiotherapy for locally advanced colorectal cancer. A preliminary report.

Preoperative radiotherapy in colorectal carcinoma invalidates surgical staging and delays performing the surgical resection. Postoperative radiotherapy does neither. From October 1972, to December 1975, 40 patients at high risk for local recurrence (B2 and C) received postoperative radiotherapy. Lesions that were located in the rectum, rectosigmoid and low sigmoid colon were given 4600 rads in four and a half weeks through an inverted T-shaped field which encompassed the pelvic and paraortic nodes. Patients with tumors located above mid-sigmoid were treated to the entire abdominal cavity by the moving strip technique. Of 19 patients with rectal and rectosigmoid lesions, 14 (74%) are alive without evidence of disease. Two had local recurrence in the treated area. Of 21 patients with lesions above the mid-sigmoid, four have failed locally, while 11 (52%) are alive without evidence of disease. One of these 40 patients died to radiation enteritis. Although the follow up period is short, the results suggest that a moderate dose of radiation may prevent local recurrence in patients with locally advanced colorectal cancer.

A nonoperative approach to subcutaneous removal of stubborn sutures from wound granulomas.

A simple device for grasping, cutting, and extracting sutures from subcutaneous granulomas has been used in more than fifty patients. It is especially useful in removing sutures embedded deeply beneath the skin level in obese patients.