Influence of temporary faecal diversion on long-term survival after curative surgery for colorectal cancer.

Experimental carcinogenesis is enhanced at colorectal anastomoses, inhibited by proximal faecal diversion and promoted by the closure of a defunctioning stoma. The clinical relevance of these observations was investigated in a retrospective study of curative restorative resection for colorectal carcinoma. The 5-year disease-free survival rate (95 per cent confidence interval) in 122 patients with a temporary stoma (50.4 (41.1-59.7) per cent) was significantly reduced (P < 0.01) compared with that in 218 with no stoma (66.8 (59.4-73.5) per cent). In patients with Dukes B tumours early stoma closure (within 3 months of resection) was associated with a worse survival (P < 0.005) and a higher tumour recurrence rate (P < 0.05) than in those with no stoma. Survival rates after late stoma closure were no different from those in patients with no stoma. Multivariate analysis revealed Dukes stage (P < 0.0001), tumour differentiation (P = 0.02) and timing of stoma closure (P = 0.02) as independent predictors of survival. In curative surgery for colorectal cancer temporary faecal diversion confers a survival disadvantage that can be prevented by delayed closure of the stoma.

Intra-abdominal sepsis and survival after surgery for colorectal cancer.

Of 361 patients who survived curative left colonic or sphincter-saving rectal resection for cancer, 44 developed significant postoperative intra-abdominal sepsis and 317 did not. The two groups were well matched for age, sex, site of tumour, Dukes stage, tumour differentiation and timing of operation. There was no significant difference in the 5-year overall actuarial survival rate (P = 0.25) or in the 5-year disease-free survival rate (P = 0.23). Stepwise regression analysis of prognostic variables including age, sex, site of tumour, Dukes stage, tumour differentiation, timing of operation, grade of surgeon and postoperative intra-abdominal sepsis identified Dukes stage, age at operation and tumour differentiation as predictors of survival. These results suggest that postoperative intra-abdominal sepsis is not a prognostic factor for long-term survival in colorectal cancer as has been previously reported.

Survival in colorectal carcinoma associated with previous extracolonic cancer.

Between 1971 and 1990, 1198 patients presented with a primary colorectal cancer, of whom 70 patients (5.8%) had survived previous extracolonic primary malignancies. Complete data were available on 63 cases (metachronous group) of the 70 patients, who had a total of 67 previous extracolonic cancers. Clinical and pathological characteristics of these cases were identical to the remaining patients with primary colorectal cancer (primary group, n = 1128), except that the former group was significantly older, P < 0.05. In the metachronous group there was a preponderance of breast, female genital, gastric, urological, lung and skin cancers, and the median time to develop a colorectal primary tumour was 7 years. The 5-year overall actuarial survival was better in the metachronous group, log rank test: chi 2 = 4.07, P = 0.04. In the metachronous group, 44 patients who had undergone curative resection were matched with patients with primary colorectal cancer (control group, n = 88) in the ratio of 1:2 based on age, sex, tumour site, Dukes' stage, tumour differentiation, grade of surgeon and date of operation. Comparison between these groups showed a significantly better survival in the former group, log rank test: chi 2 = 5.99, P = 0.01. These results suggest that patients with colorectal cancer and a history of previous extracolonic tumours have similar clinicopathological features as the general colorectal cancer population but have a better survival.

Does concurrent splenectomy at colorectal cancer resection influence survival?

Twenty-one patients had a concurrent splenectomy with resection of colorectal cancer between 1970 and 1988. These were matched individually with disease control patients based on age, sex, site of tumor, Dukes stage, tumor differentiation, and date of the operation. Significantly more patients in the splenectomy group (n = 11) developed postoperative infective complications than in the control group (n = 4) (McNemar test: P = 0.03). Five-year overall actuarial survival was 45 percent in the former group and 59 percent in the latter (log rank test: chi-squared = 1.07; P = 0.24). Similarly, five-year disease-free survival in 17 patients with Dukes B and C cancers who had curative resections did not differ between the groups (log rank test: chi-squared = 0.08; P > 0.25). These results suggest that splenectomy with resection of colorectal cancer increases the risk of postoperative sepsis and does not influence long-term survival. The infrequency of concurrent splenectomy at resection of colorectal cancer may not overcome Type II error.

Paratesticular myxoliposarcoma--(a case report).

A rare case of paratesticular myxoliposarcoma spreading to the inguinal region forming satellite nodules, hence clinically mimicking a metastatising testicular malignancy is reported. Its prognostic factors are discussed.

Corrosive acid strictures of the stomach (a case report).

Two patients presented with history of suicidal acid ingestion. Both the patients developed strictures exclusively in the stomach without involvement of the oesophagus, after a period of 12 weeks. The mechanism of this involvement is presented. The literature on this subject is briefly reviewed.