A prospective, randomized study was conducted to determine the need for nasogastric decompression following elective colorectal surgery for malignant and premalignant lesions. Seventy-seven consecutive patients were randomly assigned to one of two groups: Group 1--nasogastric decompression was maintained postoperatively until resumption of bowel function; Group 2--the nasogastric tube was removed in the recovery room. Forty patients were assigned to Group 1 (21 males, 19 females) and 37 to Group 2 (22 males and 15 females). Eleven patients in Group 1 (28%) developed nausea postoperatively, with six patients (15%) having an average of less than two emeses and five (12%) requiring nasogastric reintubation. Thirteen patients in Group 2 (35%) developed nausea, with 10 patients (27%) having an average of two emeses and three (8%) requiring nasogastric intubation (P = 0.80). Abdominal distention was observed in 13 patients (32%) in both Group 1 (32%) and Group 2 (35%). Two of the latter patients required nasogastric reintubation. Postoperative fever was noted in 23 patients (58%) in Group 1 and 14 (38%) in Group 2 (P = 0.13); atelectasis was diagnosed in 38 per cent of patients in Group 1 and 14 per cent in Group 2 (P = 0.03). These data support that nasogastric decompression is not necessary following elective colorectal surgery for malignant and premalignant lesions.

Adult↗

PubMed1992

Prognostic significance of anastomotic recurrence from colorectal adenocarcinoma.

A retrospective analysis of the prognostic significance of anastomotic recurrence in 50 patients with colorectal adenocarcinoma was conducted from 1970 to 1987. All primary cancers were located above 10 cm from the anal verge. Forty anastomotic recurrences (80 percent) followed resection of sigmoid or proximal rectal tumors. The overall disease-free interval was 13 months, with 90 percent of recurrences diagnosed within 24 months of the primary resection. Forty-five recurrences (90 percent) were associated with synchronous or metachronous metastases. Overall median survival following the recurrence was 16 months--37 months if the anastomosis was the only recurrence site. Of five patients alive without evidence of disease, all were asymptomatic, and recurrence was confined to the anastomosis. In conclusion, anastomotic recurrence following resection of colorectal adenocarcinoma frequently heralds disseminated disease but can be potentially resected for cure if it is the only site in an otherwise asymptomatic patient.

Adenocarcinoma↗

PubMed1988

Colorectal villous and tubulovillous adenomas equal to or greater than four centimeters.

The records of 237 patients treated for benign and malignant villous and tubulovillous adenomas at Roswell Park Memorial Institute from 1963 to 1987 were reviewed. Sixty-five adenomas were greater than or equal to 4 cm and form the basis of this report. Fifteen (23%) were in the cecum, 3 (5%) in the right colon, 1 (1%) in the splenic flexure, 10 (15%) in the sigmoid colon, and 36 (55%) in the rectum. The most common symptoms were rectal bleeding (70%), mucus diarrhea (44%), constipation (22%), and tenesmus (19%). Fifty-five (85%) of these large adenomas contained invasive adenocarcinoma and one in situ carcinoma. Two thirds of invasive carcinomas arose from predominantly villous adenomas and one third from tubulovillous adenomas. Half of all malignant adenomas demonstrated metastases to regional lymph nodes or distant metastases. Seven malignant adenomas (12%) were associated with synchronous adenocarcinomas of the colon, and 29% of malignant adenomas were associated with synchronous adenomatous polyps, principally tubular type. Four of nine benign, large adenomas were associated with synchronous adenomas but with no adenocarcinomas. No relationship was found between the size of the adenoma, location, or Dukes' stage. Though the incidence of in situ and invasive carcinomas is clearly related to the size of the adenoma, a linear relationship could not be demonstrated.

Adenocarcinoma↗

PubMed1988

Squamous cell carcinoma antigen as a marker for squamous cell carcinoma of the anal canal.

Twenty-one patients with documented squamous cell carcinoma (SCC) of the anal canal underwent prospective serial collection of 101 serum samples for radioimmunoassay of SCC antigen to evaluate regression or progression of disease. Eighteen presented with primary SCC of the anal canal, two with metastatic disease, and one with a recurrence in the perineum. Median follow-up was 18 months. Thirteen of 22 serum samples were true-positives, and nine of 22 were false-negatives. Four of 79 serum samples were false-positives and 75 of 79 were true-negatives. The sensitivity of this test is 59% and the specificity is 95%, with the accuracy of a positive test being 76%.

Adult↗

PubMed1987

Metastases in small lymph nodes from colon cancer.

Lymph node metastases are important determinants in the prognosis of primary colorectal cancer. Although it has been established that enlarged, palpable lymph nodes contain metastases in less than half of the cases, no definitive data concerning the incidence of metastases in lymph nodes measuring 5 mm or less are available. We treated the surgical specimens of 52 consecutive patients who had colon cancer with a lymph node clearance technique at the Roswell Park Memorial Institute, Buffalo. We found 2699 lymph nodes in the 52 specimens, with a mean of 52 lymph nodes per specimen (range, five to 151). Sixty-four lymph nodes were found with metastases in 21 (40%) of the 52 patients. Fifty-nine of 64 of the lymph nodes were reexamined and remeasured. Thirty-nine lymph node metastases measured less than 5 mm, 13 were between 5 and 10 mm, and eight were larger than 10 mm. We concluded that lymph node metastases in colon cancer occur most frequently in lymph nodes measuring less than 5 mm (small lymph nodes). The use of lymph node clearing techniques in surgical specimens improves detection of small lymph node metastases and thereby diminishes understaging.

Colonic Neoplasms↗

PubMed1986

Anastomotic recurrence of adenocarcinoma of the colon.

The cases of 158 patients with locally recurrent colorectal carcinoma were retrospectively studied. Eighteen patients (11.4%) had a recurrent lesion at the site of anastomosis. Sixteen patients who underwent a primary curative resection had a median disease-free interval of 13 months, while two patients with a palliative resection had a disease-free interval of two months. All recurrences occurred within 27 months of the primary surgery. Abdominal pain was the most frequent presenting symptom, followed by melena and a change in bowel habits. Eighty-nine percent of the recurrences occurred in the context of metachronous or synchronous metastases equally distributed between local-regional and distant diseases. Thirteen patients underwent resection of recurrent disease, of which eight resections were curative. The median survival following curative resection was 23 months, with 14 months for palliative resection and five months for no resection.

Adenocarcinoma↗

PubMed1985

Isolated metachronous metastases to soft tissues of the buttock from a colonic adenocarcinoma.

The more common patterns of dissemination and recurrence of colonic cancer are known and well-documented. In contrast, extravisceral, distant soft tissue metastases are comparatively rare. Therefore, these metastases are not subject to meaningful generalizations, with the exception that they are often associated with widespread metastatic disease. This report describes the first case of carcinoma of the colon metastatic to the skeletal muscle of the contralateral buttock and the sciatic nerve without concurrent evidence of pelvic or distant metastases. Curative resection was not possible because of involvement of the proximal sciatic nerve.

Adenocarcinoma↗

PubMed1982

Coronary sinus perforation from placement of a LeVeen shunt in a child.

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Cardiac Tamponade↗