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AIM The aim was to describe changes in incidence and mortality from colorectal cancer (CRC) in England by analysing data available from the National Cancer Registration and Analysis Service (NCRAS, 2001-2017). METHODS Data analysis was undertaken to interpret trends and patterns in age-standardized incidence and death rates from CRC, including sub-analyses by six age groups (0-24, 25-49, 50-59, 60-69, 70-79, 80+) and three sites of cancer-colonic, rectosigmoid and rectal. RESULTS Overall CRC incidence remained relatively stable-70.1 cases per 100 000 individuals (95% CI 69.3-71.0) in 2001 and 68.8 cases (95% CI 68.0-69.5) in 2017. Sub-analysis demonstrates a quarter fewer incidence of rectosigmoid cancer (-27%). This is counterbalanced by a 3% rise in colon cancers. The age-standardized incidence rate of CRC increased by 59% in the 25-49 age group. In the over 50s, CRC incidence remained stable, with reductions seen in rectosigmoid cancer (50-59 years, -19%; 60-69, -26%; 70-79, -39%; 80+, -27%). Overall, mortality improved (-18.7%), primarily as a result of the reduction in deaths from colon (-31.6%) and rectal cancers (-25.1%). Deaths from the small incident number of rectosigmoid cancers, however, demonstrated a significant increase overall (+166.7%). Grouped age-standardized death rate analyses showed increasing death rates in the under 50s (+28.3%) compared to declining rates in the over 50s (-15.8%). CONCLUSIONS There is a clear trend in increased incidence and mortality in individuals under 50 years old. There is also a trend to increased mortality from rectosigmoid cancer. These findings should have implications for national screening programme extension to under 50s and a call to arms for appropriate identification, staging and treatment of rectosigmoid cancers.

AIM Objective and reproducible quality measures of complete mesocolic excision (CME) for colon cancer are not currently available. This study aimed to measure the inferior mesenteric stump length following CME for sigmoid colon cancer and explore surgical, pathological and oncological outcomes in patients with a stump length of

Neuroendocrine tumors (NETs) are heterogeneous, and the incidence of NETs is rapidly increasing. We observed different survival in patients with rectal NETs and rectosigmoid junction NETs, which are treated similarly. We included patients with rectal and rectosigmoid junction NETs from the SEER database. The 5‐year survival was set as the end‐point. 6675 patients with rectal NETs and 329 patients with rectosigmoid junction NETs, were eligible for the analysis. Initially, the survival analyses suggested that the 5‐year survival significantly differed between the patients with rectal and rectosigmoid junction NETs (HR = 0.82, 95% CI 0.70‐0.95; P = .01). Tumor differentiation, an invasion deeper than T2, and lymph node and distant metastases were still important risk factors affecting survival for both location. While, the males showed better survival (HR = 0.69, 95% CI 0.55‐0.88; P 5, P 5, P, Survival and risk factors of rectal and rectosigmoid junction NET are different. Rectosigmoid junction NETs presented a better 5‐year survival. A clear and consistent definition of the rectosigmoid junction is urgently needed for future studies.

Aim the postoperative outcome after elective sigmoidectomy for diverticulitis has not been compared to that for cancer. The study aimed to evaluate the differences in the postoperative outcome after sigmoidectomy for diverticular disease and cancer. Method the National Inpatient Sample Database was used to identify patients who underwent elective sigmoid resection for diverticular disease or cancer between 2004 and 2011. After excluding patients with metastatic cancer and preoperative weight loss, sigmoid cancer and diverticulitis patients were matched using propensity score, controlling for age, gender, race, type of operation (open vs. laparoscopic), and co-morbidities. The end points of interest were infective complications, reoperation, anastomotic leakage, rebleeding, length of hospital stay and in-hospital mortality. Results after propensity score matching (diverticulitis=11,192 patients, sigmoid cancer=11,192 patients), the mean age was 65±12.5, 53.8% were male, and 61.5% were Caucasian. Only 18.0% of the operations were done by laparoscopy. The overall complication rate was 17.7% and the in-hospital mortality rate was 0.9%. The diverticulitis group had a higher rate of surgical site infection (3.2%vs.2.6%,p=0.004), intra-abdominal abscess formation (1.2%vs.0.4%,p

Aim It is controversial whether a high or low ligation of the inferior mesenteric artery (IMA) is superior. The former allows an extended lymph node clearance whereas the latter preserves the distal vascular supply via the left colic artery (LCA). Apical lymph node dissection of the IMA (ALMA) harvests nodal tissue along the IMA proximal to the LCA whilst performing a low ligation. This anatomically replicates the oncological benefit of high ligation and the vascular preservation of low ligation. Our study evaluates the nodal yield of ALMA and the short-term outcome of this technique. Method We retrospectively studied 19 patients with sigmoid or rectal cancer who underwent curative surgical resection with ALMA. All ALMAs were performed with a standard technique previously described (Kobayashi et al., Surg Endosc 2005, 20:563-9; Sekimoto et al. Surg Endosc 2010, 25:861-6) . The lymph node yield from the dissection (the ALMA specimen) was compared with the total lymph node yield. Data on the LCA anatomy, time required to perform ALMA, complications and postoperative recovery were evaluated. Results ALMA was successful in 18 patients. Median postoperative hospitalization was 5 (2-26) days without ALMA-related morbidity or mortality. The median lymph node yield was 20 (9-41) and a median of 14.3 (0-80)% were harvested with ALMA. Two patients not having neoadjuvant chemoradiotherapy had fewer than 12 lymph nodes, excluding nodes harvested from ALMA. The average time required for ALMA was 18 min. Conclusion ALMA is a safe and feasible technique, allowing extended lymphadenectomy without sacrificing the LCA. In this small group of patients none were upstaged due to cancerous involvement of the proximal nodes.

Aim Surgery for rectal and sigmoid cancer is a model setting for investigating preoperative information provision and shared decision making (SDM), as the decision consists of a trade-off between the pros and cons of different treatment options. The aim of this study was to explore surgeons' opinion on the preoperative information that should be given to rectal and sigmoid cancer patients and to evaluate what is actually communicated. In addition, we assessed surgeons' attitudes towards SDM and compared these with patient involvement. Method A questionnaire was sent to Dutch surgeons with an interest in gastroenterology. Preoperative consultations were recorded. A checklist was used to code the information that surgeons communicated to the patients. The OPTION-scale was used to measure patient involvement. Results Questionnaires were sent to 240 surgeons, and 103 (43%) responded. They stated that information on anastomotic leakage and its consequences, the benefits and risks of a defunctioning stoma and the impact of a stoma on quality of life were necessary preoperative information. In practice, patients were inconsistently informed of these items. Most participants agreed to using SDM in their consultations. However, in practice, most patients were offered only one treatment option and little SDM was seen. The mean OPTION-score was low (7/100). Conclusion Insufficient information is given to patients with rectal and sigmoid cancer to guide them on their preferred surgical option. Information should be given on all treatment options, together with their complications and outcome, before any decision is made.

Malignant fibrous histiocytoma (MFH) of the sigmoid colon is extremely rare and imaging characteristics of MFH during contrast-enhanced sonography have not been described yet. Here we report the case of a 55-year-old man suffering from MFH in the sigmoid colon, with an emphasis on contrast-enhanced sonography findings. © 2012 Wiley Periodicals, Inc. J Clin Ultrasound 40:439–442, 2012

Introduction A temporary loop ileostomy is often created to minimize the impact of peritoneal sepsis if anastomotic dehiscence occurs following low colorectal anastomosis. Although it has been suggested that a loop ileostomy should be reversed within 12 weeks of formation, this is often not the case. We set out to analyse the use of loop ileostomy following elective anterior resection in England and to identify factors associated with non and delayed reversal. Method Hospital episode statistics for the years 2001–2006 were obtained from the Department of Health. Patients undergoing elective anterior resection with a loop ileostomy for a primary diagnosis of rectal or recto-sigmoid cancer between April 2001 and March 2003 were identified as the study cohort. This cohort was followed until March 2006 to identify patients undergoing reversal of an ileostomy in an English NHS Hospital. Results A total of 6582 patients had an elective anterior resection between April 2001 and March 2003, of which 964 (14.6%) also had an ileostomy. Seven hundred and two (75.1%) patients were reversed before March 2006. Advancing age and comorbidity were statistically related to nonreversal. Median time to reversal was 207 days (Interquartile range 119–321.5 days). Postoperative chemotherapy and comorbidity significantly delayed reversal. Conclusions One in four loop ileostomies performed to defunction an elective anterior resection is not reversed, and in the presence of significant comorbidity one in three is not reversed. Only 12% is reversed within 12 weeks.

Eosinophilic (Langerhans' cell) granuloma is most common in children and is unusual in the elderly. A cutaneous lesion as the sole manifestation of adult Langerhans' cell histiocytosis is rare. We report an 81-year-old man who presented with a noduloulcerative lesion on the lower lip. A punch biopsy suggested a lymphoepithelioma-like carcinoma. In the absence of immunohistochemistry, the large pale cells with atypical lobular nuclei and patent nucleoli, with an overlying ulceration, were interpreted as carcinoma cells. Definitive diagnosis was established after complete resection of the lesion aided with the use of immunohistochemistry. The proliferating cells were S100, CD1a and CD207 (langerin) positive and cytokeratin, epithelial membrane antigen, CD15, CD30, melan A and carcinoembryonic antigen negative. To our knowledge, eosinophilic (Langerhans' cell) granuloma of the lip has not been described. The case constituted a diagnostic challenge because of its unusual clinical presentation and its histopathological similarity to certain other benign and malignant entities. Because there was no other organ involved, the patient was treated with complete surgical excision without recurrence or other organ involvement in the 4-month follow-up period. Labial eosinophilic (Langerhans' cell) granuloma should be considered in the histological differential diagnosis in cases with atypical polymorphous infiltrates including large pale cells.

Three cases of long-standing ulcerative colitis and invasive adenocarcinoma are described. In all three cases, pre-operative rectal and/or colonoscopic biopsies demonstrated the presence of a villous adenoma: two without dysplasia and the third with moderate dysplasia. The presence of structures compatible with villous adenoma should be, even in the absence of epithelial dysplasia, an indication for panproctocolectomy in patients with long-standing ulcerative colitis.

The location and extent of the anal transitional zone (ATZ) were investigated in the age group typical for anal canal carcinomas. The methods used were macroscopic determination after whole-mount staining with Alcian-dyes as well as conventional histological technique. The results show that the epithelial variants may be found over a larger area than previously reported, namely from 6 mm below to 20 mm above the dentate line. Variations in location and extent of the ATZ are described, as well as the frequent finding of mature squamous epithelium high in the anal canal. The significance of the findings in relation to the special types of anal canal carcinomas is discussed, and on the basis of the macroscopic definition of the canal, as well as the histological observations in this study, it is proposed that anal canal carcinomas should be defined as tumours partly or totally located within a distance of 2 cm above the dentate line.

Using single cell cytometry the pattern of DNA content in pre-operative samples from 131 carcinomas of the rectum and rectosigmoid has been studied. For comparison, 21 carcinomas of the colon, 44 colorectal polyps and mucosa adjacent to the tumours were also included. The biopsies were classified into near diploid (ND), near diploid with aneuploid cells (ND-anc) and aneuploid (AN). A more specific subclassification of aneuploid samples was not consistent because of a commonly occurring multiclonality, where different clones dominated different parts of the tumours. Fifteen of all 130 representatively sampled rectal carcinomas were ND; however, all the ND scores were based on a single sample. Among 31 multiply-sampled carcinomas none registered as ND in all samples. There were no principal differences in patterns of DNA profiles between rectal and colon carcinomas. Five samples from the pericancerous mucosa and samples from 4 adenomas showed non-ND patterns, which may be a premalignant sign. The main conclusions of these results are that rectal carcinomas, even if they contain a substantial ND cell population, to a very great extent contains cells with an abnormal DNA content. The carcinomas can be classified according to their pre-operatively estimated DNA content. The clinical relevance of this will be judged when the patients have been followed for longer time periods.

Objective Faecal occult blood testing is being introduced for population screening in the United Kingdom. Flexible sigmoidoscopy may provide a viable alternative. The outcomes of the flexible sigmoidoscopy trial are awaited but the most obvious disadvantage is that only the lower third of the colon is examined and proximal pathology cannot be excluded. The relationship between proximal pathology and distal findings at flexible sigmoidoscopy is uncertain. The aim of this study was to determine the incidence of distal neoplasia in patients with confirmed proximal cancers of the colon. Method All confirmed proximal colonic cancers (defined as those proximal to the splenic flexure) were identified from a database of pathology specimens at a single centre between January 1999 and August 2006. A retrospective analysis of preoperative and peri-operative mucosal imaging (contrast enema, colonoscopy and CT colonography) was conducted to identify any distal neoplasia in these patients. Results A total of 348 patients were identified. Pre- or peri-operative mucosal imaging was identified in 231 (66%) and 49 (21%) had distal neoplasia. Nineteen (8%) of these patients would have gone on to have a colonoscopy based on the UK flexible sigmoidoscopy trial protocol and 92% of the cohort would not have had a colonoscopy. Conclusion Nearly 80% of confirmed proximal cancers in our series did not have any demonstrable distal neoplasia. Only 8% of our cohort would have proceeded to colonoscopy. A very significant number of proximal cancers would not have been detected.

Background: Recent clinical data indicate that fast-track surgery (multimodal rehabilitation) leads to shorter postoperative length of hospital stay, faster recovery of gastrointestinal function as well as reduced morbidity and mortality rates. To date, no study has focused on the effects of fast-track surgery on postoperative immune function. This study was initiated to determine whether fast-track rehabilitation results in improved clinical and immunological outcome of patients undergoing colorectal surgery. Methods: Forty patients underwent either conventional or fast-track rehabilitation after colorectal surgery. In addition to clinical parameters (return of gastrointestinal function, food intake, pain score, complication rates and postoperative length of stay), we determined parameters of perioperative immunity by flow cytometry (lymphocyte subgroups) and enzyme-linked immunosorbent assay (interleukin-6). Results: Our findings indicate a better-preserved cell-mediated immune function (T cells, T-helper cells, natural killer cells) after fast-track rehabilitation, whereas the pro-inflammatory response (C-reactive protein, interleukin-6) was unchanged in both study groups. Furthermore, we detected a significantly faster return of gastrointestinal function (first bowel movement P

Background and Objectives Carcinoembryonic antigen (CEA) and carbohydrate antigen (CA19-9) are well known to be the most common tumor markers of colorectal carcinomas. However, the significance of increase in these markers to predict the prognosis of the patients remains a problem for debate. Methods One hundred three patients with colorectal carcinoma, who had been treated by resection and reconstruction of digestive tracts were studied. Correlation of preoperative serum value of CEA and CA19-9 with clinicopathologic features including prognosis of the patients was investigated. Results Preoperative elevation of both of the two markers proved to be an independent prognostic indicator, however, an elevation of only one of the two markers did not obtain a prognostic significance. Conclusions Combined data of preoperative increase in CEA and CA19-9 in sera can provide a powerful and useful information to predict prognosis of patients with colorectal carcinoma. J. Surg. Oncol. 2006;94:132–137. © 2006 Wiley-Liss, Inc.

Introduction: there are very little clinical and pathological data on colorectal cancer among Indigenous people in Australia. Methods: a retrospective study on Indigenous patients treated for colorectal cancer at the Townsville and Cairns Base Hospitals from 1999 to 2004 was carried out in order to better characterise this disease in the Indigenous population. Results: there were 25 patients (12 M, 13 F) with a median age of 57.3 years. The majority (56%) of the tumours were left-sided, being in the sigmoid colon, rectosigmoid junction and rectum. Of the patients, 60% had American Joint Committee on Cancer (AJCC) staging system Stage I and II disease at presentation. There was a relatively high proportion of poorly differentiated adenocarcinomas (40%). Six patients died of the disease. The median follow-up was 20.5 months (range 2−51). Conclusions: comparisons were made with available data on colorectal cancer in the general Australian population. The limitations and deficiencies of the study, as well as problems of data collection on Indigenous people were discussed.

Background Colonic stents are increasingly used topalliate or alleviate large bowel obstruction in patientswith colon cancer and other obstructing lesions in whoma definitive surgical procedure is inappropriate. We reporton the outcomes of a large group of patients whounderwent deployment of a colon stent in a singleinstitution by a single operator.Patients and methods This was a retrospective obser-vational cohort study of all patients undergoing colonicstenting between September 1995 and May 2002. Datacollected included nature of pathology, type of stentused, procedure morbidity, patient survival and details ofany definitive procedures performed after stenting.Results One hundred and seven patients were evalu-ated (58 male) with a median age of 75 years (range 36–99 years). A total of 112 stents were successfullydeployed (46 as an emergency). Twelve patients haddouble stents inserted coaxially and overlapping. In 7patients the stent could not be safely deployed. Eighty-seven patients had colorectal cancer, 13 patients had anextra-luminal malignancy, 5 had diverticular stricturesand in 2 patients the pathology was unknown. At lastreview (May 2002) 18 patients were alive, 82 patients haddied and 7 patients had been lost to follow-up. Of thosepatients who died, the median survival after stentingalone was 6 weeks (range 4 days – 36 weeks). Tenpatients underwent subsequent definitive surgery. Stentcomplications included, 2 colonic perforations, 3 stentocclusions and 4 stent migrations.Conclusion Colonic stenting can be used effectively,with acceptable morbidity, to manage patients presentingwith large bowel obstruction. In a smaller number ofpatients colon stents may safely temporize symptomswhile definitive surgery is planned.Keywords Colorectal cancer, colorectal stents, largebowel obstruction

Background. Metastatic adenocarcinoma of the colon is a frequently encountered medical situation. Metastasis to the mandible from adenocarcinoma of the colon is very unusual and rarely reported. We report the case of a 73-year-old man with metastatic adenocarcinoma to the mandible. Methods. The patient was referred for evaluation of a mass of 2 months' duration in the right parotid gland. He gave a history of watery bowel movements of unknown duration. Physical examination revealed a 7- × 6-cm hard mass, which seemed to be fixed to the right mandible. A CT scan revealed a destructive process involving the ramus and condyle of the right mandible that invaded the pterygopalatine fossa, pterygoid muscles, and middle cranial fossa. CT scans of the abdomen and pelvis revealed a 5-cm mass in the sigmoid colon with metastases to the liver. Results. A biopsy of the mass in the mandible was performed, and metastatic adenocarcinoma of colonic origin was diagnosed. Colonoscopy and biopsy of the colonic mass substantiated that the sigmoid colon was the primary site of the cancer. Because the patient had disseminated disease, he declined treatment, and he died shortly thereafter. Conclusions. Although rare, metastatic adenocarcinoma from the colon to the mandible and parotid area should be included in the differential diagnosis of masses in this area. After analysis of our case and a review of the literature, we conclude that metastasis from adenocarcinoma of the colon is quite rare and represents incurable disseminated disease. © 2005 Wiley Periodicals, Inc. Head Neck27: XXX–XXX, 2005

The introduction of a mobile linear accelerator in the OR has made intraoperative radiation therapy (IORT) more plausible. An IORT treatment can deliver a single high dose of radiation to a tumor or tumor bed after surgical resection or surgical exposure of high risk areas. This article details a case study in which IORT was used on a patient with sigmoid carcinoma and the procedure outcomes.

Introduction: We report a case of recurrence of sigmoid colon cancer in the residual urethra after cysto-prostato-sigmoidectomy. Methods/Results: The patient successfully underwent urethrectomy and is currently tumor-free. To our knowledge, this is the first case of recurrence of a non-urothelial malignant tumor in the residual urethra.

Rectal cancers are currently defined as tumours below 15 cm from the anal verge on rigid sigmoidoscopy. Clinical trials have used this criterion to select patients for neoadjuvant chemoradiotherapy, but several authors have shown that the distance between the fully peritonealized sigmoid colon and the anal canal varies significantly between individuals. A fixed anatomical landmark would be a more reliable and reproducible method of demarcating the junction between the colon and the rectum. The distinction between rectal and sigmoid colon cancers is of particular importance as treatment protocols for rectal cancer management often involve neoadjuvant treatment in contrast to colonic cancers, so it is vital to get the anatomy right. As all rectal cancers are now assessed preoperatively by MRI, the use of a bony landmark is possible. We postulate that the fixed landmark to define the upper limit of the rectum should be the sacral promontory.

The clinical presentation is described of partial rupture of a colonic anastomosis two hours after surgery during epidural analgesia. The unusually early presentation of this complication is possibly due to removal of normal intestinal sympathetic activity by epidural analgesia resulting in normal or increased colonic motility. It is not known whether epidural analgesia may precipitate anastomotic breakdown due to increased contractions and strain on the anastomosis, or lead to an earlier presentation of a disruption caused by failure of surgical technique or other factors.

Aims: Four cases of hepatoid adenocarcinoma, three in the stomach, and one in the sigmoid colon, are presented to emphasize venous permeation and mimicry of hepatocellular carcinoma by metastatic liver nodules. Methods and results: Tumour cells in all cases extensively invaded veins, and intravenous tumour thrombi in two cases were grossly observed as anastomosing, worm-like cords up to 10 mm in diameter in the lesser omentum and mesentery in continuity with the primary mucosal lesions. The cytological features and trabecular architecture of the metastatic liver nodules in these subjects mimicked primary hepatocellular carcinoma. In a third case the tumour contained grossly visible bile in a metastatic lung nodule, but there was no evidence of bile production in the primary gastric or metastatic liver lesions. In the fourth case, detailed histopathological study revealed a gastric origin of the hepatoid adenocarcinoma, rather than primary hepatocellular carcinoma metastatic to the stomach, the initial diagnosis. Conclusions: These cases are reported here to draw attention to this rare variant of gastrointestinal adenocarcinoma, its mimicry of hepatocellular carcinoma when metastatic to the liver and other sites, and its propensity for venous permeation.

BACKGROUND In recent years, the mortality rate for colorectal carcinoma in Japan has rapidly been increasing, and there are indications that it may surpass that of gastric carcinoma, with colorectal carcinoma fast becoming one of the main targets of cancer treatment in Japan. METHODS Eight thousand three hundred and eighty-six case records of colorectal carcinoma (4479 males and 3907 females; 4691 colon carcinoma cases and 3695 rectal carcinoma cases), diagnosed over 18 years from 1974 to 1991 in Aomori Prefecture, were analyzed. RESULTS Age-adjusted incidence for colorectal carcinoma per 100,000 population were 12.6 and 8.7 for males and females, respectively, in 1974. The corresponding rates were 20 and 13.6, respectively, in 1980, and 42.5 and 25.6, respectively, in 1991. Among patients with colon carcinoma, a higher proportion have sigmoid colon carcinoma. The degree of increase in the incidence of sigmoid colon carcinoma was almost the same as that of right-sided colon carcinoma. By birth cohort analysis, among those born in 1934 or earlier, the incidence at the same age was higher in the younger population. CONCLUSION It is possible that the age-adjusted incidence of colorectal carcinoma in Japan will soon resemble that of the white population in the United States, in a manner similar to that of Japanese-Americans. Cancer 1996;78:1187-94.

A hospital-based study was performed in order to examine the subsite distribution of colorectal cancer diagnosed in 1992-93 in the Zaanstreek region. The localization was compared with tumours diagnosed in the years 1972-73 and 1982-83. The number of colorectal cancers has markedly increased, and a significant rise in localization of tumours proximal to the splenic flexure has occurred (32% in 1972-73 to 43% in 1992-93). There also appears to be greater incidence of colorectal cancer in women. A trend towards an increase of proximal localization of tumours in women was noted. Possible explanations for this phenomenon are discussed. The results of this study suggest the importance of improved diagnostic accuracy in colorectal cancer and, in addition, may have consequences for screening programmes.

The relation between obesity and adenomatous polyps of the sigmoid colon was investigated in male self-defense officials who received a retirement health examination at three hospitals of the Self-Defense Forces in Japan between January 1991 and December 1992. Body mass index (BMI) and waist-hip circumference ratio (WHR) were used as indices of obesity. A total of 228 adenoma cases and 1484 controls with normal sigmoidoscopy were identified in 2228 men: cases having small adenomas (5 mm in diameter) and those with large adenomas (5 mm or greater) numbered 115 and 102, respectively. Smoking, alcohol use, physical activity, rank, and hospital were controlled for by multiple logistic regression analysis. BMI and WHR were classified into four levels using the 30th, 60th, and 90th percentiles of each distribution in the control as cut-off points. There was a significant two-fold elevation in the overall adenoma risk among men at the highest BMI level (or = 26.95) compared with those at the lowest level (22.48), but the risk did not linearly increase: a similar increase was also noted for large adenomas. While WHR was only weakly related to the overall adenoma risk, the risk of large adenomas progressively increased with increasing levels of WHR; odds ratio (OR) 2.9 (95% confidence interval (CI) 1.4-5.9) for the highest (or = 0.958) versus lowest (0.878) levels. BMI was not materially associated with adenoma risk after additional adjustment for WHR, but a positive association between WHR and large adenomas was independent of BMI: OR 3.4 (95% CI 1.5-7.6) for the highest versus lowest levels. These findings suggest that obesity is associated with an increased risk of colon adenomas, probably with adenoma growth.

Cytogenetic analysis of short-term cultures from 52 colorectal carcinomas revealed a normal karyotype in 13 and clonal chromosome aberrations in 39 tumors. In the abnormal group, 13 tumors had simple numerical changes only, whereas 26 had at least one structural rearrangement with or without concomitant numerical changes. The most common numerical abnormalities were, in order of decreasing frequency, +7, −18, −Y, +8, +13 and −14. The most common structural rearrangements affected, again in order of decreasing frequency, chromosomes 8, 1, 6, 7, 17, 3, 11, 13, 14, 16, 2 and 10. The chromosome bands most frequently involved in the structural changes were 8q 10, 17p11, 11q13, 8p11, 6q21, 7p15, 7q36, 12q13, 13q10, and 16q13. The most frequent genomic imbalances brought about by the structural rearrangements were losses from chromosome arms 8p, 1 p, 6q, 17p, 7p, and 16q, as well as gains of 7q, 8q, 13q, and 11 q. A statistically significant (p < 0.05) correlation between the karyotypic pattern and tumor grade was found, with the poorly differentiated carcinomas generally having more massive chromosomal abnormalities.

The Radiation Therapy Oncology Group (RTOG) initiated a phase I/II study of intraoperative radiotherapy (IORT) in advanced or recurrent rectal cancer to assess therapeutic efficacy, toxicity, and establish quality control guidelines prior to beginning a phase III trial. From October 1985 through December 1989, 87 patients with histologically proven adenocarcinoma of the rectum or rectosigmoid with recurrent/persistent disease after surgery or those primarily inoperable were entered by 14 institutions. Of 86 evaluable patients, 42 patients received IORT either alone (n = 15) or in combination with external beam (n = 27). Local control was dependent on the amount of residual disease prior to IORT, with 2-year actuarial local control of 77% if no gross residual disease remained vs. 10% with gross residual disease (P = 0.0001). For the recurrent/residual group (n = 33), this observation was also significant with a 2-year actuarial local control rate of 64% if no gross residual remained vs. 10% with gross residual disease (P = 0.004). Local control translated into an improved survival for all patients and the recurrent/residual group with 2-year actuarial survival of 88% and 89% if no gross residual disease remained vs. 48% and 45% with gross residual disease, respectively (P = .0005, 0.006). Six patients (14.6%) experienced four grade 3 and three grade 4 complications as a possible result of IORT during follow-up with a 2-year actuarial risk of major complications of 16%. We conclude that IORT is feasible within a cooperative group and can be performed with acceptable complication rates. A phase III trial to demonstrate a therapeutic advantage for IORT over external beam alone is currently in progress. © 1993 Wiley-Liss, Inc.

A colonoscopy and colonoscopic polypectomy service was established at Wellington Hospital, New Zealand in April 1975. Between April 1975 and March 1990 1157 polyps were either removed or biopsied and examined histologically. Twenty-five polyps were lost. Patient-age seemed to increase through the spectrum hyperplastic, tubular, tubulovillous, villous, and polypoid carcinoma. Sessile6 mm in diameter hyperplastic polyps were more numerous than small adenomatous polyps. Pedunculated tumours were most commonly adenomata in all sizes, whereas sessile tumours in the rectum and sigmoid colon were usually hyperplastic. As polyp size increased the numbers of hyperplastic polyps decreased relative to the numbers of adenomatous polyps. The majority of hyperplastic polyps were found in the distal colo-rectum. Site distribution for hyperplastic polyps corresponded to the site distribution for colorectal carcinomata. One of five patients with hyperplastic index polyps was found to have an adenomatous polyp at follow-up. Strong evidence for a sequential relationship between hyperplastic and adenomatous polyps was not found in this study. It is unlikely that an aggressive attitude to the investigation and removal of hyperplastic polyps will have a significant effect on the later development of colorectal cancer.

The thymidylate synthase (TS) inhibition rate was measured after tegafur (FT) administration (1.5 g/day, at least 10 days) in 7 sigmoid colon cancer patients. The TS inhibition rate decreased as the interval between the time of the last administration and the time of the tumor resection increased longer. This study provides basic data for considering methods of drug administration and assessment of modification, for example, by leucovorin. © 1993 Wiley-Liss, Inc.

Summary— The induction of tumours at the site of uretero-intestinal anastomosis was investigated in Hannover: WISTAR rats. The rats were divided into 3 groups. In one group (n = 70) the ureter of the left kidney was implanted into the colon, using microsurgical techniques developed for humans. In 13% of the rats in this group benign tumours developed; in 16% malignant tumours occurred. In a second group (n = 76) the ureter was implanted into a rectal bladder; the faeces were excluded from the anastomosis by a descending colon anus praeter. In this group benign tumours developed in 17% and malignant tumours in 8%, all of them being situated at the site of the anastomosis. In a control group (n = 80) no colonic tumour could be identified.

Rectal involvement from prostate cancer occurs in 1.5-11% of cases. A rarer presentation is that of a separate metastasis to the high rectosigmoid colon causing an annular stricture. We present our experience with six such cases who presented with gastrointestinal symptoms. Two of the cases had undergone intestinal resections. All 6 patients had radiographic evidence of an annular stricture in the rectosigmoid area. Retrospective review revealed evidence of metastatic disease in all cases in the form of abnormalities in one or more of the following: intravenous urography, radionuclide bone scan, liver spleen scan, acid phosphatase, or alkaline phosphatase. The mean survival was 9.3 months. This rare presentation of prostate cancer may be difficult to distinguish from primary colorectal cancer and therefore needs to be ruled out to avoid intestinal resections.

This article describes the light and electron microscopic studies from a macule and the surrounding lightly hyperpigmented skin of a patient with the Cronkhite-Canada syndrome. Increased numbers of melanin granules in keratinocytes, increased numbers of melanosomes in melanocytes, and areas with increased numbers of melanocytes were found in the macular lesion. Skin from both the macule and surrounding area were also characterized by compact hyperkeratosis as well as perivascular inflammation and exocytosis not previously reported in these patients.

Background: Little is known of colonic lipomas, especially in an Asian population, and their management is controversial. Methods: A computerized colonoscopy database was analysed and patients with colonic lipomas were reviewed. Results: There were 16 colonic lipomas (incidence of 0.15%) in a series of 10 658 consecutive colonoscopies. There were seven men and nine women, with a mean age of 61.8 years (range: 28–80 years). The size of the lipomas ranged from 1.5 to 6 cm; all those larger than 3.5 cm were symptomatic (P= 0.05). The most common symptom was mild bleeding per rectum. Right-sided lipomas were palpable while left-sided lipomas presented with obstructive symptoms. Colonoscopic removal by hot biopsy or snare polypectomy was possible where the lipomas were 2.5 cm and pedunculated. Surgery was performed in six patients (four open, two laparoscopic) for symptoms and to exclude malignancy. There was no morbidity or mortality. Conclusions: Small or pedunculated lipomas may be safely removed colonoscopically and the diagnosis confirmed histologically. Larger lipomas require surgical resection for relief of symptoms or to exclude malignancy.

Background and Objectives Testicular seminoma is a very radiosensitive and curable cancer, with survival rates following radiation therapy within the range of 90–98% without apparent severe side effects. However, long-term survival following exposure to moderate-dose radiation therapy can result in radiation-induced tumors. Methods The incidence of radiation-induced tumors was determined in 81 irradiated stage I testicular seminoma patients treated at the Northern Israel Oncology Center (NIOC) from 1968 through 1993. Results Three (4%) patients developed second cancers within the high-dose volume. Indeed, those patients received a higher than usual dose to the para-aortic and pelvic regions. One patient, who developed inoperable pancreatic carcinoma, was treated with “hockey stick” field and mediastinal irradiation, plus, as a result of relapses, multiple cisplatin and VP-16 based regimens. Conclusions The elimination of causative factors through lower total doses and field size reduction may reduce the, albeit very low, incidence of radiation-induced cancer in cured testicular seminoma. J. Surg. Oncol 1998;67:38–40.©1998 Wiley-Liss, Inc.

This paper documents a 15 year experience with Hartmann's operation in the Colorectal Service at the Wellington School of Medicine, New Zealand. There were 31 male and 30 female patients. The majority had either complicated diverticular disease (27) or rectal cancer (27). Fifty-six patients were discharged home and five patients died within 30 days of surgery (8.2%). Of the 27 patients with complicated diverticular disease 19 proceeded to stoma closure with no mortality. Of the 27 patients who had complicated colorectal cancer only 2 had their stoma closed. There were 41 patients in whom bowel continuity was restored following construction of a Hartmann's stoma. Thirty-nine anastomoses were hand-sewn and two anastomoses were stapled. One patient developed a major anastomotic leak and one patient died postoperatively. Hartmann's operation has a definite place in the management of patients with complicated diverticular disease and recto-sigmoid cancer. The operation can be performed and the stoma closed safely in the former group but is less likely to be followed by restoration of continuity in the latter group.