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43 multiple carcinomas of the colon and rectum were studied. 20 of those tumours showed a simultaneous manifestation, and 23 of them a metachroneous one. The interval between primary and secondary manifestation varied from 1 to 17 years. This clearly demonstrates that even after a very long tumour-free interval a secondary manifestation of the carcinoma can still be possible. The high percentage of multiple carcinomas of the colon calls for a careful preoperative diagnosis and an extensive intraoperative exploration of the whole colon. After hospitalisation a repeated check-up (3 months) is needed in the outpatients department to detect any secondary or recurrent carcinoma at the very earliest stage. In this way we were able to find 23 metachroneous manifestations and 27 recurrent carcinomas which were still resectable. The treatment of choice for polyposis coli is total colectomy.

Familial polyposis of the colon and rectum does always present an absolute indication for immediate total colectomy because of the predictable malignant degeneration. The patient concerned as well as his family have to be examined and treated if necessary. 12 such cases have been operated upon in the surgical Department of the University of Mainz Medical School. In 4 cases proctocolectomy with terminal ileostomy were performed, in 7 cases ileorectostomies. The procedure of mucosectomy with subsequent pulling of the terminal ileum through the colon (Hochen-egg and Reifferscheid) has been tried by us so far only in animals. Since a terminal, life-long ileostoma does present a considerable disadvantage for the mostly younger patients we did perform in most cases an ileo-rectal end-to-end anastomosis. This procedure can be looked upon as adequate cancer prophylaxis if control rectoscopies are performed regularly in cooperative patients.