Extrarectal colonic carcinoma: analysis of 138 cases with long-term follow-up.

To identify factors that determine long-term survival after resection of extrarectal colonic cancer, we analyzed 138 such patients operated upon in a five-year period. Because rectal tumors have lower survival rates, they were excluded hoping to enhance the prognostic accuracy of the study. The sigmoid colon was the most common location of the tumor (59%) followed by the ascending (19%), the transverse (15%), and the descending colon (9%). In 95 patients (69%), operation was curative. In 12 patients (9%), a resection even with palliative aims could not be done. The five-year survival rates were 87% for 23 patients with Dukes' A and B lesions, 62% for 32 patients with Dukes' B2 lesions, 36% for 42 patients with Dukes' C1 lesions, and 0% for 34 patients with Dukes' C2 or higher. The overall five-year survival rate was 42%. These results emphasize the prognostic reliability of pathologic staging methods and bring into focus the importance of enhancing efforts for detecting extrarectal colonic cancers at early stages of development when curative resection offers maximal chances for cure.

Reliability of pre- and intraoperative tests for biliary lithiasis.

The records of 242 patients, operated consecutively for biliary lithiasis, were analyzed to determine the reliability of oral cholecystography (OCG), ultrasonography (US), and HIDA in detecting biliary calculi. Preoperative interpretations were correlated to operative findings. OCG obtained in 138 patients was accurate in 92%. US obtained in 150 was correct in 89%. The accuracy of HIDA was 92% in acute and 78% in chronic cholecystitis. Intraoperative cholangiography (IOC) done in 173 patients indicated the need for exploratory choledochotomy in 24; 21 had choledocholithiasis. These observations suggest that OCG and US are very accurate, but not infallible, in detecting cholelithiasis. US should be done first; when doubt persists, the addition of OCG allows the preoperative diagnosis of gallstones in 97% of the cases. HIDA is highly accurate but not infallible in detecting acute calculous cholecystitis. IOC is very reliable in detecting choledocholithiasis; thus, its routine is justifiable.