Electrocoagulation of selected carcinoma of the rectum.

Abdominoperineal resection for the treatment of carcinoma of the rectum has been the benchmark for all other forms of therapy since Miles described the procedure in 1908. During the past 25 years, 81 patients have had carcinoma of the rectum treated curatively by electrocoagulation and have been observed for five years or more. Treatment was selectively applied to those patients whose tumors were less than 7.5 centimeters from the anal verge with less than 50 per cent of the rectum involved. All of the tumors were freely movable. The over-all five year survival rate was 47 per cent. Thirty-one of the 81 patients underwent conversion to abdominoperineal resection because of recurrence. The survival rate for those treated by electrocoagulation alone was 58 per cent and for those converted to abdominoperineal resection, 29 per cent. The survival rate was 65 per cent for those with lesions less than 4 centimeters in diameter versus 30 per cent for those with lesions more than 4 centimeters. The morbidity rate was 21.0 per cent and the mortality rate was 2.7 per cent. There were an additional 33 patients treated for palliation with only one five year survivor. Electrocoagulation for the treatment of carcinoma of the distal part of the rectum is a reasonable alterative to abdominoperineal resection when selectively applied.

Critical analysis of retained and residual common duct stones.

Two-hundred and seven consecutive patients with suspected choledocholithiasis were treated at three university-affiliated hospitals. Twenty-one patients had residual common bile duct (CBD) stones documented after previous biliary tract operations and 28 patients had retained stones in the CBD on predischarge postoperative t-tube cholangiograms. Use of operative cholangiography was analyzed to determine correlation with the incidence of retained and residual CBD stones. Operative cystic duct cholangiography was not done in any patient who developed residual stones after simple cholecystectomy. Twenty-five of the 28 patients (86%) with retained stones either left the operating room with an abnormal postexploration cholangiogram or did not have a postexploration cholangiogram. Only three patients (10%) had falsely negative postexploration t-tube cholangiograms. The percentage of abnormal postoperative CBD exploration cholangiograms that showed filling defects as opposed to ampullary obstruction was significantly higher in patients with retained stones versus patients not having retained stones (P less than or equal to 0.0009). The vast majority of cases of retained and residual stones could be attributed to poor surgical judgment regarding either use or interpretation of operative cholangiography.