[Pancreatic metastases of nephro-epitheliomas. Apropos of 2 cases]. / Les métastases pancréatiques des néphro-épithéliomes. A propos de deux observations.

Pancreatic metastasis from clear cell carcinoma of the kidney are exceptional (1 to 3 per cent). Twelve cases have been found in the literature, to which our two observations must be add. Intestinal haemorrhage rule the clinical signs. The complementary arteriography is a very good investigation. Surgery with excision may be effect when a solitary metastasis to the pancreas exist. We can argue about chemotherapy when there is a metastatic dissemination.

[Thyroid metastases from a nephro-epithelioma]. / Les métastases thyroïdiennes du néphro-épithéliome.

The authors report a rare case of thyroid metastasis from a nephro-epithelioma, which appeared four years after nephrectomy, and was revealed by a Basedow-type goiter. It was treated by total thyroidectomy. A cervical recurrence was diagnosed in the course of a routine checkup and arteriography. Death occurred 22 years after thyroidectomy and 26 years after nephrectomy. The diagnosis is often only made at necropsy. The slow growth of these metastases does not preclude extended survival after surgical excision, and requires active therapy.

[Posterior approach to the rectum. Technic, indications, complications. Apropos of 41 cases]. / L'abord postérieur du rectum. Technique, indications, complications. A propos de 41 observations.

Certain lesions in the middle part of the rectal ampulla can only be approached with safety through the posterior surface of the rectum after resection of the coccyx and the last part of the sacrum. This approach was employed in 41 patients, with conservation of the sphincter in all cases. Operation was performed 39 times for excision of a large villous tumor, in 1 case for a polycystic lesion, and in 1 case for a localized epithelioma. Extensive tumors in 3 cases required rectal resection with end-to-end anastomosis, employing a circular mechanical suturing apparatus in 1 patient. Two patients died of causes unrelated to the operation, and 5 developed a fistula, three of these cases needing proximal colostomies. Delayed healing of the perineal wound was noted in 5 other patients, residual perineal pain being reported by 2 patients. The posterior approach to the rectum is an exceptional technique, mainly indicated when wide excision of a histologically doubtful tumor cannot be approached from above or below.

Natural history of colorectal carcinoma with untreated liver metastases.

In a series of 474 patients operated on for colonic and rectal carcinoma, 65 were shown to have hepatic metastases. Factors influencing spontaneous survival were evaluated in 56 patients. This study emphasizes the dominant role of the amount of liver involvement. A clinical staging referring to the size and number of liver deposits, to the presence or absence of jaundice and/or malignant ascites, and to liver function tests abnormalities provides an available classification which can be closely related to the outcome of such patients. Thus, it yields a valuable basis to avoid misleading prognostic data and to substantiate the effectiveness of aggressive treatments in case of carefully selected patients.