Summary and conclusionsClinically evident anastomotic dehiscence was studied in 1466 patients who had undergone resection of a largebowel adenocarcinoma. The overall incidence of anastomotic leakage was 13%, but the incidence varied between surgeons (range 0-5% to over 30%). Morbidity and mortality were significantly higher in those patients in whom the anastomosis failed to heal primarily.If these results are extrapolated to the national level, it should be possible by achieving results closer to those in patients without leakage to reduce overall postoperative mortality after resection of large-bowel cancer by 2% and to achieve an appreciable reduction in morbidity.4 Both factors are clinically important and, taken together, could result in appreciable saving of revenue.

SUMMARY A review of histopathology reports on 2046 patients in the large bowel cancer project showed considerable observer variation in histological grading, Dukes staging, and lymph node harvest. These parameters have a well-established relationship to prognosis, but, if they are to be applied for both clinical and research purposes, they must be assessed consistently. A minimal level of information which should be recorded from a resection specimen is suggested, with a description of the methods by which this information can be obtained.The large bowel cancer project was initiated in 1976, and currently specimens are sent to the 22 histopathology departments from the 84 participating surgeons. Although many departments have more than one histopathologist to deal with these specimens, they have been treated as 22 observers for this analysis.The objective of this part of the study was to assess the consistency of reports on the histopathology of the resected specimens. We anticipated that there might be considerable observer variation in histological grading, which is a subjective process, but we did not expect significant differences in the staging of local tumour spread, which is an objective assessment with sharp delineation between subgroups, or in lymph node harvest. We report here the results on 2046 resected tumours. We found clinically important and statistically significant differences between histopathology departments in the reporting of these specimens. Differences between hospitals have been calculated using the x2 test for independent samples. (Fig. 1). The difference between observers was statistically significant (p < 0-001). Some lack of uniformity is inevitable in grading, but the order of difference shown can be due only to different techniques of assessment. In the present study of 2046 specimens 26 0 were well, 58% moderately, and 16% poorly differentiated;however, the proportion placed in each grade by the different observers varied widely: well-differentiated 3-93 %, moderately 8-82 %, and poorly 5-30 %

Summary.-Analysis of pathological data in the 10th year of follow-up of a multicentre trial of the management of operable breast cancer has confirmed the correlation of prognosis with tumour grade, tumour size and lymph-node status. For each factor examined there was no difference in survival between the 2 treatment groups ("watch policy" and radiotherapy) but patients in the WP group whose tumours were of Grade II or III or >2 cm, or with lymph-node metastases, had a greater chance of local recurrence. Cellular reaction had no relationship with prognosis, except in patients with Grade III tumours. The clinical relevance and application of these results are discussed.

A total of 24 patients with renal cell carcinoma involving the inferior vena cava underwent thoracoabdominal radical nephrectomy with removal of tumor thrombus by an open or closed technique. The tumor extended in the inferior vena cava to the level of the renal or lower hepatic veins in 18 patients and it reached the level of the diaphragm or right atrium in 6. Of the 24 patients 3 with preoperative findings minimally suggestive of disseminated disease were shown later to have metastases in the questionable areas, 3 with disease at the level of the diaphragm had incomplete resections, 4 had metastases to regional lymph nodes and 1 had questionable preoperative findings and lymph node metastases. Only 13 of the 24 patients (54 per cent) did not have either disseminated or residual tumor postoperatively. The mean survival duration of this subgroup (20 months) was comparable to that of the group as a whole (21 months). However, 4 patients from this subgroup are free of disease, with a mean followup of 30 months. There was 1 postoperative death. Morbidity, including renal failure, intraoperative hypotension and sepsis, was common. The results in this series suggest that the prognosis for patients with renal cell carcinoma and inferior vena cava involvement is guarded.