This report analyses an experience with 80 liver resections for metastatic colorectal carcinoma. Primary colorectal cancers had all been resected. Liver metastases were solitary in 44 patients, multiple in 36 patients, unilobar in 76 patients, and bilobar in 4 patients. Tumor size was less than 5 cm in 33 patients, 5-10 cm in 30 patients, and larger than 10 cm in 17 patients. There were 43 synchronous and 37 metachronous liver metastases with a delay of 2-70 months. The surgical procedures included more major liver resections (55 patients) than wedge resections (25 patients). Portal triad occlusion was used in most cases, and complete vascular exclusion of the liver was performed for resection of the larger tumors. In-hospital mortality rate was 5%. Three- and 5-year survival rates were 40.5% and 24.9%, respectively. None of the analysed criteria: size and number of liver metastases, delay after diagnosis of the primary cancer, Duke's stage, could differentiate long survivors from patients who did not benefit much from liver surgery due to early recurrence. Recurrences were observed in 51 patients during the study, two thirds occurring during the first year after liver surgery. Eight patients had resection of "secondary" metastases after a first liver resection: two patients for extrahepatic recurrences and six patients for liver recurrences. Encouraging results raise the question of how far agressive surgery for liver metastases should go.
A prospective study was undertaken to evaluate the results of a single layer appositional technique for large bowel anastomoses used in a University Hospital. 316 patients were entered during an 18-month period. Anastomoses were situated within the peritoneal cavity in 277 patients and below the peritoneal reflection in 39. No covering stoma was made. The incidence of clinical leakage was 1.6% and of wound infection 1.9%. These results compare favourably with those obtained by stapling. For intraperitoneal anastomoses and high anterior resection manual suture remains the standard technique and is less expensive than stapling. For low rectal tumours, there is still debate on the relative merits of stapling and various manual techniques of colo-anal anastomosis in terms of morbidity, tumour clearance and functional results.
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