Sir Ernest Miles first performed his radical abdomino-perineal excision for carcinoma of the rectum in 1907. This event was the culmination of almost a decade of audit in which he carefully studied the outcomes of patients with rectal carcinoma. Miles's interpretation of his audit led, in a stepwise manner, to gradual changes in his operative technique and the eventual development of the radical abdomino-perineal operation; the operation that bears his name. The Miles operation and the principles upon which it is based, would lead to an improved outcome for patients with rectal carcinoma.
There is a high level of acceptability among Australian clinicians for both surgical and non-surgical approaches to management of the in situ primary colorectal tumour in patients with unresectable synchronous metastases. Further research is warranted to determine the management strategy that will yield the best outcome for these patients.
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