J.Jpn. Surg. Soc.. 56(8): 975-992, 1955
CANCER OF THE RECTUM : A STATISTICAL ANALYSIS OF 300 CASES
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Second Surgical Department, Osaka University Medical School Akira SAITO, Heitaro MOGAMI, Toyoaki YAMAMOTO |
1. Rectal cancer cases occupy 71.3% of the whole number of intestinal cancers surveyed.
2. The sex distribution for male and female is about 5 : 3. The incidence is predominant between 40 and 70 years of age for both sex, the highest being heId by their fifties. It is rather common in older males, and in younger females.
3. The site is the most common in the pars ampullaris recti with the highest frequency (56.3%), followed by the coIon pelvicum (18%), the pars perinealis (17%) and anus (3.3%).
In reference to the wall. frontal is the highest common (56.1%), laternl is the lowest. The highest operative rate is observed in the dorsal wall cancer, the whole region involved shows the lowest operative rate accompanied by the highest operative mortality.
4. Of the initial symptoms, bleeding is the most common (48%), being followed by irregular defecation as well as disturbance on defecation consisting of obstipation (21.4%) , diarrhea (16.3%), pain on defecation (13.0%), pus-mucus stool (13.0%), and Iower abdominal pain (12.9%). Bleeding is the most common complaint on admission (47.0%). Those who are conscious tumor occupy 11.3%.
5. On an average 8.3 months is known duration of symptom. Forty-three cases are of known duration Iess than 2 months, 27 more than 2 years, the shortest being one day, the longest 4 years. The majority of the cases are known duration within 6 months (58.6%). Less than 2 months duration cases and Ionger than 13 months cases show comparatively Iow operative rates. Less than 6 months duration cases show higher operative rates than longer than 7 months duration cases.
6. Thirty-one short duration cases show no remarkable differences in sex, and pathological findings. Seven cases were of the anus region, 9 had involvement of the whole intestinal wall, while only 3 cases had no metastasis or adhesion. Fifty-eight per cent have been radical operative cases.
7. Of the 300 cases, 176 were resectable (58.7%), 90 cases were for colostomy (30.0%), and 34 cases for exploratory laparotomy or non-operation (11.3%). Twenty-three cases (13.1%) resulted in death by radical operation. Anesthesia was performed by lumber puncture with no death.
8. The 29 years in which this survey is made are divided into 3 periods, first (1924-36), second (1936-49) and third period (1949-53). The improvement of resectability is startinig in the first period towards the third (57.0-57.0-70.3%) showing decrease of operative death of 15.9-13.6-3.8%. The mortality rates due to the Miles' method shows a decrease, 37.5 -13.6-5.0%). The Kraske's method was employed for the first period, and the one-stage abdominoperineal operations (Miles) for the second and third periods.
9. The reduction in mortality rates was due to improved technics, effective pre-and postoperative treatment, advanced chemotherapy and especially up-to-date antibiotics.
10. Among the operated cases, 84.1% have been followed up in the first period and 52.3% in the second and third periods. Three-year-survival-rate is 37.0% in the first period and 52.0% in the second-and third period. Five-year-survival-rate is 22.7% in the first period and 46.7% in the second-and third periods.
Of the colostomized cases, 2 are of more than three-year-survival : Most of them died within 12 months.
11. Seventy-nine cases (45%) show metastasis to perirectal lymph-nodes, 34 cases to the mesenteric lymph nodes, and 48 cases to the inguinal lymph nodes.
12. Based on the recent literatures, new aspects of surgical treatment, including especially sphincter-preserving technics and some factors for influencing a long survival have been discussed.
Acknowledgments are due to Professor Emeritus H. Iwanaga who has generally offered every instruction in completing this experimentation, to the members of the Second Surgical Department, Osaka University Medical SchooI and to the collegues at home and abroad, who have been very helpful and have afforded information and literatures.
(authors' abstract)
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