Preservation of the anal sphincter is a goal of all surgeons treating colorectal malignancies. In the hands of many, transsacral and low anterior resections with end-to-end anastomosis have been associated with high morbidity and leakage. The EEA stapler represents an alternative in re-establishing bowel continuity. Fifty-eight patients with adenocarcinoma of the rectum were treated over a three-year period at Roswell Park Memorial Institute. Forty-nine procedures judged to be curative and nine, palliative. All patients had an EEA stapler introduced through the anus. No protective colostomies were needed. No case of clinically significant anastomotic leakage was seen. Minor spotting or bleeding was documented, but no patient required blood transfusions. Two patients developed constipation; 16 patients had temporary soiling, two had prolonged soiling. Frank incontinence was not observed. The EEA stapler is an evolutionary instrument derived from the Russian PKS model. It is safe, reliable, and simple to operate. With adequate training of the surgeon, precious time can be saved. Intraoperative sigmoidoscopies, as well as postoperative barium enema examinations, were not needed. Gaps in the stapled anastomotic line (when present) were easily repaired. It is too early to tell whether anastomotic and local recurrence rates will increase, as more sphincter-saving procedures are performed. Five-year follow up is crucial to establish criteria for the use of the EEA stapler.

Adenocarcinoma↗

PubMedDate not supplied

Perforation of the colon--a hazard of colostomy irrigation: report of four cases.

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Adenocarcinoma↗

PubMedDate not supplied

Surgical treatment of metastatic colorectal adenocarcinoma.

Ninety-one patients with recurrent or metastatic colorectal adenocarcinomas were studied according to the anatomic areas of the recurrent tumor. In Group A, 30 patients with anastomotic recurrence, diagnosis was made in the majority within two years from initial surgery; most of them had specific symptomatology. A significant number of patients had blood in the stools. In half of the patients, complete resection of the recurrent tumor was feasible. In Group B, 47 patients with intra-abdominal recurrence, there was some delay in diagnosis; the symptomatology was less specific, and fewer patients were rendered free of tumor following reresection. The medial survival and estimated five-year survival rate were, in both groups, strongly related to the completeness of the resection. In Group C, with distant metastasis (eight patients with pulmonary and six with liver metastasis), the disease-free interval was longer compared to the previous groups. The metastatic tumor was found in three patients, four or more years after the initial surgery. The medial survival was the same as in the two other subgroups with complete resection of the recurrent tumor.

Adenocarcinoma↗

PubMedDate not supplied

Human high molecular weight-melanoma associated antigen mimicry by mouse anti-idiotypic monoclonal antibodies MK2-23. Experimental studies and clinical trials in patients with malignant melanoma.

Following a description of the characteristics of the human high molecular weight-melanoma associated antigen (HMW-MAA), the rationale to use anti-idiotypic (anti-id) monoclonal antibodies (mAb) as immunogens to implement active specific immunotherapy in patients with malignant diseases is discussed. Among the anti-id mAb developed in this laboratory the mAb MK2-23, which had been elicited with the syngeneic anti-HMW-MAA mAb 763.74, has been shown with serological and immunochemical assays to bear the mirror image of the determinant recognized by mAb 763.74 on HMW-MAA. The anti-id mAb elicited humoral anti-HMW-MAA immunity in about 60% of patients with malignant melanoma. The immunogenicity of mAb MK2-23 is markedly enhanced by conjugation to a carrier and administration with an adjuvant, but is not affected by the administration of low doses of cyclophosphamide. Development of anti-HMW-MAA immunity in patients with malignant melanoma is associated with survival prolongation. These results in conjunction with the lack of major side effects in spite of repeated administrations of mAb MK2-23 suggest that active specific immunotherapy with mAb MK2-23 represents a useful therapeutic approach to malignant melanoma.

Animals↗