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R J Heald

Publications and source records attributed to R J Heald.

107 records · Page 6Linked to original sources
PubMedDate not supplied

Results of radical surgery for rectal cancer.

This paper examines the hypothesis that a reduction in the distal mural margin during anterior resection for sphincter conservation in rectal cancer excision is safe, provided total mesorectal excision is undertaken with wash-out of the clamped rectum. One hundred ninety-two patients underwent anterior resection and 21 (less than 10%) patients underwent abdomino-perineal excision (APE) by one surgeon (RJH). Anterior resections were classified as "curative" (79%) and "non-curative" (21%); in the "curative" sub-group less than 4% of patients developed local recurrence. The series was retrospectively analyzed for the effect of mural margins on local recurrence with 152 patients undergoing "curative" anterior resections and 40 patients undergoing "non-curative" resections. In the 152 specimens from curative resections, 110 had a resection margin greater than 1 cm and 42 had a resection margin less than 1 cm. Four patients developed local recurrence in the greater than 1 cm margin group (95% confidence interval: 0.8%-7.8%) and no patients developed local recurrence in the less than or equal to 1 cm margin group (95% confidence interval: 0%-5.9%). In each patient with local recurrence a cause for failure was apparent. There was no statistically significant difference in local recurrence rate between the less than or equal to 1 cm margin group and the greater than 1 cm margin group. A reduction in resection margin therefore did not compromise survival after anterior resection. The significance of lateral resection margins is discussed. The role of deep radiotherapy and cytotoxics are considered.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMedDate not supplied

Clinical experiences at St. Mark's Hospital with multiple synchronous cancers of the colon and rectum.

We have reviewed the experience of St. Mark's Hospital with double synchronous cancers of the large intestine. This occurs in 3.5 per cent of cancer resections, and in 75 per cent there are associated benign neoplasms. Patients with double or treble cancers fare much the same as those with single cancers, and the prognosis appears to be surprisingly favorable, even when the second growth is comparatively advanced. The second lesion, however, is usually not palpable at operation, and full clinical and radiologic investigation is therefore essential before any resection is undertaken for cancer of the colon or rectum.

Aged↗
PubMedDate not supplied

Rectal cancer: the surgical options.

The hypothesis is considered that the tissue block relevant to optimal cure encompasses the integral visceral mesentery of the hind gut, or mesorectum. Surgical technique can recreate the tissue planes around an intact globular specimen which must not be torn or the margin compromised. This emphasis on the "perfect tumour package" has reduced the local recurrence rates in a consecutive personal series of 333 rectal cancer operations to 4% in those operated upon for cure. If patients with metastases or residual disease at presentation are included, the figure increases to 7%. Introduction of selective pre-operative high dose radiotherapy (DXT) for locally unfavourable cancers has combined with further attention to surgical detail to achieve a 5-year follow-up period (January 1990-January 1995) without a single case of locally recurrent disease. Problems remain with healing of the ultra-low anastomosis.

Follow-Up Studies↗
PubMedDate not supplied

Management and imaging of low rectal carcinoma.

Large variations in recurrence rates have been reported with the best results following total mesorectal excision (TME) surgery for low and middle rectal cancers. However, the low rectal cancers still have higher rates of local recurrence (up to 30%) whether operated by low anterior resection or abdominoperineal excision (APE) due to high rates of circumferential margin involvement. The treatment of choice for low rectal cancers that encroach upon the potential circumferential resection margin is surgery combined with preoperative neoadjuvant treatment. Preoperative chemotherapy combined with long-term radiotherapy reduces recurrence rates and preoperative loco-regional staging can help to select the patients more likely to benefit from neo-adjuvant therapy. Surface coil MRI is the most promising modality for patient selection, which can provide good views of the circumferential resection margin especially the presence or absence of tumour encroaching the intersphincteric plane.

Adenocarcinoma↗