THE ROLE OF SUTURE MATERIAL ON TUMOR IMPLANTATION

A new cross sectional echocardiographic method for estimating the volume of large pericardial effusions

OBJECTIVE

To evaluate a new cross sectional echocardiographic method for estimating the volume of pericardial effusions.

DESIGN

The volume of pericardial fluid removed by surgical drainage or paracentesis was compared with the volume estimated by the echocardiographic method. The pericardial sac volume and cardiac volume were calculated by applying the formula for the volume of a prolate ellipse (pi x 4/3 x L/2 x D1/2 x D2/2) where L is the major axis and D1 and D2 are the minor axes. The pericardial fluid volume was calculated as the pericardial sac volume minus the cardiac volume.

PATIENTS

13 patients with 14 large pericardial effusions (one recurrence) all of whom had tamponade and cross sectional echocardiography just before therapeutic full drainage of the effusion.

RESULTS

The volumes of pericardial fluid drained ranged from 0.5 to 2.11. The correlation between these actual volumes and the volumes estimated by echocardiography was excellent (r = 0.97); the correlation was good in four patients with intrapericardial adhesions.

CONCLUSIONS

Because of certain approximations in measuring quantity of pericardial fluid drained, the echocardiographic estimations cannot be claimed to be definite. The data, however, indicate that the echocardiographic method is sufficiently reliable to provide useful estimates for practical clinical purposes.

The effect of inadvertent intraoperative perforation on survival and recurrence in colorectal cancer

Inadvertent perforation of the bowel during curative resection for colorectal cancer has serious consequences. In 174 curative resections with spillage, five-year survival was 29 per cent. In 67 patients where the cancer itself was disrupted during dissection, five-year survival fell to 14 per cent in the colon and to 9.3 per cent in the rectum. Local recurrence developed in 65 per cent of spillage cases. In Dukes' C tumors that were perforated during surgery, local recurrence occurred in 87 per cent. As surgeons, our efforts must be directed toward preventing injury to the bowel during definitive resection of colorectal cancers. The instillation of tumoricidal solutions within the bowel lumen and the application of bowel ligatures prior to dissection may help toward preventing recurrence, should inadvertent perforation and spillage occur.

Local recurrence following 'curative' surgery for large bowel cancer: I. The overall picture

The Large Bowel Cancer Project is a collaborative prospective study of 4228 patients with a histologically proven adenocarcinoma, of whom 2336 (55 per cent) survived a 'curative' resection. Follow-up information is available on 2220 patients (95 per cent). Subsequently, 309 (14 per cent) have developed a local recurrence confirmed by: biopsy (127; 41 per cent), clinical examination (77; 25 per cent), X-ray (15; 5 per cent), a raised CEA (2; 1 per cent), or some other method - e.g. CT scan or a confident unbiopsied laparotomy finding (88; 29 per cent). Statistically significant factors (chi2 test, P less than 0.05) associated with local recurrence are: Dukes' classification: A 4 per cent; B 13 per cent; C 18 per cent Tumour differentiation: Well 11 per cent; Moderate 14 per cent; Poor 21 per cent Obstruction: Absent 13 per cent; Present 21 per cent Perforation: Absent 13 per cent; Present 28 per cent Tumour mobility: Freely mobile 11 per cent; Others 21 per cent Operation performed (rectal and rectosigmoid tumours): Abdomino-perineal 12 per cent; Anterior resection 18 per cent; Surgeon (Consultant only): Range less than 5 per cent to greater than 20 per cent. Stratification of the above variables altered only the statistical significance pertaining to tumour differentiation (P less than 0.1, d.f. = 2). In particular, the differences between Consultant surgeons remained.