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Aim: Subtotal colectomy (STC) involves an extended resection of the large bowel over the splenic flexure. In a period of 8 years, a total of 72 subtotal colectomies (STC) were performed for the treatment of large bowel obstructions or symptomatic stenosis caused by cancer of the left colon. A primary ileocolic latero-terminal anastomosis was made in each case. The aim of study was to evaluate the late results of procedure., Patients and Methods: In a non-prospective, non-randomized study of 23 of the total of 72 STC cases, authors investigated the postoperative quality of life, the changes in the intestinal bacterial flora, and signs of a nutritional deficiency or of an accelerated bowel transit., Methods: 1) H2 excretion test, 2) UDCA-PABA and 3) Schilling test for contaminated small bowel syndrome and bowel transit time, studied by means of a 4) barium meal and 5) radiopaque marker passage, and 6) registration of the number of defecations/day., Results: The laboratory findings were in the normal range in each case. The daily number of defecations gradually decreased during the 3 months after the operation (mean 1.9/day). The lack of an ileocoecal valve did not result in bacterial overgrowth in the small bowel and the investigations did not reveal contaminated bowel syndrome. The oro-anal transit time was reduced in only four cases. Three months postoperatively, no patient had a deteriorated quality of life., Conclusions: STC offers 1) one-stage treatment for colonic obstruction in emergency surgery, 2) tumour removal with sufficient oncological radicality, and 3) primary reconstruction of the digestive tract, with a safe ileocolic anastomosis even in emergency cases. The follow-up study of 23 of the patients proved that loss of 60-80% of the colon did not cause any symptomatic disturbance of the digestive functions. The quality of life after surgery was normal, the slightly increased number (mean 1.9) of daily defecations was acceptable, and bacterial colonization of the small bowel did not occur.

Method: Between 1997 and 2000 the authors performed 110 fine-wire localized breast biopsies in patients with nonpalpable suspicious lesions., Results: 108 target lesions (98.1%) were accurately excised during the initial surgery. Overall, 56 lesions were malignant, among these cases 50 invasive carcinomas and 6 DCIS were found. Breast conservation was achieved in 48 patients (88.5%), simple mastectomy with axillary lymph node sampling was performed in 8 cases. 86% of the invasive malignant lesions belonged to the good prognostic subgroup of the Nottingham Prognostic Index., Conclusion: There in an importance of the close cooperation between radiologist, surgeon, pathologist and oncologist in the treatment of nonpalpable preclinical breast carcinomas.

The authors report a total of 62 middle and low third rectal cancer cases operated on by total mesorectal excision by the method of Heald. The oncological basis of this procedure is the horizontal regional metastatization of rectal cancer. The total mesorectal excision facilitates, the low anterior resections and preservation of sphincter with an ultra-low colorectal, or coloanal anastomosis using the double stapling technique. In the authors' experience, the "UltraCision" cutting-coagulating device permits an atraumatic, bloodless and oncologically correct dissection. Using the double stapling technique, we succeeded in 60% of our middle- and low-third rectal cancer patients to perform a sphincter preserving low anterior resection. In 9 (28%) of the low third rectal cancer patients, preservation of the sphincter was possible with oncologically correct anterior resection and an ultra-low colo-anal anastomosis. Three anastomotic insufficiencies occurred, two of them healed on lotion-suction drainage, and one on the application of transient protective ileostomy. The literature data suggest a lower local recurrency rate after radical rectal cancer surgery, if total mesorectal excision is performed.