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The technique using the EEA stapler for low anterior resection of the rectum has been modified to permit a low anastomosis that can be done with greater facility and safety. The method eliminates the bulky puckering of the ampullary purse string and avoids the disadvantage of joining segments of bowel of different sizes. It also decreases intraoperative contamination and minimizes chances for sepsis. Additionally, it affords an opportunity to check the integrity of the anastomosis. Success of the method seems to document the safety of stapling across a staple line. Results of this method used in a small group of patients are encouraging.

Eighteen patients seen between 1974 and 1982 with the clinical diagnosis of inflammatory breast carcinoma underwent modified radical mastectomy after preoperative chemotherapy and radiation therapy. In 17 of the 18 patients (94%), residual carcinoma was detected in either the resected breast or the axillary nodes. All mastectomies were accomplished without major technical difficulty. Seven wound complications, including three infections, occurred. Local recurrence was noted in 29% (five of 17 patients) and distant metastasis was detected in 89% (16 of 18 patients). Only three patients are presently alive without evidence of disease 19, 21, and 21 months since the onset of symptoms. Eleven patients have died, the median survival being 23 months since the development of symptoms, and four are alive with distant metastasis. Modified radical mastectomy can be accomplished in patients with inflammatory breast cancer after preoperative chemotherapy and radiation therapy and may have a role in reducing local tumor burden.