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The records of all patients with familial polyposis coli and ulcerative colitis operated at The Mount Sinai Hospital were reviewed to determine the proportion of patients with cancer at the time of colon resection. Sixty-nine patients with familial polyposis coli undergoing operation between 1947 and 1983 were identified and 25 (36 percent) were found to have cancer. In the group with ulcerative colitis, 548 patients had surgical treatment between 1957 and 1983 and 65 (12 percent) had colonic cancer. There was a significant decrease in the proportion of patients with familial polyposis coli having cancer at the time of colon resection from 50 percent before 1968 to 20 percent since 1978. This change in cancer incidence was found to correlate with a decrease in the mean age at operation from 40 to 25 years. In the group with ulcerative colitis, the mean age at operation has remained essentially unchanged at 36 years. The proportion of patients with ulcerative colitis having cancer at the time of colon resection has remained constant throughout this study. Progression to carcinoma is still a significant concern in both familial polyposis coli and ulcerative colitis. Although removal of the colon and rectum prevents cancer development, patient selection and timing of the operation remain a difficult problem. [ABSTRACT FROM AUTHOR]

The surgical treatment of patients with familial polyposis coli and ulcerative colitis often requires removal of the rectum. Abdominoperineal resection, however, has a substantial morbidity. Ultrasonic fragmentation allows complete removal of the distal rectal mucosa with preservation of the surrounding muscularis. Ten adult mongrel dogs underwent ultrasonic mucosal proctectomy with resection of the proximal rectum and end colostomy. Two months later, the animals were sacrificed and the remaining rectum was removed and examined. The rectal remnant had shrunk and there was fibrous healing of the muscular wall with obliteration of the lumen. There was no mucosal regeneration. Ultrasonic mucosal proctectomy appears to achieve the same results as abdominoperineal resection of the rectum without the morbidity of the perineal dissection. This procedure may be useful in those patients where removal of the rectum is necessary for benign disease and endorectal pull-through is not indicated. [ABSTRACT FROM AUTHOR]

Three hundred twenty patients with rectal cancer were studied to determine factors that correlate with development of pelvic recurrence. The mean age was 65 years; anterior resection, was performed in 202 (63 percent) and abdominoperineal resection in 118 (37 percent). Fifty-two patients (16 percent) developed pelvic recurrence. The mean duration of follow-up to development of pelvic recurrence was 22 months. Depth of tumor invasion, presence of lymph node metastasis, and colloid features were found to correlate with plevic recurrence. The recurrence rate in patients having anterior resections was the same as that of patients undergoing abdominoperineal resections. Patients having anterior resection with distal margins of 1 cm or less had an extremely high recurrence rate (36 percent). Pelvic recurrent did not continue to improve when the distal margins, were extended over 2 cm. Microscopic lateral tumor extension, which is not removed during operation, appears to be the major determinant of local recurrence in rectal cancer. [ABSTRACT FROM AUTHOR]

This is a report of two cases of giant sigmoid diverticular, representing a rare complication of diverticular disease. The diagnosis is usually made on barium enema examination. These large cysts arise from the antimesenteric border of the sigmoid colon and usually communicate with the lumen. Management consists of sigmoid resection with excision of the cyst. [ABSTRACT FROM AUTHOR]