The histopathologic and clinical findings in 682 patients with carcinoma of the rectum have been analyzed. Invasion of veins and nerves by primary growth was found in 38.9 and 34.9 per cent, respectively. The five-year survival rate for patients with resectable tumors was 49 per cent. The age, Dukes' staging, and presence and/or absence of liver metastases, of venous invasion, and of nerve invasion were found to be of statistically significant importance for the prognosis. Sex was found to be on the borderline of significance and Broders' grading was even less significant. Invasion of veins was found statistically significant more frequently than nerve invasion, but the present investigation revealed the importance of the invasion of veins as well as of nerves. When venous invasion was observed, liver metastases developed over three times as frequently in these patients as when metastases were not demonstrated. In contrast to Dukes' staging. Broders' grading can be applied to tumor biopsies preoperatively. The importance of venous and nerve invasion for the selection of patients for adjuvant therapy after termination of surgical treatment is discussed.

The association between histopathologic findings and postoperative survival in 442 patients with potentially curable carcinomas of the colon has been analyzed using Cox's regression model. The prognostic variables included in the study were age, sex, stage of disease according to Dukes' classification and Broders' grading, as well as presence/absence at the time of operation of venous and nerve invasion. The overall five-year postoperative survival rate was 46.6 percent. Using a model including all prognostic factors, sex and Dukes' classification were not found to be associated with survival. Broders' grading and/or nerve invasion yielded only a borderline statistical significance in the model that included all factors. The invasion of veins was almost always associated with invasion of nerves.

Results after operations for acute obstruction of the large intestine due to cancer were analyzed during a 10-year period and compared with the results after operations for nonobstructive tumors during the same period. The following conclusions could be deduced: 1) Cancer is more often obstructive in the colon than in the rectum. Cancers of the splenic flexure are relatively more often obstructive than cancers in other parts of the colon. 2) Postoperative morbidity (and probably mortality) is higher and the five-year survival shorter in patients with obstructive cancers of the large intestine than in those without obstruction. Obstructive Dukes' A tumors are very few. 3) The early morbidity and mortality after acute cecostomy are probably not higher than after acute transversostomy, if the cecostomy wound is left open. The cecostomy carries a risk of peritoneal contamination. 4) Cecostomy does not relieve obstruction in 5-10 per cent of the patients, while transversostomy seems always to be effective. Emergency exploratory laparotomy for obstructive cancer of the large bowel instead of a blind cecostomy reduces the number of patients who need two operations by 10 per cent. 5) Hernias are frequent at the sites of previous spontaneously closed cecostomies. 6) Antibiotic bowel preparation seems not to be effective shortly after decompressive colostomy.

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