No abstract

This study compares colorectal cancer from the King Faisal Specialist Hospital and Research Center (KFSHRC) Tumour Registry in patients under and over 40 years and contrasts the data with registry data from New Zealand (NZ). Between 1975 and 1989 622 patients were registered at KFSHRC and 528 were Saudi. Three hundred and twenty‐one were male and 207 were female. The average ages were 55.3 and 49.6. One hundred and nineteen were less than 40 years. More patients with proximal lesions were less than 40 years. Of the young patients 8.3% had small tumours (< 4cm) compared with 24.9% of patients over 40. Mucinous and signet ring carcinomata were more common in the young. Tumours were less well differentiated in younger patients. There were more young patients with ‘localized’ disease and nodal involvement. Older patients had more distant metastases. Of patients registered in NZ 5.5% were young compared with 23% of Saudi patients. In both countries localized disease was more common in the young. Nodal involvement was more frequently seen in the young in the Kingdom of Saudi Arabia (KSA) whereas the opposite was true in NZ. Distant metastases were more common in the old in the KSA but there were more young patients with metastases in NZ. In both countries young females with rectal tumours were more common but this ratio was reversed in the old. This study suggests that colorectal cancer may be more aggressive in the young in KSA but there was no evidence that the disease was more aggressive in young New Zealanders. Differences in the epidemiology of the disease in the young and old were found in both countries.

Anastomotic leakage may be minimized by ensuring that patients are as fit as possible prior to surgery, stomata are used liberally, particularly in emergency patients, and a good anastomotic technique is utilized at all times. Despite these precautions some patients will still develop a leak and if timely and appropriate action is taken the majority will survive and have their stomata closed.

Background: Morbidity and mortality rates are higher in elderly compared to younger patients undergoing colorectal cancer surgery. This study was undertaken to see whether this finding applied to all colorectal surgery in the elderly and if so to try to identify the determining factors. Methods: All patients undergoing colorectal surgery between 1975 and 1990 were entered into a computerized database. Patients were divided into two groups, those less than 80 years (< 80) and those 80 years and more (80+), and compared with regard to the type of surgery performed, the patient's race, the seniority of the surgeon, the patient's disease, the operation performed and the postoperative morbidity and mortality. In addition, patients undergoing major resectional surgery and patients undergoing colorectal cancer surgery were compared separately.Results: Of 201 1 admissions, 88 were for patients of 80-t. The male to female admission rate was 1 : 0.79 in the < 80 group and 1 : 1.25 in the 80+ group. More surgical procedures were performed by consultants in older patients. More emergency admissions were for 80+ patients. Rectal, sigmoid and right colonic pathology was more common in the elderly. Very few elderly patients were admitted with minor anorectal problems. Rectal prolapse and colorectal cancer were the commonest causes for admission in octogenarians. There were more pulmonary and cardiovascular postoperative complications in 80+ patients. Urinary tract infections were also more common. The postoperative mortality rate was higher in older patients (7.9 vs 1.4%). Four hundred and sixty-two patients underwent major resectional surgery and 45 were 80+. Surgery for diverticular disease was more frequent in younger patients (13.4 vs 2.2%) and cancer surgery in older patients (93.3 vs 70.5%). The postoperative mortality rate was higher in the elderly (1 1.1 vs 3.6%). Three hundred and thirty-six major resections were for cancer and 42 were 80+. Emergency surgery was performed more commonly in the older group (38.1 vs 14.9%). The rate of advanced disease seemed to be similar in both groups. The postoperative death rate was higher in the elderly (11.9 vs 3.4%). Conclusions: Elderly patients were more likely to die from cardiopulmonary problems after surgical interventions than either from their primary disease or from the surgery undertaken for it. Good postoperative cardiopulmonary support should thus be provided for all such patients.

Summary.-The leucocyte adherence inhibition (LAI) test, previously described for the detection of cell mediated immunity and serum blocking factors associated with murine tumours, has now been adapted for use with human cancer patients. Blood leucocytes from these patients, mixed in vitro with antigenic extracts of tumours of the same type, had their normal adherence to glass surfaces diminished. This inhibition was reversed (blocked) by the addition of the patients' own sera. Both LAI and blocking were tumour-type specific, but showed complete cross-reactivity within each type of tumour (melanoma, colon carcinoma, mammary carcinoma).The LAI test could be of great value in diagnosis and evaluation of treatment, since it seems to reproduce consistently the findings made by more elaborate techniques but has the advantage of being simple, rapid and inexpensive.