Operability of Carcinoma of the Rectum

a problem, moreover, whose solution, in the present state of our knowledge, lies entirely with surgery. No assistance can as yet be sought from radiotherapy. It is particularly fortunate, therefore, that there are now available for this condition methods of surgical treatment, based on sound pathological knowledge, that are capable of yielding really excellent restilts. The writings of Miles (1939), LockhartMummery (1934), and Gabriel (1937) leave no doubt on this point. If, howtever, the cure of rectal cancer on a large scale by surgery is to become a practical proposition it.is essential that these methods should be widely applied; in other words, surgeons in general must endeavour to find operable a large percentage of the total number of cases of rectal carcinoma that they see. It seems to me that it is their failure to attain this objective that constitutes the most unsatisfactorv feature of present-day treatment of this disease. Several surgeons have undoubtedly recorded high rates of operability in recent years ; these for the most part, however, have represented the achievements of experts. It is strongly to be suspected that the unrecorded rate among surgeons who have no very special experience in this branch of surgery is still extremely low. In considering the operability of rectal carcinoma it is essential to have a clear conception of the aims of radical surgery in this condition. I he primary objective is naturally to secure a complete eradication of the disease, as measured by freedom from recurrence over a period of five years; but even where this is not achieved the operation is not to be looked upon as having been completely valueless. On the contrary, excision has a high palliative value, which must not be disregarded in assessing the benefits of radical surgery. Practically all cases improve enormously in general health after an excision, and, even though recurrence should eventually take place, the patient may meanwhile have enjoyed two, three, or more years of comfortable and useful life. This contrasts very favourably with the fate of inoperable cases treated solely by colostomy. For though colostomy relieves the obstrLctive element it does little to alleviate the other distressing features of an inoperable growth-the severe sacral or sciatic pain, the profuse rectal discharge, the occasional