I. Six Cases of Colonic Cancer Complicating Fistula Formation

Fistula formation as a complication of colonic cancer is relatively rare. Six cases of colonic cancer with gastrocolic, jejunocolic or clocolic fistulas underwent an en bloc resection in the authors' Department of Surgery, from January 1956 through August 1977. In every cases, the resected specimen showed a large advanced carcinoma originating in the left colon invaded the adjacent holeorgan by direct extension, forming a fistula at the central portion of cancer invasion between both the organs.Microscopically, all the carcinomas were of low grade, and the fistulas were lined by different degree of necrotic or viable growth and inflammatory tissues.Survival after an en bloc resection seems to bo related to the degree of anaplasia of a neoplasm and metastatic involvement in the regional lymph node.In this series, all the 5 patients except recently operated one survived longer beyond expectation, and the longest surviving one is alive more than 9 years. Both the cases re-ported in the literature and of the authors themselves reveal the ratio of occurrence of a fistula in the left colon is much higher than in the right.