Sir William Ernest Miles changed the treatment for rectal cancer
The Miles operation remains an important procedure in the treatment of operable rectal cancer.
William Ernest Miles dissatisfaction with operations practiced during his time led to an unwavering dedication to solving the anatomical and pathological mysteries of metastatic rectal cancer. As a result, the oncology community was left with an invaluable discovery in the treatment of rectal cancer.
Though first performed before his birth, Miles perfected the procedure of excising the rectum for cancer by improving the efficacy, safety and efficiency of the operation. Now, nearly 100 years after his methods were introduced, the one-stage procedure that bears his name is still used for the treatment of operable rectal cancer.
Miles was born in England in 1869. Shortly after his birth, his parents relocated to Port of Spain, Trinidad, BWI, where his father became headmaster of Queens Royal College. The younger Miles received his early education at the college and later attended medical school at St. Bartholomews Hospital in London where he received the distinctions MRCS and LRCP in 1891. In 1894, at age 25, Miles became a fellow of the Royal College of Surgeons in England and served as a demonstrator in pathology at St. Bartholomews until 1899. He was also a house surgeon at both St. Marks Hospital and the Metropolitan Hospital where he met David Goodsall, a senior surgeon.
Courtesy of the Royal College of Surgeons of England
Miles was appointed to the surgical staff of the Royal Cancer Hospital in 1899 and later became surgeon at the Gordon Hospital for diseases of the rectum. In 1900 and 1905 Miles and Goodsall published the first and second volumes of their textbook collaboration, Diseases of the Rectum and Anus.
Improving rectal cancer treatment
When Miles introduced his methods for abdomino-perineal resection for rectal cancer in 1906, it was not the first time the procedure had been used. Due to the inability to remove cancerous growths from below, surgeons extended the operation from the perineum into the abdomen out of necessity.
Miles, however, chose to combine the procedures after reviewing perineal excision cases he treated between 1899 and 1906. Upon his review, Miles determined that local recurrence occurred in 54 of 57 cases; almost all developed recurrence within the first six months after surgery.
Through postmortem dissection of both postoperative patients and those with inoperable disease, Miles determined that the lymphatic drainage of the rectum consisted of three separate pathways leading from the rectum: upward, lateral and downward. Based on his findings, he concluded that pelvic colon excision with adequate mesenteric lymphadenectomy was needed to prevent recurrence from proximal lymphatic spread.
Using the same principle enacted by Wertheim for uterine cervix cancer, Miles devised an operation that removed not only the rectum but also as much of the lymphatic drainage of the rectum as possible. The Miles operation was not the preferred choice when introduced, due mostly to the fact that it was more difficult to perform and led to more operative deaths compared with perineal excision. However, Miles fine-tuned the procedure until he had considerably reduced the operative time, eventually gaining the support of other surgeons.
Aside from his fame as a surgeon and teacher, Miles was known as a committed, outspoken man with many friends and few enemies. He kept a box at the Royal Ascot racecourse in London where he enjoyed horse racing; he often entertained former patients-turned friends whose lives he had saved.
He received a gift and letter from the staff at St. Marks Hospital on his last birthday. They referred to him as a great friend and trusted leader in proctology.
On Sept. 24, 1947, Miles died in London. A colleague named Lawrence Abel wrote, So long as cancer of the rectum can only be cured by the surgeon, Miles name will be honored for the pioneer work he did and for the firm foundation of pathology and splendid superstructure of finished technique he has bequeathed. by Stacey L. Adams
For more information:
- Holleb A. CA Cancer J Clin. 1971;21:360.
- Diseases of the Colon & Rectum. 1959;2:523-528.
- Tech Coloprotocol. 2007;11:71-74.
- Ungley HG. Proc R Soc Med. 1959;52:36-40.