Recommandations pour la pratique clinique Cancer du rectum

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• 作者：V. Bridoux ; C. de Chaisemartin ; L. Beyer ; N. Goasguen ; C. Sabbagh…
• 关键词：Rectal cancer ; TME ; Audit of surgical quality ; Circumferential margin ; Macroscopic assessment of mesorectum ; Surgical approach ; Pathologic assessment
• 刊名：C?lon & Rectum
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：10
• 期：1
• 页码：12-27
• 全文大小：254 KB
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• 作者单位：V. Bridoux (1)
  C. de Chaisemartin (2)
  L. Beyer (3)
  N. Goasguen (4)
  C. Sabbagh (5)
  N. Guedj (6)
  P. Dartigues (7)
  A. Bardier (8)
  
  1. Service de chirurgie digestive, CHU Charles Nicole, 1, rue Germont, 76000, Rouen, France
  2. Service de chirurgie oncologique 1, Institut Paoli Calmettes, 232, boulevard Sainte Marguerite, 13009, Marseille, France
  3. Service de chirurgie digestive, Hôpital Nord, Marseille, France
  4. Service de chirurgie digestive, Hôpital de la Croix Saint Simon, Paris, France
  5. Service de chirurgie digestive, CHU Amiens, Amiens, France
  6. Service d’anatomo-pathologie, Hôpital Beaujon, Paris, France
  7. Service d’anatomo-pathologie, Institut Gustave Roussy, Paris, France
  8. Service d’anatomo-pathologie, Hôpital de la Pitié Salpêtrière, Paris, France
  
• 刊物主题：Medicine/Public Health, general; Proctology; Gastroenterology; Colorectal Surgery; Surgery; Imaging / Radiology;
• 出版者：Springer Paris
• ISSN：1951-638X

文摘

The main therapeutic advances in surgery for rectal cancer during the past two decades have focused on ensuring the quality of surgical excision. The extrafascial mesorectum resection developed by Heald in the 80’s is now the standard surgical although no randomized study was done comparing it to conventional surgery. Since this time, new surgical approaches have been developed: laparoscopy, robotic approach, and trans-anal approach. Laparoscopy provides oncologic outcome equivalent to resection by laparotomy for tumors T1, T2 and T3 low. Laparoscopy also provides a benefit in terms of hospital stay and blood loss at the price, however of a longer operative time. The robotic approach is feasible but generates an additional cost while it provides no significant benefit for the patient. A perineal approach first, can be offered whenever it is necessary to perform a manual colo-anal anastomosis, especially in difficult situations (narrow pelvis, male gender, obesity, large tumors) but in view of the lack of data for functional and oncological results, endoscopic trans anal total mesorectal excision (ETAP) may not currently be recommended. The evaluation of the excision requires close collaboration between the surgeon and the pathologist. Indeed, the pathological examination of rectal specimen allows the TNMstadification, an estimation of the prognosis and provide the indication of an adjuvant chemotherapy.