Total perineal reconstruction after abdominoperineal excision for rectal cancer: long‐term results of dynamic graciloplasty with Malone appendicostomy

Aim This study aimed to assess long‐term function after total perineal reconstruction (TPR) with dynamic graciloplasty (DG) and systematic Malone appendicostomy (MA) adjunction after abdominoperineal excision (APR) for rectal cancer. Method From 1999 to 2004, TPR using DG and MA was performed in 10 patients [seven women; median age 40 (range 28–55) years] after APR for rectal cancer (cT2 in one patient, cT3 in six patients and cT4 in three patients). We prospectively recorded early and late morbidity, mortality, oncological outcome, functional results (using the modified Working Party on Anal Sphincter Replacement ‘WPASR’ scoring system) and quality of life (QoL; using the European Organisation for Research and Treatment of Cancer ‘EORTC’ QLQ‐C30 and QLQ‐CR38 questionnaires). Results There was no procedure‐related mortality. One patient required intra‐abdominal re‐operation. Nine patients required local and multiple revisions [there was one coloperineal anastomosis (CPA) stenosis, five CPA mucosal prolapse, three stenosis related to graciloplasty, two MA stenosis and one MA reflux]. After a median follow up of 78 months, there was no local recurrence and six patients were alive and disease‐free. Regarding the functional results, the median modified WPASR score, of 8, after a follow up of 78 months, was good. The overall QoL scores remained stable over time. Conclusion In carefully selected patients who want to avoid definitive abdominal colostomy after APR for rectal cancer, reconstruction involving MA and DG after APR for low rectal cancer is followed by good long‐term function and QoL.     

Techniques chirurgicales de traitement du carcinome ��pidermo?de de l��anus: amputation abdominop��rin��ale, colostomie p��rin��ale, reconstruction p��rin��ale par lambeaux

Although the treatment of anal squamous carcinoma is primarily medical, abdomino-perineal resection remains the only alternative treatment if primary chemoradiotherapy is contraindicated or is unsuccessful. Salvage surgery for anal squamous carcinoma requires wide excision of the anal sphincter and permanent abdominal colostomy. Such major surgery in an irradiated field is associated with significant morbidity from delayed wound healingm, but this can be reduced by the use of myocutaneous flaps, whilst perineal colostomy allows a permanent abdominal stoma to be avoided. These techniques have been employed in the management of low rectal cancer with good oncological and functional results. However, there is little data on perineal colostomy and its feasibility in squamous carcinoma is limited by the extent of the perineal surgical resection.     

Extensive suppuration and being overweight are factors associated with the failure of laser treatment for pilonidal disease: lessons from the first French retrospective cohort

Techniques in Coloproctology - The aim of our study was to assess the efficacy of sinus laser therapy (SiLaT) for the treatment of pilonidal disease. All adult patients treated with SiLaT in our...     

Primary mammary focus of malignant non-Hodgkin's lymphoma. Apropos of 10 cases

The authors describe 10 cases of malignant non-Hodgkin's lymphoma in a mammary site in women aged 38 to 82 years. The clinical examination and the sometimes suggest an adenocarcinomatous lesion, thus leading to a useless surgical exeresis. An initial histological study provides the diagnosis. A complete assessment of extension allows an accurate staging and the refinement of the therapeutic schedule. Exclusive radiation therapy seems to be justified in low-malignancy forms remaining strictly confined to the breast. For the high- and medium-malignancy forms, the essential weapon is chemotherapy, which seems to improve the duration and rate of remission.     

Male breast cancer]

This study has been realized to determine epidemiological profile and clinico-pathologic aspects of male breast cancer in the south of Tunisia. We has counted and analysed all male breast cancers diagnosed in the general surgery department of the Sfax university teaching hospital with proof pathologic or to defect cytologic of malignancy, between 1989 and 2000. In the court of these years 23 new cases of mammary cancer has been diagnosed at the man. The average patient age was 68 years (extremes 40 and 95 years). According to TNM classification of 1988, 4.3% were classified T1, 26.1% T2, 8.6% T3 and 61% T4; 22% of tumors were M1. Histology found: 3 in-situ carcinomas (13%), 18 ductular infiltrating carcinomas (79%), 1 papillary cystadenocarcinoma, and 1 neuro-endocrin tumor. The clinic profile of male breast cancer in our country rest again relatively little frequent and its clinic profile resist alarming. To get better prognosis it is important to increase information and to promote early detection.     

Forum: dermopigmentation or medical tattooing. Dermography in cancerology. Apropos of 220 clinical cases]

Based on a series of 220 cases of reconstruction (63 cases) or correction (67 cases) of the nipple-areolar complex and various extramammary procedures (tattoo scar revision, lips, eyebrows, eyelashes) (90 cases), the authors present their 2-year experience of medical dermography in a cancer centre. Dermography allows breast reconstruction to be completed in a large number of patients who had initially refused to complete their reconstruction. This minimally aggressive outpatient technique which reconstitutes the areolo-nipple complex with sufficient quality, is now part of reconstruction protocols and is gradually replacing surgical techniques.