Résection cœlioscopique du côlon pour adénocarcinome. Présentation d'une série de 218 cas

Study aimThe aim of this retrospective study was to report the results of a series of 218 laparoscopic resections for adenocarcinoma of the colon by the same surgical team over a 6-year period.Patients and methodsLaparoscopic procedures included, for the right and the left colon, at first a ligature of the vascular pedicles, secondarily a dissection of the mesocolons, and were almost identical to the conventional procedures. A conversion to open laparotomy was necessary in 8.3% of the patients. Among 218 patients, there were 117 men and 101 women; the mean age was 69 years. Twenty nine per cent of the patients had already undergone open laparotomy. Mean ASA grade was 2.1. An emergency operation was necessary for 9% of the patients in relation with colonic obstruction (n = 20) or peritonitis (n = 3).ResultsColonic resections were considered curative in 180 patients (82.6%). The mean duration of surgery was 157 minutes for the right colectomies and 148 for the left. The proportion of A, B, C, D Dukes stage tumours was respectively 19.3%, 38.5%, 27.5% and 14.7%. There was one post-operative death related to a serious epileptic seizure due to unknown cerebral métastases. The morbidity rate was 5.5% and the early reintervention rate 2.8%. There was no lost to follow-up. With a mean 35-month follow-up. 82.2% of the patients were alive after curative surgery. Abdominal wall recurrence at port sites occurred in four patients operated on for a Dukes C cancer before 1994. Prognosis was significantly dependant on cellular differentiation, lymph node extension, pericolic extension and Dukes stage. The 5-year actuarial survival rate, according to Kaplan-Meier method was 65.36%.ConclusionLaparoscopic colon cancer resection was used by the authors in 92% of patients during 1997. The conversion rate to open laparotomy has been lower than 5% since 1995. Post-operative mortality was 0.4% and post-operative morbidity 5.5%. After curative colonic cancer resection, the 5-year actuarial survival rate was 65%.     

Microbiote et cancer du côlon

Colorectal cancer (CRC) is a major issue for healthcare services. Although genetic and familial inheritance only account for a small amount of the whole CRC spectra, it is now well recognized that environmental factors, so-called the exposome, play a major role in the development of CRC. The intestinal microbiome has been proposed as a tool to study colorectal carcinogenesis as he interplays with both environmental factors and its host. Two complementary strategies has been used so far: an investigation for a candidate pathogen microorganism and an extensive analysis of the intestinal microbiome while investigating a compositional imbalance. Herein, we aimed to present an overview of the contribution of the intestinal microbiome to the colorectal carcinogenesis     

Stratégie chirurgicale devant un patient porteur d’un cancer du côlon avec métastases hépatiques synchrones non résécables

At the time of diagnosis, up to 25% of patients with colorectal cancer have synchronous liver metastases and for the majority (70–90%), metastatic disease is not suitable for cure. For patients with irresectable synchronous liver metastases, it remains controversial whether first-step primary tumor resection followed by chemotherapy or up-front chemotherapy without resection of the primary is the best option. No randomized trial is available to answer this question directly and both strategies are currently practiced. Some argue that the conventional surgical approach, i.e. tumor resection followed by chemotherapy, allows precise abdominal tumor staging, prevents local complications, improves patient’s status and efficacy of chemotherapy through a reduction of tumor burden and may favourably impact survival. In contrast, others favour a more conservative approach, i.e. first step chemotherapy reserving resection of the primary for the treatment of local complications or with a curative intent if tumor downstaging occurs. The rationale of this approach is the high mortality and morbidity rates associated with bowel resection in a metastatic setting, resulting in an increased risk of delaying or even precluding chemotherapy administration and the relatively low-risk of local complication through the effect of systemic therapy on the primary tumor. The aim of the present review is to discuss both therapeutic options taking into account the recent advances in chemotherapy with more effective drugs and the possibility of colon stenting for obstructive tumor.     

Chirurgie du cancer du côlon non métastatique, critères de qualité, avancées récentes

The latest French practice parameters regarding colonic cancer surgical management have been published in 1998. Since, the widespread of laparoscopic approach and enhanced recovery programs, including the fast track multimodal management, have deeply modified this surgical management. Furthermore, endoscopic colonic stenting for the management of urgent colonic cancer obstruction has been initially regarded as a major advance but recent data raise some concern regarding its long-term safety. This article aims to assess the colonic cancer surgical management guidelines, to define its quality criteria, and to review recent advances on the topic.     

Prise en charge des cancers du côlon non métastatique chez les patients âgés

Colon cancer occurred mainly in elderly. Improvements have been made in surgery but the indication of chemotherapy remains controversial. The choice of chemotherapy regimen and the selection of the patient to be treated are crucial. Prospective studies specific of elderly are needed.     

Schwannome intraosseux du premier métatarsien au sujet d’un cas et revue de la littérature

The Schwannoma-type peripheral nerve tumors are rare. It is related to Neurofibromatosis type 1 (von Recklinghausen disease) in some cases. A 63-year old retired female patient reported a history of multiple pains over a year, with no sensorimotor deficit. MRI revealed presence of an isolated Schwannoma in the 1st intermetatarsal area, growing on the first metatarsal with no associated fracture complication. The diagnosis was confirmed through preoperative biopsy. Patient underwent curative surgical resection, bone curretage and an adjunctive liquid nitrogen treatment without bone void filling. Final analysis of the resected specimen confirmed the Schwannoma diagnosis. At last check, no recurrence was detected in clinical and imagery assessments. This case is only the third metatarsal intraosseous Schwannoma reported so far.