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Quoi de neuf en chirurgie du cancer colorectal depuis la fin du dernier millénaire ?

What’s new in the surgical treatment of colorectal cancer since year 2000?

  • Dossier Thématique / Thematic File
  • Published:
Côlon & Rectum

Résumé

Cette mini-revue détaille les principales avancées depuis les années 2000 dans la prise en charge des cancers colorectaux. La laparoscopie est maintenant la voie d’abord de choix pour la majorité des cancers du colon ou du rectum. La préparation colique n’est plus nécessaire qu’avant une proctectomie pour cancer. L’endoprothèse ne doit plus être posée en première intention curative en cas de cancer colique en occlusion. Le syndrome MAP (MUTYH-Associated Polyposis) a été découvert en 2002 et permet d’expliquer une partie des polyposes sans mutation identifiée sur APC.

Pour les cancers du rectum, la radiothérapie doit être administrée en néoadjuvant préférentiellement. Il est préférable de réaliser un réservoir en J plutôt qu’une anastomose colo-anale directe pour améliorer le résultat fonctionnel. Toute anastomose sous-douglassienne doit être protégée par une iléostomie afin de réduire le taux et la gravité des fistules anastomotiques. La résection trans-anale par microchirugie endoscopique est la technique de choix pour les petites tumeurs T1 du rectum.

Abstract

This short-review details major advances since 2000 in the surgical management of colorectal cancers (CRC). The laparoscopic approach is now the standard for the vast majority of CRC. A bowel preparation is only needed before an anterior resection. Colonic stent should not be used with curative intent for colonic cancer obstruction. In 2002 discovery of a new genetic syndrome, the MAP (MUTYH-Associated Polysis) explained some of the cases of polyposis without germline mutation on APC.

For rectal cancer, radiotherapy should be administrated before surgery. A J-pouch is preferable to a straight coloanal anastomosis to improve the functional result. All low colorectal or coloanal anastomosis should be diverted by a stoma to reduce the rate and the gravity of anastomotic leakage. Trans-anal endoscopic microsurgery (TEM) is the technique of choice for the management of T1 rectal tumor.

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  1. Service de Chirurgie Générale et Digestive, Hôpital Saint Antoine, Département de Chirurgie Générale et Digestive, Hôpital Saint-Antoine, Université Pierre et Marie Curie, Paris VI, 184, rue du Faubourg Saint-Antoine, 75012, Paris, France

    T. Hor & J. H. Lefevre

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Correspondence to J. H. Lefevre.

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Hor, T., Lefevre, J.H. Quoi de neuf en chirurgie du cancer colorectal depuis la fin du dernier millénaire ?. Colon Rectum 9, 25–29 (2015). https://doi.org/10.1007/s11725-015-0566-6

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  • DOI: https://doi.org/10.1007/s11725-015-0566-6

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