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Recommandations pour la pratique clinique Cancer du rectum

Question 2 Quels sont les critères de qualité de l’exérèse chirurgicale ?

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

Résumé

Les principales avancées thérapeutiques dans la chirurgie du cancer du rectum au cours de ces deux dernières décennies se sont attachées à garantir la qualité de l’exérèse chirurgicale synonyme de meilleure survie sans récidive et de meilleure survie globale. La technique d’exérèse extrafasciale du mésorectum developpé par Heald dans les années 80 est aujourd’hui le standard chirurgical bien qu’il n’y ait jamais eu d’étude randomisée la comparant à la chirurgie classique. Depuis de nouvelles voies d’abord ont été développées : l’abord laparoscopique, l’approche robotique, et l’abord trans-périnéal premier. L’exérèse rectale par laparoscopie assure un résultat oncologique au moins équivalent à l’exérèse par laparotomie pour les tumeurs T1 à T3 faibles. Cet abord apporte également un bénéfice en termes de durée d’hospitalisation et de pertes sanguines au prix cependant d’une durée opératoire plus longue. L’approche robotisée, est faisable et sûre mais engendre un surcoût alors qu’elle n’apporte aucun bénéfice significatif pour le patient. Un abord périnéal premier peut être proposé chaque fois qu’il est nécessaire de réaliser une anastomose colo-anale manuelle, notamment dans les situations difficiles (bassin étroit, sexe masculin, obésité, tumeurs volumineuses) mais compte-tenu de l’absence de données concernant les résultats fonctionnels et oncologiques, l’exérèse totale du mesorectum par voie transanale ne peut-être actuellement recommandée. L’évaluation de l’exérèse nécessite une collaboration étroite entre le chirurgien et le pathologiste. En effet, l’examen histologique de la pièce de résection rectale permet la stadification TNM, une estimation du pronostic et de poser l’indication d’un traitement adjuvant.

Abstract

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.

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Références

  1. Rullier A, Laurent C. (2007) Recommendations for clinical practice. Therapeutic choices for rectal cancer. What quality criteria are important for surgical excision of rectal cancer? Gastroenterol Clin Biol 31S1:34–51

    Article  PubMed  Google Scholar 

  2. Heald RJ. (1979) A new approach to rectal cancer. Br J Hosp Med 22(3):277–81

    CAS  PubMed  Google Scholar 

  3. Heald RJ, Ryall RD. (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 1(8496):1479–82

    Article  CAS  PubMed  Google Scholar 

  4. Miskovic D, Foster J, Agha A, et al (2015) Standardization of laparoscopic total mesorectal excision for rectal cancer: a structured international expert consensus. Ann Surg 261(4):716–22

    Article  PubMed  Google Scholar 

  5. Nagtegaal ID, van de Velde CJ, van der Worp E, et al (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20(7):1729–34

    Article  PubMed  Google Scholar 

  6. Nagtegaal ID, van Krieken JH. (2002) The role of pathologists in the quality control of diagnosis and treatment of rectal cancer-an overview. Eur J Cancer 38(7):964–72

    Article  CAS  PubMed  Google Scholar 

  7. Quirke P (1998) The pathologist, the surgeon and colorectal cancer - get it right because it matters. Prog Pathol 4:201–13

    Google Scholar 

  8. Quirke P, Steele R, Monson J, et al (2009) Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial. Lancet 373(9666):821–8

    Article  PubMed Central  PubMed  Google Scholar 

  9. Sebag-Montefiore D, Stephens RJ, Steele R et al (2009) Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet 373(9666):811–20

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bondeven P, Laurberg S, Hagemann-Madsen RH, et al (2015) Suboptimal surgery and omission of neoadjuvant therapy for upper rectal cancer is associated with a high risk of local recurrence. Colorectal Dis 17(3):216–24

    Article  CAS  PubMed  Google Scholar 

  11. Rosenberg R, Maak M, Schuster T et al (2010) Does a rectal cancer of the upper third behave more like a colon or a rectal cancer? Dis Colon Rectum 53(5):761–70

    Article  PubMed  Google Scholar 

  12. Bernstein TE, Endreseth BH, Romundstad P, et al (2012) Improved local control of rectal cancer reduces distant metastases. Colorectal Dis 14(10):e668–e678

    Article  CAS  PubMed  Google Scholar 

  13. Kim YW, Kim NK, Min BS, et al (2009) The influence of the number of retrieved lymph nodes on staging and survival in patients with stage II and III rectal cancer undergoing tumorspecific mesorectal excision. Ann Surg 249(6):965–72

    Article  PubMed  Google Scholar 

  14. Rutkowski A, Bujko K, Nowacki MP, et al (2008) Distal bowel surgical margin shorter than 1 cm after preoperative radiation for rectal cancer: is it safe? Ann Surg Oncol 15(11):3124–31

    Article  PubMed  Google Scholar 

  15. Mezhir JJ, Shia J, Riedel E, et al (2012) Whole-mount pathologic analysis of rectal cancer following neoadjuvant therapy: implications of margin status on long-term oncologic outcome. Ann Surg; 256(2):274–9

    Article  PubMed  Google Scholar 

  16. Pahlman L, Bujko K, Rutkowski A, et al (2013) Altering the therapeutic paradigm towards a distal bowel margin of <1 cm in patients with low-lying rectal cancer: a systematic review and commentary. Colorectal Dis 15(4):e166–e174

    Article  CAS  PubMed  Google Scholar 

  17. Guillem JG, Chessin DB, Shia J, et al (2007) A prospective pathologic analysis using whole-mount sections of rectal cancer following preoperative combined modality therapy: implications for sphincter preservation. Ann Surg 245(1):88–93

    Article  PubMed Central  PubMed  Google Scholar 

  18. Kiran RP, Lian L, Lavery IC. (2011) Does a subcentimeter distal resection margin adversely influence oncologic outcomes in patients with rectal cancer undergoing restorative proctectomy? Dis Colon Rectum 54(2):157–63

    Article  PubMed  Google Scholar 

  19. Debove C, Maggiori L, Chau A, et al (2015) Risk factors for circumferential R1 resection after neoadjuvant radiochemotherapy and laparoscopic total mesorectal excision: a study in 233 consecutive patients with mid or low rectal cancer. Int J Colorectal Dis 30 (2):197–203

    Article  PubMed  Google Scholar 

  20. Ng CW, Lieske B, Tan KK. (2014) Routine histological sampling of doughnuts post oncologic anterior resection is not necessary. Int J Colorectal Dis 29(7):843–5

    Article  PubMed  Google Scholar 

  21. Rullier E, Denost Q, Vendrely V, et al (2013) Low rectal cancer: classification and standardization of surgery. Dis Colon Rectum 56(5):560–7

    Article  PubMed  Google Scholar 

  22. Shihab OC, Moran BJ, Heald RJ, et al (2009) MRI staging of low rectal cancer. Eur Radiol 19(3):643–50

    Article  PubMed  Google Scholar 

  23. Rullier E, Laurent C, Bretagnol F, et al (2005) Sphincter-saving resection for all rectal carcinomas: the end of the 2-cm distal rule. Ann Surg 241(3):465–9

    Article  PubMed Central  PubMed  Google Scholar 

  24. Marr R, Birbeck K, Garvican J, et al (2005) The modern abdominoperineal excision: the next challenge after total mesorectal excision. Ann Surg 242(1):74–82

    Article  PubMed Central  PubMed  Google Scholar 

  25. Nagtegaal ID, Quirke P (2008) What is the role for the circumferential margin in the modern treatment of rectal cancer? J Clin Oncol 26(2):303–12

    Article  PubMed  Google Scholar 

  26. Holm T, Ljung A, Haggmark T, et al (2007) Extended abdominoperineal resection with gluteus maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 94(2):232–8

    Article  CAS  PubMed  Google Scholar 

  27. Tudyka V, Blomqvist L, Beets-Tan RG, et al (2014) EURECCA consensus conference highlights about colon & rectal cancer multidisciplinary management: the radiology experts review. Eur J Surg Oncol 40(4):469–75

    Article  CAS  PubMed  Google Scholar 

  28. Yang TX, Morris DL, Chua TC. (2013) Pelvic exenteration for rectal cancer: a systematic review. Dis Colon Rectum 56(4):519–31.

    Article  PubMed  Google Scholar 

  29. Maurer CA. (2005) Urinary and sexual function after total mesorectal excision. Recent Results Cancer Res; 165:196–204

    Article  PubMed  Google Scholar 

  30. Hida K, Hasegawa S, Kataoka Y, et al (2013) Male sexual function after laparoscopic total mesorectal excision. Colorectal Dis 15(2):244–51

    Article  CAS  PubMed  Google Scholar 

  31. Moszkowicz D, Alsaid B, Bessede T, et al (2011) Where does pelvic nerve injury occur during rectal surgery for cancer? Colorectal Dis 13(12):1326–34

    Article  CAS  PubMed  Google Scholar 

  32. Luca F, Valvo M, Ghezzi TL, et al (2013) Impact of robotic surgery on sexual and urinary functions after fully robotic nervesparing total mesorectal excision for rectal cancer. Ann Surg 257(4):672–8

    Article  PubMed  Google Scholar 

  33. Szynglarewicz B, Zietek M, Forgacz J, et al (2012) Urinary complications in rectal cancer patients are related to the dissection tool. Hepatogastroenterology 59(115):724–6

    PubMed  Google Scholar 

  34. Bonnet S, Berger A, Hentati N, et al (2012) High tie versus low tie vascular ligation of the inferior mesenteric artery in colorectal cancer surgery: impact on the gain in colon length and implications on the feasibility of anastomoses. Dis Colon Rectum 55 (5):515–21

    Article  CAS  PubMed  Google Scholar 

  35. Cirocchi R, Trastulli S, Farinella E, et al (2012) High tie versus low tie of the inferior mesenteric artery in colorectal cancer: a RCT is needed. Surg Oncol 21(3):e111–e123

    Article  PubMed  Google Scholar 

  36. Matsuda K, Hotta T, Takifuji K, et al (2015) Randomized clinical trial of defaecatory function after anterior resection for rectal cancer with high versus low ligation of the inferior mesenteric artery. Br J Surg 102(5):501–8

    Article  CAS  PubMed  Google Scholar 

  37. Lange MM, Buunen M, van de Velde CJ, et al (2008) Level of arterial ligation in rectal cancer surgery: low tie preferred over high tie. A review. Dis Colon Rectum 51(7):1139–45

    Article  PubMed Central  PubMed  Google Scholar 

  38. Fujita S, Akasu T, Mizusawa J, et al (2012) Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol 13 (6):616–21

    Article  PubMed  Google Scholar 

  39. Georgiou P, Tan E, Gouvas N, et al (2009) Extended lymphadenectomy versus conventional surgery for rectal cancer: a metaanalysis. Lancet Oncol 10(11):1053–62

    Article  PubMed  Google Scholar 

  40. Nagawa H, Muto T, Sunouchi K, et al (2001) Randomized, controlled trial of lateral node dissection vs. nerve-preserving resection in patients with rectal cancer after preoperative radiotherapy. Dis Colon Rectum 44(9):1274–80

    Article  CAS  PubMed  Google Scholar 

  41. Kodeda K, Holmberg E, Jorgren F, et al (2010) Rectal washout and local recurrence of cancer after anterior resection. Br J Surg 97(10):1589–97

    Article  CAS  PubMed  Google Scholar 

  42. Matsuda A, Kishi T, Musso G, et al (2013) The effect of intraoperative rectal washout on local recurrence after rectal cancer surgery: a meta-analysis. Ann Surg Oncol 20(3):856–63

    Article  PubMed  Google Scholar 

  43. Rondelli F, Trastulli S, Cirocchi R, et al (2012) Rectal washout and local recurrence in rectal resection for cancer: a metaanalysis. Colorectal Dis 14(11):1313–21

    Article  CAS  PubMed  Google Scholar 

  44. Zhou C, Ren Y, Li J, et al (2014) Systematic review and metaanalysis of rectal washout on risk of local recurrence for cancer. J Surg Res 189(1):7–16

    Article  PubMed  Google Scholar 

  45. Amato A, Pescatori M (2006) Perioperative blood transfusions for the recurrence of colorectal cancer. Cochrane Database Syst Rev (1):CD005033

    PubMed  Google Scholar 

  46. Jagoditsch M, Pozgainer P, Klingler A, et al (2006) Impact of blood transfusions on recurrence and survival after rectal cancer surgery. Dis Colon Rectum 49(8):1116–30

    Article  PubMed  Google Scholar 

  47. Warschkow R, Guller U, Koberle D, et al (2014) Perioperative blood transfusions do not impact overall and disease-free survival after curative rectal cancer resection: a propensity score analysis. Ann Surg 259(1):131–8

    Article  PubMed  Google Scholar 

  48. Braga M, Frasson M, Vignali A, et al (2005) Laparoscopic vs. open colectomy in cancer patients: long-term complications, quality of life, and survival. Dis Colon Rectum 48(12):2217–23

    PubMed  Google Scholar 

  49. Guillou PJ, Quirke P, Thorpe H, et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365(9472):1718–26

    Article  PubMed  Google Scholar 

  50. Jayne DG, Guillou PJ, Thorpe H, et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25 (21):3061–8

    Article  PubMed  Google Scholar 

  51. Jayne DG, Thorpe HC, Copeland J, et al (2010) Five-year follow-up of the Medical Research Council CLASICC trial of laparoscopically assisted versus open surgery for colorectal cancer. Br J Surg 97(11):1638–45

    Article  CAS  PubMed  Google Scholar 

  52. Green BL, Marshall HC, Collinson F, et al (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Br J Surg 100(1):75–82

    Article  CAS  PubMed  Google Scholar 

  53. van der Pas MH, Haglind E, Cuesta MA, et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14(3):210–8

    Article  PubMed  Google Scholar 

  54. Bonjer HJ, Deijen CL, Abis GA, et al (2015) A randomized trial of laparoscopic versus open surgery for rectal cancer 1. N Engl J Med 372(14):1324–32

    Article  CAS  PubMed  Google Scholar 

  55. Jeong SY, Park JW, Nam BH, et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15(7):767–74

    Article  PubMed  Google Scholar 

  56. Fleshman J, Branda M, Sargent DJ, et al (2015) Effect of Laparoscopic-Assisted Resection vs Open Resection of stage II or III Rectal Cancer on Pathologic Outcomes: the ACOSOG Z6051 Randomized Clinical Trial. JAMA 314(13):1346–55

    Article  PubMed  Google Scholar 

  57. Stevenson AR, Solomon MJ, Lumley JW, et al (2015) Effect of Laparoscopic-Assisted Resection vs Open Resection on Pathological Outcomes in Rectal Cancer: The ALaCaRT Randomized Clinical Trial. JAMA 314(13):1356–63

    Article  PubMed  Google Scholar 

  58. Funahashi K, Koike J, Teramoto T, et al (2009) Transanal rectal dissection: a procedure to assist achievement of laparoscopic total mesorectal excision for bulky tumor in the narrow pelvis. Am J Surg 197(4):e46–e50

    Article  PubMed  Google Scholar 

  59. Akiyoshi T, Kuroyanagi H, Oya M, et al (2009) Factors affecting the difficulty of laparoscopic total mesorectal excision with double stapling technique anastomosis for low rectal cancer. Surgery 146(3):483–9

    Article  PubMed  Google Scholar 

  60. Denost Q, Adam JP, Rullier A, et al (2014) Perineal transanal approach: a new standard for laparoscopic sphincter-saving resection in low rectal cancer, a randomized trial. Ann Surg 260 (6):993–9

    Article  PubMed  Google Scholar 

  61. Sylla P, Rattner DW, Delgado S, et al (2010) NOTES transanal rectal cancer resection using transanal endoscopic microsurgery and laparoscopic assistance. Surg Endosc 24(5):1205–10

    Article  PubMed  Google Scholar 

  62. Simillis C, Hompes R, Penna M, et al (2015) A systematic review of transanal total mesorectal excision. Is this the future of rectal cancer surgery? Colorectal Dis

    Google Scholar 

  63. Tuech JJ, Karoui M, Lelong B, et al (2015) A step toward NOTES total mesorectal excision for rectal cancer: endoscopic transanal proctectomy. Ann Surg 261(2):228–33

    Article  PubMed  Google Scholar 

  64. de’Angelis N, Portigliotti L, Azoulay D, et al (2015) Transanal total mesorectal excision for rectal cancer: a single center experience and systematic review of the literature. Langenbecks Arch Surg

    Google Scholar 

  65. Fernandez-Hevia M, Delgado S, Castells A, et al (2015) Transanal total mesorectal excision in rectal cancer: short-term outcomes in comparison with laparoscopic surgery. Ann Surg 261 (2):221–7

    Article  PubMed  Google Scholar 

  66. Velthuis S, Nieuwenhuis DH, Ruijter TE, et al (2014) Transanal versus traditional laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc 28(12):3494–9

    Article  PubMed  Google Scholar 

  67. deSouza AL, Prasad LM, Ricci J, et al (2011) A comparison of open and robotic total mesorectal excision for rectal adenocarcinoma. Dis Colon Rectum 54(3):275–82

    Article  PubMed  Google Scholar 

  68. Park JS, Choi GS, Lim KH, et al (2011) S052: a comparison of robot-assisted, laparoscopic, and open surgery in the treatment of rectal cancer. Surg Endosc 25(1):240–8

    Article  PubMed  Google Scholar 

  69. Ghezzi TL, Luca F, Valvo M, et al (2014) Robotic versus open total mesorectal excision for rectal cancer: comparative study of short and long-term outcomes. Eur J Surg Oncol 40(9):1072–9

    Article  CAS  PubMed  Google Scholar 

  70. Baik SH, Ko YT, Kang CM, et al (2008) Robotic tumor-specific mesorectal excision of rectal cancer: short-term outcome of a pilot randomized trial. Surg Endosc 22(7):1601–8

    Article  CAS  PubMed  Google Scholar 

  71. Trastulli S, Farinella E, Cirocchi R, et al (2012) Robotic resection compared with laparoscopic rectal resection for cancer: systematic review and meta-analysis of short-term outcome. Colorectal Dis 14(4):e134–e156

    Article  CAS  PubMed  Google Scholar 

  72. Xiong B, Ma L, Huang W, et al (2015) Robotic versus laparoscopic total mesorectal excision for rectal cancer: a meta-analysis of eight studies. J Gastrointest Surg 19(3):516–26

    Article  PubMed  Google Scholar 

  73. Cho MS, Baek SJ, Hur H, et al (2015) Short and Long-Term Outcomes of Robotic versus Laparoscopic Total Mesorectal Excision for Rectal Cancer: A Case-Matched Retrospective Study. Medicine (Baltimore) 94(11):e522.

    Article  Google Scholar 

  74. Collinson FJ, Jayne DG, Pigazzi A, et al (2012) An international, multicentre, prospective, randomised, controlled, unblinded, parallel-group trial of robotic-assisted versus standard laparoscopic surgery for the curative treatment of rectal cancer. Int J Colorectal Dis 27(2):233–41

    Article  PubMed  Google Scholar 

  75. Park JS, Kim NK, Kim SH, et al (2015) Multicentre study of robotic intersphincteric resection for low rectal cancer. Br J Surg 102(12):1567–73

    Article  CAS  PubMed  Google Scholar 

  76. Bateman AC, Jaynes E, Bateman AR. Rectal cancer staging post neoadjuvant therapy—how should the changes be assessed? Histopathology 2009; 54(6):713–21.

    Article  PubMed  Google Scholar 

  77. Mace AG, Pai RK, Stocchi L, et al (2015) American Joint Committee on Cancer and College of American Pathologists regression grade: a new prognostic factor in rectal cancer. Dis Colon Rectum 58(1):32–44

    Article  PubMed  Google Scholar 

  78. Ryan R, Gibbons D, Hyland JM, et al (2005) Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer. Histopathology 47(2):141–6

    Article  CAS  PubMed  Google Scholar 

  79. Shia J, McManus M, Guillem JG, et al (2011) Significance of acellular mucin pools in rectal carcinoma after neoadjuvant chemoradiotherapy. Am J Surg Pathol 35(1):127–34

    Article  PubMed  Google Scholar 

  80. de Campos-Lobato LF, Dietz DW, Stocchi L, et al (2012) Clinical implications of acellular mucin pools in resected rectal cancer with pathological complete response to neoadjuvant chemoradiation. Colorectal Dis 14(1):62–7

    Article  CAS  PubMed  Google Scholar 

  81. Rullier A, Laurent C, Capdepont M, et al (2008) Lymph nodes after preoperative chemoradiotherapy for rectal carcinoma: number, status, and impact on survival. Am J Surg Pathol 32(1):45–50

    Article  PubMed  Google Scholar 

  82. Leibold T, Shia J, Ruo L, et al (2008) Prognostic implications of the distribution of lymph node metastases in rectal cancer after neoadjuvant chemoradiotherapy. J Clin Oncol 26(13):2106–11

    Article  PubMed  Google Scholar 

  83. Perez RO, Habr-Gama A, Nishida Arazawa ST, et al (2005) Lymph node micrometastasis in stage II distal rectal cancer following neoadjuvant chemoradiation therapy. Int J Colorectal Dis 20(5):434–9

    Article  PubMed  Google Scholar 

  84. Caricato M, Ausania F, De DE, et al (2007) Tumor regression in mesorectal lymphnodes after neoadjuvant chemoradiation for rectal cancer. Eur J Surg Oncol 33(6):724–8

    Article  CAS  PubMed  Google Scholar 

  85. Jakob C, Aust DE, Liebscher B, et al (2011) Lymphangiogenesis in regional lymph nodes is an independent prognostic marker in rectal cancer patients after neoadjuvant treatment. PLoS One 6 (11):e27402

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  86. Sannier A, Lefevre JH, Panis Y, et al (2014) Pathological prognostic factors in locally advanced rectal carcinoma after neoadjuvant radiochemotherapy: analysis of 113 cases. Histopathology 65(5):623–30

    Article  PubMed  Google Scholar 

  87. Mirbagheri N, Kumar B, Deb S, et al (2014) Lymph node status as a prognostic indicator after preoperative neoadjuvant chemoradiotherapy of rectal cancer. Colorectal Dis 16(10):O339–O346

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Service de chirurgie digestive, CHU Charles Nicole, 1, rue Germont, 76000, Rouen, France

    V. Bridoux

  2. Service de chirurgie oncologique 1, Institut Paoli Calmettes, 232, boulevard Sainte Marguerite, 13009, Marseille, France

    C. de Chaisemartin

  3. Service de chirurgie digestive, Hôpital Nord, Marseille, France

    L. Beyer

  4. Service de chirurgie digestive, Hôpital de la Croix Saint Simon, Paris, France

    N. Goasguen

  5. Service de chirurgie digestive, CHU Amiens, Amiens, France

    C. Sabbagh

  6. Service d’anatomo-pathologie, Hôpital Beaujon, Paris, France

    N. Guedj

  7. Service d’anatomo-pathologie, Institut Gustave Roussy, Paris, France

    P. Dartigues

  8. Service d’anatomo-pathologie, Hôpital de la Pitié Salpêtrière, Paris, France

    A. Bardier

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  1. V. Bridoux
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Bridoux, V., de Chaisemartin, C., Beyer, L. et al. Recommandations pour la pratique clinique Cancer du rectum. Colon Rectum 10, 12–27 (2016). https://doi.org/10.1007/s11725-015-0617-z

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