Skip to main content
SpringerLink
Log in

Recommandations pour la pratique clinique Cancer du rectum

Question 4 Quelle est la place du traitement local pour les petits cancers du rectum ?

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

Résumé

La prise en charge par exérèse locale d’un petit cancer du rectum permet d’éviter la morbidité et les séquelles d’une exérèse du rectum et du mésorectum. Cette stratégie s’adresse à des patients et des tumeurs sélectionnés sur des critères cliniques et écho-endoscopiques (usTis et usT1). Différentes techniques chirurgicales et endoscopiques permettent actuellement de réaliser ce geste d’excision locale avec un avantage à la microchirurgie transanale endoscopique (TEM). Le risque d’envahissement ganglionnaire peut être estimé après l’exérèse locale par la recherche sur pièce opératoire de facteurs de bon pronostic: adénocarcinome pTis ou pT1sm1, moyennement ou bien différencié, absence d’emboles vasculaires ou lymphatiques, et absence de budding tumoral. En présence de facteurs de mauvais pronostic, une résection rectale complémentaire avec exérèse mésorectale s’impose. Un traitement adjuvant de rattrapage par irradiation pelvienne n’est pas recommandé.

Abstract

Local excision for early rectal cancer allows rectal conservation without morbidity compared to total mesorectal excision. This strategy is indicated in patients with tumors selected on clinical and EUS criteria (usTis and usT1). Different surgical and endoscopic procedures are currently used to perform local excision with an advantage to TEM. The risk of lymph node involvement can be assessed after local excision by research on surgical specimen of good prognosis criteria such as: pTis or pT1sm1 adenocarcinoma, moderately or well-differentiated tumor, no vascular or lymphatic emboli, and no tumor budding. In the presence of poor prognosis criteria, additional rectal resection with TME is required. A salvage pelvic irradiation as adjuvant therapy is not recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

References

  1. Morino M, Risio M, Bach S, et al (2015). Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference. Surg Endosc 29:755–73

    Article  PubMed  Google Scholar 

  2. Arezzo A, Passera R, Saito Y, et al (2014). Systematic review and meta-analysis of endoscopic submucosal dissection versus transanal endoscopic microsurgery for large noninvasive rectal lesions. Surg Endosc 28: 427–38

    Article  PubMed  Google Scholar 

  3. Darwood RJ, Wheeler JM, Borley NR (2008). Transanal endoscopic microsurgery is a safe and reliable technique even for complex rectal lesions. Br J Surg 95: 915–8

    Article  CAS  PubMed  Google Scholar 

  4. Marks JH, Frenkel JL, Greenleaf CE, et al (2014) Transanal endoscopic microsurgery with entrance into the peritoneal cavity: is it safe? Dis Colon Rectum 57: 1176–82

    Article  PubMed  Google Scholar 

  5. Christoforidis D, Cho HM, Dixon MR, et al (2009). Transanal endoscopic microsurgery versus conventional transanal excision for patients with early rectal cancer. Ann Surg 249: 776–82

    Article  PubMed  Google Scholar 

  6. Ishikawa Y, Akishima-Fukasawa Y, Ito K, et al (2008). Histopathologic determinants of regional lymph node metastasis in early colorectal cancer. Cancer 112: 924–33

    Article  PubMed  Google Scholar 

  7. Sohn DK, Chang HJ, Park JW, et al (2007). Histopathological risk factors for lymph node metastasis in submucosal invasive colorectal carcinoma of pedunculated or semipedunculated type. J Clin Pathol 60: 912–5

    Article  PubMed Central  PubMed  Google Scholar 

  8. Beaton C, Twine CP, Williams GL, et al (2013). Systematic review and meta-analysis of histopathological factors influencing the risk of lymph node metastasis in early colorectal cancer. Colorectal Dis 15: 788–97

    Article  CAS  PubMed  Google Scholar 

  9. Ueno H, Hashiguchi Y, Kajiwara Y, et al (2010). Proposed objective criteria for “grade 3” in early invasive colorectal cancer. Am J Clin Pathol 134: 312–22

    Article  PubMed  Google Scholar 

  10. Kobayashi H, Mochizuki H, Kato T, et al (2010). Is total mesorectal excision always necessary for T1-T2 lower rectal cancer? Ann Surg Oncol 17: 973–80

    Article  PubMed  Google Scholar 

  11. Kazama S, Watanabe T, Ajioka Y, et al (2006). Tumour budding at the deepest invasive margin correlates with lymph node metastasis in submucosal colorectal cancer detected by anticytokeratin antibody CAM5.2. Br J Cancer 94: 293–8

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Morino M, Allaix ME, Caldart M, et al (2011). Risk factors for recurrence after transanal endoscopic microsurgery for rectal malignant neoplasm. Surg Endosc 25: 3683–90

    Article  PubMed  Google Scholar 

  13. Puli SR, Bechtold ML, Reddy JB, et al (2009). How good is endoscopic ultrasound in differentiating various T stages of rectal cancer? Meta-analysis and systematic review. Ann Surg Oncol 16: 254–65

    Article  PubMed  Google Scholar 

  14. Taylor FG, Quirke P, Heald RJ, et al (2011). Preoperative highresolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg 253: 711–9

    Article  PubMed  Google Scholar 

  15. Halefoglu AM, Yildirim S, Avlanmis O, et al (2008). Endorectal ultrasonography versus phased-array magnetic resonance imaging for preoperative staging of rectal cancer. World J Gastroenterol 14: 3504–10

    Article  PubMed Central  PubMed  Google Scholar 

  16. Buess G, Hutterer F, Theiss J, et al (1984). A system for a transanal endoscopic rectum operation. Chirurgy 55: 677–80

    CAS  Google Scholar 

  17. Allaix ME, Rebecchi F, Giaccone C, et al (2011). Long-term functional results and quality of life after transanal endoscopic microsurgery. Br J Surg 98: 1635–43

    Article  CAS  PubMed  Google Scholar 

  18. Clancy C, Burke JP, Albert MR, et al (2015). Transanal endoscopic microsurgery versus standard transanal excision for the removal of rectal neoplasms: a systematic review and meta-analysis. Dis Colon Rectum 58: 254–61

    Article  PubMed  Google Scholar 

  19. Saito Y, Uraoka T, Yamaguchi Y, et al (2010). A prospective, multicenter study of 1111 colorectal endoscopic submucosal dissections (with video). Gastrointest Endosc 72: 1217–25

    Article  PubMed  Google Scholar 

  20. Hahnloser D, Wolff BG, Larson DW, et al (2005). Immediate radical resection after local excision of rectal cancer: an oncologic compromise? Dis Colon Rectum 48: 429–37

    Article  PubMed  Google Scholar 

  21. van Gijn W, Brehm V, de Graaf E, et al (2013). Unexpected rectal cancer after TEM: outcome of completion surgery compared with primary TME. Eur J Surg Oncol 39: 1225–9

    Article  PubMed  Google Scholar 

  22. Piessen G, Cabral C, Benoist S, et al (2012). Previous transanal full-thickness excision increases the morbidity of radical resection for rectal cancer. Colorectal Dis 14: 445–52

    Article  CAS  PubMed  Google Scholar 

  23. Levic K, Bulut O, Hesselfeldt P, et al (2013). The outcome of rectal cancer after early salvage TME following TEM compared with primary TME: a case-matched study. Tech Coloproctol 17: 397–403

    Article  CAS  PubMed  Google Scholar 

  24. Hompes R, McDonald R, Buskens C, et al (2013). Completion surgery following transanal endoscopic microsurgery: assessment of quality and short-and long-term outcome. Colorectal Dis 15: e576–81

  25. Sun Myint A, Grieve RJ, McDonald AC, et al (2007). Combined modality treatment of early rectal cancer: the UK experience. Clin Oncol (R Coll Radiol) 19: 674–81

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service de chirurgie viscérale, digestive et cancérologique, Unité de Transplantation Hépatique, CHRU Besançon, 3 bd Alexandre Fleming, 25030, Besançon cedex, France

    Z. Lakkis

  2. Service de gastro-entérologie, Hôpital Nord, Marseille, France

    M. Barthet

  3. Service de gastro-entérologie, CHRU Besançon, Besançon, France

    S. Koch

  4. Département de chirurgie oncologique, Institut Paoli-Calmettes, Marseille, France

    B. Lelong

  5. Département de chirurgie oncologique, Institut du Cancer de Montpellier, Montpellier, France

    P. Rouanet

  6. Département de radiothérapie, Centre Antoine-Lacassagne, Nice, France

    J. P. Gerard

Authors
  1. Z. Lakkis
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Barthet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Koch
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. B. Lelong
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Rouanet
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. P. Gerard
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Z. Lakkis.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lakkis, Z., Barthet, M., Koch, S. et al. Recommandations pour la pratique clinique Cancer du rectum. Colon Rectum 10, 35–41 (2016). https://doi.org/10.1007/s11725-015-0618-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11725-015-0618-y

Mots clés

Keywords

Search

Navigation