Traitement chirurgical du cancer du rectum

Surgical treatment of rectal cancer

Résumé

Pour les cancers du rectum localement évolués, la radiochimiothérapie préopératoire augmente le taux de réponse tumorale et diminue le taux de récidive locale. Le traitement curatif des cancers du rectum repose sur l’exérèse chirurgicale dont le gold standard associe la proctectomie, l’exérèse totale du mésorectum et la conservation sphinctérienne si le niveau de la tumeur l’autorise. La qualité des résultats carcinologiques est influencée par les degrés de spécialisation du chirurgien et du centre dans lequel est opéré le patient.

Abstract

Neoadjuvant chemoradiation therapy reduces the likelihood tumour regression and decreases the local recurrence rate for locally advanced rectal cancer. Radical resection according to the principles of total mesorectal excision and sphincter preservation has become widely accepted. Optimal oncology outcomes depend on the specific relevant expertise of the colorectal unit and surgeon.

This is a preview of subscription content, access via your institution.

Références

  1. 1.

    Heald RJ, Ryall RD (1986) Recurrence and survival after total mesorectal excision for rectal cancer. Lancet 11: 1479–1482

    Article  Google Scholar 

  2. 2.

    Nascimbeni R, Bugart LJ, Nivatvongs S, et al. (2002) Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum 45: 200–206

    PubMed  Article  Google Scholar 

  3. 3.

    Nascimbeni R, Nivatvongs S, Larson DR, et al. (2004) Long-term survival after local excision for T1 carcinoma of the rectum. Dis Colon Rectum 47: 1773–1779

    PubMed  Article  Google Scholar 

  4. 4.

    Gao JD, Shao YF, Bi JJ, et al. (2003) Local excision carcinoma in early stage. World J Gastroenterol 9: 871–873

    PubMed  Google Scholar 

  5. 5.

    Balani A, Turoldo A, Braini A, et al. (2000) Local excision for rectal cancer. J Surg Oncol 74: 158–162

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Garcia-Aguilar J, Mellgren A, Sirivongs P, et al. (2000) Local excision of rectal cancer without adjuvant therapy. A word of caution. Ann Surg 3: 354–351

    Google Scholar 

  7. 7.

    Mellgren A, Sirivongs P, Rothenberger DA, et al. (2000) Is local excision adequate therapy for early rectal cancer? Dis Colon Rectum 43: 1064–1074

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Russel AH, Harris J, Rosenberg PJ (2000) Anal sphincter conservation for patients with adenocarcinoma of the distal rectum: long-term results of radiation therapy oncology group protocol 89-02. In J Radiat Oncol Biol Phys 46: 313–322

    Article  Google Scholar 

  9. 9.

    Varma MG, Rogers SJ, Schrock TR, et al. (1999) Local excision for rectal carcinomas. Arch Surg 134: 863–867

    PubMed  Article  CAS  Google Scholar 

  10. 10.

    Steele GD, Herndon JE, Bleday R, et al. (1999) Sphincter-sparing treatment for distal rectal adenocarcinoma. Ann Surg Oncol 6: 433–441

    PubMed  Article  Google Scholar 

  11. 11.

    Chakravarti A, Compton CC, Shellito PC, et al. (1999) Long-term follow-up of patients wit rectal cancer managed by local excision with and without adjuvant irradiation. Ann Surg 230: 49–54

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Taylor RH, Hay JH, Larsson SN (1998) Transanal local excision of selected rectal cancers. Am J Surg 175: 360–363

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Kim JC, Yeatman TJ, Coppola D (2001) Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg 234: 352–359

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Faivre J, Chaume JC, Pigot F, et al. (1996) Transanal electroresection of small rectal cancer: a sole tretament? Dis Colon Rectum 39: 270–278

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Heimann TM, Oh C, Steinhagen RM, et al. (1992) Surgical treatment of tumors of the distal rectum with sphincter preservation. Ann Surg 216: 432–436

    PubMed  Article  CAS  Google Scholar 

  16. 16.

    Heald RJ, Brendan JM, Ryall RDH, et al. (1998) Rectal cancer. The Basingstoke experience of total mesorectal excision, 1978–1997. Arch Surg 133: 894–899

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    Kapitejn E, Marijnen CA, Nagtegaal ID, et al. (2001) Preoperative radiotherapy combined with total mesorectal excision for respectable rectal cancer. N Engl J Med 345: 638–646

    Article  Google Scholar 

  18. 18.

    Bosset JF, Calais G, Mineur L, et al. (2004) Does the addition of chemotherapy (CT) to preoperative radio-therapy (preopRT) increase the pathological response in patients with resected rectal cancer: report of the 22921 EORTC phase III trial. ASCO Report no 3504

  19. 19.

    Gerard JP, Conroy T, Bonnetain F (2005) FFCD 9203 randomized trial results: preoperative radiotherapy +/-5FU FA in T3-4 rectal cancers (Mo). ASCO, Orlando

    Google Scholar 

  20. 20.

    Quirke P, Durdey P, Dixon MF, et al. (1986) Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excision. Lancet 1,38: 996–999

    Article  Google Scholar 

  21. 21.

    Pollet WG, Nicholls RJ (1983) The relationship between the extent of distal clearance and survival and loval recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 70: 159–163

    Article  Google Scholar 

  22. 22.

    Shirouzu K, Isomoto H, Kakegawa T (1995) Distal spread of rectal cancer and optimal distal margin of resection for sphincter-preserving surgery. Cancer 76: 388–392

    PubMed  Article  CAS  Google Scholar 

  23. 23.

    Rullier E, Zerbib F, Laurent C, et al. (1999) Intersphincteric resection with extension of internal anal sphincter for conservative treatment of very low rectal cancer. Dis Colon Rectum 42: 1168–1175

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Dehni N, Schlegel RD, Cunningham C, et al. (1998) Influence of a defunctionning stoma on leakage rates after low colorectal anastomosis and colonic J pouch-anal anastomosis. Br J Surg 85: 1114–1117

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Alves A, Panis Y, Mathieu P, et al., Association française de chirurgie (2005) Mortalité et morbidité après exérèse du cancer du rectum sous péritonéal: résultats d’une enquête prospective multicentrique française. Gastroenterol Clin Biol 29: 509–514

    PubMed  Article  Google Scholar 

  26. 26.

    Cawthorn SJ, Parums DV, Gibbs NM, et al. (1990) Extent of mesorectal spread and involvement of lateral resection margin as prognostic factors after surgery for rectal cancer. Lancet 335: 1055–1059

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Hall NR, Finan PJ, Al-Jaberi T, et al. (1998) Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum 41: 979–983

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    Wibe A, Rendedal PR, Svensson E, et al. (2002) Prognostic significance of the circumferential resection margin following total mesorectal excision for rectal cancer. B J Surg 89: 327–334

    Article  CAS  Google Scholar 

  29. 29.

    Nagtegaal ID, van de Velde CJ, van der Worp E, et al., Cooperative Clinical Investigators of the Dutch Colorectal Cancer Group (2002) Macroscopic evaluation of rectal cancer resection specimen: clinical significance of the pathologist in quality control. J Clin Oncol 20: 1729–1734

    PubMed  Article  Google Scholar 

  30. 30.

    Cecil TD, Sexton R, Moran BJ, et al. (2004) Total mesorectal excision results in low local recurrence rates in lymph node-positive rectal cancer. Dis Colon Rectum 47: 1145–1150

    PubMed  Article  Google Scholar 

  31. 31.

    Wichmann MW, Muller C, Meyer G, et al. (2002) Effect of preoperative radiochemotherapy on lymph node retrieval after resection of rectal cancer. Arch Surg 137: 206–210

    PubMed  Article  Google Scholar 

  32. 32.

    Porter GA, Soskolne CL, Yakimets WW, et al. (1998) Surgeon-related factors and outcome in rectal cancer. Ann Surg 227: 157–167

    PubMed  Article  CAS  Google Scholar 

  33. 33.

    Schrag D, Panageas KS, Riedel E, et al. (2002) Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann Surg 5: 583–592

    Article  Google Scholar 

  34. 34.

    Habr-Gama A, Perez RO, Nadalin W, et al. (2004) Operative versus nonoperative treatment for stage o distal rectal cancer following chemoradiation therapy. Ann Surg 4: 711–718

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to A. Alvès.

About this article

Cite this article

Alvès, A., Panis, Y. Traitement chirurgical du cancer du rectum. Côlon Rectum 1, 8–12 (2007). https://doi.org/10.1007/s11725-006-0011-y

Download citation

Mots clés

  • Proctectomie
  • Exérèse du mésorectum
  • Réservoir colique
  • Exérèse locale

Keywords

  • Rectal cancer surgery
  • Total mesorectal excision