In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level. All consecutive patients who had elective surgery for SDD (2010–2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD. In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m2, and 2310 (50

Acute right colic diverticulitis (ARD) is less frequent in Western countries than acute sigmoid diverticulitis (ASD). We aimed to compare the management of ARD and ASD operated on in emergency. All consecutive patients who had emergency surgery for ASD and ARD (2010–2021) were included in a retrospective, multicenter, cohort study. Patients were identified from databases in French centers that were members of the French Surgical Association. Emergency surgery was performed during the same hospitalization for peritonitis or after failure of conservative treatment. Early and late postoperative outcomes were studied. A total of 2297 patients were included with 2256 (98.2

Il trattamento chirurgico del cancro del colon sinistro è attualmente ben codificato e, se i principi di base sono cambiati poco negli ultimi decenni, questo trattamento è stato rivoluzionato dallo sviluppo della chirurgia mini-invasiva a partire dagli anni 90 e più recentemente da un cambiamento radicale nella gestione perioperatoria dei pazienti sottoposti a colectomia. Le regole oncologiche da rispettare si basano sull’asportazione del segmento colico colpito e sull’asportazione linfonodale mediante legatura all’origine dei peduncoli vascolari principali. La chirurgia mini-invasiva diventa la via d’accesso preferita per questo intervento e la tecnica chirurgica descritta in questo articolo è una colectomia per cancro del sigma mediante laparoscopia con i due tipi di dissecazione, legatura all’origine dell’arteria mesenterica inferiore o dell’arteria rettale superiore con conservazione dell’arteria colica superiore sinistra. La gestione perioperatoria del paziente ha un ruolo preponderante: comprende una preabilitazione con valutazione delle comorbilità e una ricerca di potenziali carenze che vengono corrette prima dell’intervento attraverso una preparazione specifica adattata a ciascun paziente e una riabilitazione il cui obiettivo è quello di migliorare il follow-up postoperatorio riducendo la morbilità e favorendo il ritorno all’autonomia. Vengono affrontate diverse situazioni specifiche: cancro della flessura colica sinistra, polipi “degenerati” non asportabili endoscopicamente o che comportano un rischio di invasione linfonodale che giustifica una colectomia complementare e tumori del colon sinistro complicati da perforazione.

El tratamiento quirúrgico del cáncer de colon izquierdo está bien codificado y, aunque los principios básicos han cambiado poco en las últimas décadas, este tratamiento se ha visto revolucionado por el desarrollo de la cirugía mínimamente invasiva desde la década de 1990 y, más recientemente, por un cambio radical en el tratamiento perioperatorio de los pacientes sometidos a colectomía. Las reglas oncológicas se basan en la exéresis del segmento cólico afectado y el vaciamiento ganglionar por ligadura en el origen del pedículo o pedículos vasculares principales. La cirugía mínimamente invasiva se está convirtiendo en la vía de acceso preferida para esta cirugía y la técnica quirúrgica descrita en este artículo es una colectomía para el cáncer de colon sigmoide por laparoscopia con los dos tipos de vaciamiento, ligadura en el origen de la arteria mesentérica inferior o de la arteria rectal superior con conservación de la arteria cólica superior izquierda. El tratamiento perioperatorio ocupa un lugar preponderante: incluye una prehabilitación con una evaluación de las comorbilidades y una búsqueda de posibles deficiencias, que se corrigen antes de la intervención mediante una preparación específica adaptada a cada paciente, y una rehabilitación cuyo objetivo es mejorar el postoperatorio reduciendo la morbilidad y favoreciendo la recuperación de la actividad. Se abordan varias situaciones especiales: el cáncer del ángulo izquierdo del colon, los pólipos «degenerados» que no son resecables por endoscopia o que conllevan un riesgo de invasión ganglionar que justifica una colectomía complementaria y el cáncer de colon izquierdo complicado por una perforación.

L’invagination de l’appendice est une entité rare pouvant être responsable de douleurs abdominales chroniques et non expliquées. Elle est principalement associée à des remaniements inflammatoires ou à de l’endométriose. Chez une jeune femme de 23 ans atteinte de la maladie de Crohn, une invagination appendiculaire a été diagnostiquée sur un scanner et lors d’une coloscopie réalisés pour des épisodes aigus de douleurs abdominales. Ces épisodes douloureux paroxystiques semblaient indépendants de la maladie de Crohn, mais plutôt en rapport avec l’invagination. Une résection combinant à la fois une ligature par voie endoscopique et une typhlectomie par voie cœlioscopique a été réalisée sans complication. Aucun argument en faveur d’une maladie de Crohn n’a été retrouvé à l’examen anatomopathologique de la pièce opératoire.

Appendix intussusception is rare, can be responsible of chronic unexplained abdominal pain and is mostly associated with inflammatory changes or endometriosis. A 23-year-old woman with Crohn's disease was diagnosed invaginated appendix by CT-scan and colonoscopy after several acute atypical abdominal pain episodes. These episodes were suspected to be independent of the Crohn's disease and to be attributed to the intussusception itself. A resection combining ligation of the base by colonoscopy and cecectomy by laparoscopy was performed successfully. However, no argument for Crohn's disease was found on the pathologic examination.

C-reactive protein (CRP) has been suggested as a satisfactory early marker of postoperative complications after colorectal surgery. The aim of this study was to assess the impact of a CRP monitoring-driven discharge strategy, after stoma reversal following laparoscopic sphincter-saving surgery for rectal cancer. Eighty-eight patients who had stoma reversal between June 2016 and April 2018 had CRP serum level monitoring on postoperative day (POD) 3 and, if necessary, on POD5. Patients were discharged on POD4 if the CRP level was < 100 mg/L. Patients were matched [according to age, gender, body mass index, neoadjuvant pelvic irradiation, type of anastomosis (stapled or manual), and adjuvant chemotherapy] to 109 identical control patients who had stoma reversal between 2012 and 2016 with the same postoperative care but without CRP monitoring. Postoperative 30-day overall morbidity [CRP group: 12/88 (14%) vs controls: 11/109, (10%), p = 0.441] and severe morbidity rates (i.e. Dindo 3–4) [CRP group: 2/88 (2%) vs controls: 2/109 (2%), p = 0.838] were similar between groups. Mean length of stay was significantly shorter in the CRP group (CRP group: 4.6 ± 1.3 vs controls: 5.8 ± 1.8 days; p < 0.001). Discharge occurred before POD5 in 59/88 (67%) CRP patients vs 15/109 (14%) controls (p < 0.001). The unplanned rehospitalization rate [CRP group: 6/88 (7%) vs controls: 4/109 (4%), p = 0.347] was similar between groups. In patients having temporary stoma closure after laparoscopic surgery for rectal cancer, postoperative CRP monitoring is associated with a significant shortening of hospital stay without increasing morbidity or rehospitalization rates.

Background: Small bowel adenocarcinoma (SBA) is a rare tumour with a poor prognosis. Molecular biology data on SBA carcinogenesis are lacking. Methods: Expression of HER2, β -catenin, p53 and mismatch repair (MMR) protein was assessed by immunohistochemistry. KRAS , V600E BRAF mutations and microsatellite instability were investigated. Results: We obtained samples from 63 SBA patients (tumour stages: I–II: 30%; III: 35%; IV: 32%; locally advanced: 3%). HER2 overexpression (3+) was observed in 2 out of 62 patients, overexpression of p53 in 26 out of 62, abnormal expression of β -catenin in 12 out of 61, KRAS mutation in 21 out of 49, BRAF V600E mutation in 1 out of 40 patients, MMR deficiency (dMMR) in 14 out of 61 and was consistent with Lynch syndrome in 9 out of 14 patients. All of the dMMR tumours were in the duodenum or jejunum and only one was stage IV. Median overall survival (OS) was 36.6 months (95% CI, 26.9–72.2). For all patients, in univariate analysis, stages I–II ( P <0.001), WHO PS 0–1 ( P =0.01) and dMMR phenotype ( P =0.02) were significantly associated with longer OS. In multivariate analysis, disease stage ( P =0.01) and WHO PS 0–1 ( P =0.001) independently predicted longer OS. For stage IV patients, median OS was 20.5 months (95% CI: 14.6; 36.6 months). In multivariate analysis, WHO PS 0–1 ( P =0.0001) and mutated KRAS status ( P =0.02) independently predicted longer OS. Conclusion: This large study suggests that molecular alterations in SBA are closer to those in colorectal cancer (CRC) than those in gastric cancer, with low levels of HER 2 overexpression and high frequencies of KRAS mutations. The seemingly higher frequency of dMMR than in CRC may be explained by the higher frequency of Lynch syndrome in SBA patients. A dMMR phenotype was significantly associated with a non-metastatic tumour ( P =0.02). A trend for a good prognosis and a duodenum or jejunum primary site was associated with dMMR.

AIM:A poor functional outcome is often reported after total mesorectal excision (TME) for rectal cancer, especially when sphincter-saving resection with intersphincteric dissection is performed for low tumours. Anal sphincter rehabilitation is widely proposed for faecal incontinence. Very few studies have reported results to improve anal dysfunction following rectal surgery. This prospective study aimed to assess the benefits of sphincter training after TME in terms of functional outcome and quality of life. METHODS:Anal sphincter training was performed in patients undergoing laparoscopic sphincter-saving TME for rectal cancer. Rehabilitation was performed after ileostomy closure. This group was compared with 24 matched patients. Assessment included one functional and two quality of life questionnaires (SF-36 Health Status and Faecal Incontinence Quality of Life score). RESULTS:From 2007 to 2009, 22 patients underwent laparoscopic TME. The median follow-up after stoma closure was 21.2 (range 8-46) months. The mean stool frequency per day was significantly lower after sphincter training (2.6 in the training group vs 4.0 in the control group, P=0.025). Following rehabilitation, patients complained significantly less about dyschezia (22 vs 63%, P=0.008). Both groups had similar continence (Wexner score 8.3 after training vs 9.9 in controls, NS). Quality of life was significantly improved by sphincter training as measured by the vitality (P=0.004) and mental functioning (P=0.02) subscales on the SF-36 Health Status questionnaire and by the depression and self-perception (P = 0.005) categories of the Faecal Incontinence Quality of Life score. CONCLUSION:This study suggests that anal sphincter training following TME could decrease stool frequency and improve both general and specific quality of life.

ABSTRACT Background Small bowel adenocarcinoma (SBA) is a rare tumor with poor prognosis. Data about molecular biology on SBA carcinogenesis are lacking. Methods We characterised a number of candidate oncogenic pathways and the immunophenotype according to the primary localisation of patients with SBA treated in 11 centers between 1996 and 2008. Tissue microarrays were constructed from tumour samples and DNAs were extracted from formalin fixed paraffin embedded samples. HER2, b catenin, TP53 and mismatch repair (MMR) protein expression were assessed by immunohistochemistry. Overexpression of TP53 was defined as more than 50% of cells with nuclear staining. Abnormal expression of b catenin was defined as a nuclear staining. KRAS mutation was investigated. Patients were enrolled in the study at all stage of the disease. Results Samples from 63 patients were obtained, ampullary tumours were excluded. The median age was 58 years. Tumour stages were I-II n = 19 (30%), III n = 22 (35%), IV n = 20 (32%) and undefined n = 2 (3%). A HER2 surexpression (3+) was observed in 2/51 (3.9%) cases both in ileum. Overexpression of TP53 was observed in 23/53 (43%). Abnormal expression of b catenin was observed in 11/52 (21%) cases. A loss of MMR proteins occurred in 7/55 (13%) cases (3 MLH1, 2 MSH2, 2 MSH6), none was stage IV. A KRAS mutation was observed in 19/48 (40%) cases that involved codon 12 in 13 (68%) cases or G > A transition in 16 (84%). Tumours with KRAS mutation were stage IV in 31% of the cases. Survival analysis will be available at the meeting. Conclusion This large study suggests that molecular phenotype of SBA is close to colon phenotype with low level of HER 2 surexpression and high level of KRAS mutation. Ileum tumours seem to have a different phenotype than proximal tumours. Duodenum n = 32 (51%) Jejunum n = 18 (28%) Ileum n = 13 (21%) Stage IV n = 20 9 (45%) 6 (30%) 5 (25%) HER2 surexpression n = 2 0 (0%) 0 (0%) 2 (100%) TP53 overexpression n = 23 12 (52%) 6 (26%) 5 (22%) Abnormal b catenin n = 11 4 (36%) 2 (18%) 5 (45%) Abnormal MMR n = 7 3 (43%) 4 (57%) 0 (0%) KRAS mutation n = 19 11 (58%) 6 (32%) 2 (10%) Disclosure All authors have declared no conflicts of interest.