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

The aim of this study was to compare long-term survival after laproscopic completed and laparoscopic converted rectal resection for cancer. All consecutive patients who underwent curative laparoscopic rectal surgery for cancer at our institution between January 2001 and December 2016 were included in a single-center retrospective study. Patients were divided into two groups: the converted (CONV) group and the totally laparoscopic (LAP) group. The primary outcomes were long-term oncologic outcomes including overall survival (OS) and disease-free survival (DFS), as well as local and distant recurrence (LR, DR). The secondary outcomes included postoperative mortality and morbidity as defined as death or any complication occurring within 90 days postoperatively. Of 214 consecutive patients included, 57 were converted to open surgery (CONV group), leading to a 26.6% conversion rate. Mean length of follow-up was 68 ± 42 months in the LAP group and 70 ± 41 months in the CONV group. Five-year OS was significantly shorter in the CONV group compared to the LAP group (p = 0.0016). On multivariate analysis, rectal tumor location (middle and low) and conversion to open surgery were predictors of both OS and DFS. This study suggests that conversion to open surgery after laparoscopic rectal resection appears to significantly reduce OS without having a significant impact on DFS and recurrence rates.

Objective: To evaluate, regarding previous published studies, postoperative outcomes between patients undergoing rectal cancer resection performed by totally laparoscopic approach (LAP) compared to those who underwent peroperative conversion (CONV). Methods: Studies comparing LAP versus CONV for rectal cancer published until December 2017 were selected and submitted to a systematic review and meta-analysis. Articles were searched in Medline and Cochrane Trials Register Database. Meta-analysis was performed with Review Manager 5.0. Results: Twelve prospective and retrospective studies with a total of 4503 patients who underwent fully laparoscopic approach for rectal cancer and a total of 612 patients who underwent conversion were included. Meta-analysis did not show any significant difference on overall mortality between both approaches (OR = 0.47, 95% CI = 0.18-1.22, P=0.12). However, Meta-analysis showed that anastomotic leakage rate, wound abscess rate and postoperative morbidity rate were significantly decreased with totally laparoscopic approach (OR = 0.37, 95% CI = 0.24-0.58, P<0.0001; OR = 0.29, 95% CI = 0.19-0.45, P<0.00001; OR = 0.56, 95% Cl = 0.46-0.67, P<0.00001 respectively). Conclusion: This meta-analysis suggests that conversion increases anastomotic leakage, overall morbidity and wound abscess rates without increasing mortality rate for patients who underwent rectal resection for cancer. (C) 2019 Elsevier Masson SAS. All rights reserved.

Medical care in rectal cancer is subject to social inequality. According to the last French guidelines, a 1-cm distal margin below the lower pole of the rectal tumor is now considered sufficient. This extends the limits of the current sphincter preservation gold standard. Like for other innovative technics, the dissemination of such technics is often subject to social and geographical inequalities. The objective was to analyze whether sphincter preservation in rectal cancer is subject to social or geographical inequality. The odds of sphincter preservation was modeled by logistic regression among the 1453 patients in the Calvados digestive cancer registry between 1 January 1997 and 31 December 2015 by examining some of the variables that could influence it: social inequalities and geographical remoteness, sex, age, and stage. A total of 69.4% of the population received sphincter preservation. Patients in the more deprived quintiles had a significantly higher probability of having sphincter amputation (odds ratio (OR) = 1.469 (1.046–2.064)). This result was no longer significant after adjustment on stage and travel time. There was a dose-effect pattern of geographical remoteness on likelihood of sphincter preservation with a progressive increase in OR between patients living the nearest and the furthest from the reference center (p-trend = 0.0178). This study shows that the probability of receiving sphincter preservation is influenced by the social environment and strongly influenced by remoteness. Although management guidelines have had a huge impact on the rates of sphincter preservation, they have not reduced the influence of the social and geographical environment on sphincter preservation.

Au cours de l’année 2006, ont été diffusées les recommandations pour la pratique clinique (RPC) sous l’égide de la Haute Autorité de Santé, sur la prise en charge du cancer du rectum. Les objectifs de cette étude étaient d’évaluer les conséquences de l’application de ces RPC dans notre pratique multidisciplinaire en termes de choix des thérapeutiques basé sur le bilan d’extension, et des critères de qualité de l’exérèse chirurgicale. Secondairement, nous avons évalué l’impact de ces RPC sur les résultats opératoires et carcinologiques. Tous les patients opérés consécutivement à visée curative d’un cancer du rectum sous péritonéal de 1995 à 2017 du centre hospitalier universitaire de Caen, ont été inclus et divisés, selon la date de diffusion des RPC en deux groupes : avant (Gr1) et après 2006 (Gr2). Étaient colligées dans chaque groupe, les caractéristiques préopératoires du patient et de la tumeur rectale ; les modalités thérapeutiques incluant les données périopératoires, les résultats postopératoires et oncologiques. Six cent quatre patients ont été inclus (Gr1 = 266 et Gr2 = 338). L’application des RPC influençait significativement la réalisation : (i) d’un bilan d’extension exhaustif [ex., imagerie par résonnance magnétique pelvienne (p < 0,0001) et scanner thoraco-abdomino-pelvien (p < 0,0001)] ; (ii) d’une discussion en réunion de concertation pluridisciplinaire (p < 0,0001) et d’un traitement néoadjuvant adapté à la classification préthérapeutique (p < 0,0001). Elle améliorait significativement les critères de qualité de l’exérèse chirurgicale (ex., exérèse extrafasciale du mésorectum (p < 0,0001), le taux de conservation sphinctérienne (p = 0,0005) et le caractère complet R0 de la résection (p < 0,0001). Si la mortalité à 90 jours était comparable, la morbidité globale était significativement augmentée dans G2 (p < 0,0001). Les survies globale (p = 0,0005) et sans récidive (p = 0,0016) étaient significativement prolongées dans le Gr 2, corrélées à la réduction significative des récidives locales et à distance. L’adhésion aux RPC a permis d’améliorer la qualité de la prise en charge multidisciplinaire des patients opérés à visée curative d’un cancer du rectum sous péritonéal. Toutefois, des progrès supplémentaires sont encore nécessaires pour améliorer l’exhaustivité de l’adhésion aux RPC. In 2006 under the supervision of the French health authorities (HAS), recommendations for clinical practice (RCP) in the management of rectal cancers were first published. The primary objective of this study was to assess the impact of these guidelines on multidisciplinary management in terms of therapeutic strategies based on disease staging and quality indicators for surgical excision. Secondarily, we assessed the impact of the RCPs on postoperative and oncological outcomes. All consecutive patients having undergone curative surgical excision for middle and low (subperitoneal)l rectal cancer from 1995 to 2017 in the university hospital of Caen were included in accordance with the relevant French guidelines. They were divided into two groups: before (Gr1) and after (Gr2) 2006. For each group, a chart review was conducted on demographic variables, preoperative rectal tumor features, disease severity variables and quality of surgery variables. Post-operative and oncological outcomes were likewise assessed and compared between the two groups. Six hundred and four patients were included (Gr1, n = 266; Gr2, n = 338). Compliance with French guidelines significantly improved (i) use of magnetic resonance imaging (P < 0.0001) and CT-scan (P < 0.0001)]; (ii) organization of multidisciplinary tumor boards (P < 0.0001) leading to suitable neo-adjuvant treatment plan classification (P < 0.0001). Consequently, compliance improved widespread total mesorectal excision (P < 0.0001), sphincter-sparing surgery (P = 0.0005), and completeness of curative resection in the specimen (P < 0.0001). Although postoperative 90-day mortality was similar, overall postoperative morbidity significantly increased in Gr2 (P < 0.0001). Overall (P = 0.0005) and disease-free survival (P = 0.0016) of patients in Gr2 were significantly prolonged and correlated with a significant reduction in local and distant recurrences. Compliance with the relevant French guidelines improved the quality of multidisciplinary management of patients undergoing curative surgery for subperitoneal rectal cancer. However, further progress is still needed to render accession to the recommendations more comprehensive.

INTRODUCTION:In 2006 under the supervision of the French health authorities (HAS), recommendations for clinical practice (RCP) in the management of rectal cancers were first published. The primary objective of this study was to assess the impact of these guidelines on multidisciplinary management in terms of therapeutic strategies based on disease staging and quality indicators for surgical excision. Secondarily, we assessed the impact of the RCPs on postoperative and oncological outcomes. METHODS:All consecutive patients having undergone curative surgical excision for middle and low (subperitoneal) rectal cancer from 1995 to 2017 in the university hospital of Caen were included in accordance with the relevant French guidelines. They were divided into two groups: before (Gr1) and after (Gr2) 2006. For each group, a chart review was conducted on demographic variables, preoperative rectal tumor features, disease severity variables and quality of surgery variables. Postoperative and oncological outcomes were likewise assessed and compared between the two groups. RESULTS:Six hundred and four patients were included (Gr1, n=266; Gr2, n=338). Compliance with French guidelines significantly improved (i) use of magnetic resonance imaging (P<0.0001) and CT-scan (P<0.0001)]; (ii) organization of multidisciplinary tumor boards (P<0.0001) leading to suitable neo-adjuvant treatment plan classification (P<0.0001). Consequently, compliance improved widespread total mesorectal excision (P<0.0001), sphincter-sparing surgery (P=0,0005), and completeness of curative resection in the specimen (P<0.0001). Although postoperative 90-day mortality was similar, overall postoperative morbidity significantly increased in Gr2 (P<0.0001). Overall (P=0.0005) and disease-free survival (P=0.0016) of patients in Gr2 were significantly prolonged and correlated with a significant reduction in local and distant recurrences. CONCLUSION:Compliance with the relevant French guidelines improved the quality of multidisciplinary management of patients undergoing curative surgery for subperitoneal rectal cancer. However, further progress is still needed to render accession to the recommendations more comprehensive.

Évaluer, à partir des données publiées de la littérature, les résultats postopératoires entre patients opérés d’une proctectomie carcinologique par une approche totalement laparoscopique (LAP) par rapport à ceux qui ont été opérés et ont eu une conversion peropératoire (CONV). Les études comparant la LAP à la CONV pour le cancer du rectum publiées jusqu’en décembre 2017 ont été sélectionnées, soumis à un examen systématique et à une méta-analyse. Les articles ont été recherchés dans Medline et Cochrane Trials Register Database. La méta-analyse a été effectuée avec Review Manager 5.0. Douze études prospectives et rétrospectives, portant sur un total de 4503 patients opérés par une approche entièrement laparoscopique pour le cancer du rectum, et un total de 612 patients qui ont eu une conversion ont été incluses. La méta-analyse n’a révélé aucune différence significative sur la mortalité entre les deux approches (OR 0,47 ; IC à 95 % = 0,18–1,22 ; p = 0,12). Cependant, la méta-analyse a montré que le taux de fistule anastomotique, le taux d’abcès de paroi et le taux de morbidité postopératoire ont été significativement diminués avec l’approche totalement laparoscopique (OR = 0,37 ; IC à 95 % = 0,24–0,58 ; p < 0,0001/OR = 0,29 ; IC à 95 % = 0,19–0,45 ; p < 0,00001/OR = 0,56 ; IC à 95 % = 0,46–0,67 ; p < 0,00001 respectivement). Cette méta-analyse suggère que la conversion augmente le taux de fistules anastomotiques, la morbidité globale et le taux d’abcès de paroi sans augmenter le taux de mortalité chez les patients qui ont subi une proctectomie carcinologique. To evaluate, regarding previous published studies, postoperative outcomes between patients undergoing rectal cancer resection performed by totally laparoscopic approach (LAP) compared to those who underwent per-operative conversion (CONV). Studies comparing LAP versus CONV for rectal cancer published until December 2017 were selected and submitted to a systematic review and meta-analysis. Articles were searched in Medline and Cochrane Trials Register Database. Meta-analysis was performed with Review Manager 5.0. Twelve prospective and retrospective studies with a total of 4503 patients who underwent fully laparoscopic approach for rectal cancer and a total of 612 patients who underwent conversion were included. Meta-analysis did not showed any significant difference on overall mortality between both approaches (OR = 0.47, 95%CI = 0.18–1.22, P = 0.12). However, meta-analysis showed that anastomotic leakage rate, wound abscess rate and postoperative morbidity rate were significantly decreased with totally laparoscopic approach (OR = 0.37, 95%CI = 0.24–0.58, P < 0.0001; OR = 0.29, 95%CI = 0.19–0.45, P < 0.00001; OR = 0.56, 95%CI = 0.46–0.67, P < 0.00001 respectively). This meta-analysis suggests that conversion increases anastomotic leakage, overall morbidity and wound abscess rates without increasing mortality rate for patients who underwent rectal resection for cancer.

Background: Transanal excision (TAE) is increasingly used in the treatment of early rectal cancer because of lower rate of both postoperative complications and postsurgical functional disorders as compared with total mesorectal excision (TME). Objective: To compare in a meta-analysis surgical outcomes and pathologic findings between patients who underwent TAE followed by completion proctectomy with TME (TAE group) for early rectal cancer with unfavorable histology or incomplete resection, and those who underwent primary TME (TME group). Methods: The Medline and Cochrane Trials Register databases were searched for studies comparing short-term outcomes between patients who underwent TAE followed by completion TME versus primary TME. Studies published until December 2016 were included. The meta-analysis was performed using Review Manager 5.0 (Cochrane Collaboration, Oxford, UK). Results: Meta-analysis showed that completion TME after TAE was significantly associated with increased reintervention rate (OR = 4.28; 95% CI, 1.10-16.76; P <= 0.04) and incomplete mesorectal excision rate (OR = 5.74; 95% CI, 2.24-14.75; P <= 0.0003), as compared with primary TME. However there both abdominoperineal amputation and circumferential margin invasion rates were comparable between TAE and TME groups. Conclusions: This meta-analysis suggests that previous TAE impaired significantly surgical outcomes and pathologic findings of completion TME as compared with primary TME. First transanal approach during completion TME might be evaluated in order to decrease technical difficulties. (c) 2018 Published by Elsevier Masson SAS.

Le but de notre étude était d’évaluer l’impact du délai médian de conversion (précoce < 60 min versus tardive > 60 min) sur les résultats opératoires (morbi-mortalité) et carcinologiques (récidive locale, survie). De 2001 à 2016, 213 patients consécutifs ont eu une proctectomie carcinologique laparoscopique. Une conversion a été nécessaire chez 53 patients (25 %) dont 27 précoces et 26 tardives. Les groupes étaient comparables en termes de comorbidités, de hauteur tumorale, de traitement néo-adjuvant et de stomie de protection. Un patient est décédé, converti précocement. La conversion tardive augmentait significativement la durée opératoire (197 ± 55 vs 258 ± 79 p = 0,001), le taux d’infection du site opératoire (1/27 contre 7/26, p = 0,048) et la durée d’hospitalisation (13 ± 5 vs 17 ± 9, p = 0,039). Selon la classification de Dindo–Clavien, la morbidité globale était comparable. Il n’existait pas de différence en termes de marge circonférentielle ni distale. Avec un suivi médian de 50 mois, le délai de conversion n’avait pas d’impact ni sur la survie globale ni sur le risque de récidive locale (1/27 vs 0/26 p = 0,9) et à distance (2/27 vs 4/26 p = 0,63). Notre étude plaide pour une conversion précoce afin de diminuer la durée opératoire et le risque d’infection du site opératoire.

L’exérèse trans-anale (ETA) est de plus en plus utilisée pour le traitement des petits cancers du rectum à cause de son faible taux de complications postopératoires et de séquelles fonctionnelles par rapport à une exérèse totale du mésorectum (ETM). Comparer dans une méta-analyse les résultats chirurgicaux et anatomopathologiques entre les patients ayant eu une ETA suivie d’une proctectomie avec ETM (groupe TAE) pour un petit cancer du rectum ayant nécessité une ETM complémentaire versus ceux ayant eu une proctectomie avec ETM d’emblée (groupe TME). Nous avons réalisé une revue de littérature dans les bases de données MedLine, Cochrane Trial Register qui comparaient les résultats à court terme entre les patients opérés d’une ETA suivie d’une ETM complémentaire contre les ETM primaires. Les études publiées jusqu’à décembre 2016 étaient incluses. La méta-analyse était effectuée grâce au logiciel Review Manager version 5.0 (Cochrane Collaboration, Oxford, Royaume-Uni). La méta-analyse montrait que l’ETM complémentaire après ETA était significativement associée à une augmentation du taux de reprise chirurgicale (OR = 4,28 ; 95 % IC, 1,10–16,76 ; p < 0,04) et du taux d’exérèse incomplète du mésorectum (OR = 5,74 ; 95 % IC, 2,24–14,75 ; p < 0,0003) comparé à l’ETM d’emblée. Toutefois, le taux d’amputation abdomino-périnéale et le taux d’envahissement de la marge circonférentielle étaient comparables entre les groupes TAE et TME. Cette méta-analyse suggère que l’ETA altère significativement les résultats chirurgicaux et les résultats anatomopathologiques sur le caractère complet de l’ETM comparé à l’ETM d’emblée. L’approche trans-anale première durant l’ETM complémentaire devrait être évaluée afin d’en diminuer les difficultés techniques. Transanal excision (TAE) is increasingly used in the treatment of early rectal cancer because of lower rate of both postoperative complications and postsurgical functional disorders as compared with total mesorectal excision (TME). To compare in a meta-analysis surgical outcomes and pathologic findings between patients who underwent TAE followed by completion proctectomy with TME (TAE group) for early rectal cancer with unfavorable histology or incomplete resection, and those who underwent primary TME (TME group). The MedLine and Cochrane Trials Register databases were searched for studies comparing short-term outcomes between patients who underwent TAE followed by completion TME versus primary TME. Studies published until December 2016 were included. The meta-analysis was performed using Review Manager 5.0 (Cochrane Collaboration, Oxford, UK). This meta-analysis showed that completion TME after TAE was significantly associated with increased reintervention rate (OR = 4.28; 95% CI, 1.10–16.76; P < 0.04) and incomplete mesorectal excision rate (OR = 5.74; 95% CI, 2.24–14.75; P < 0.0003), as compared with primary TME. However, both abdominoperineal amputation and circumferential margin invasion rates were comparable between TAE and TME groups. This meta-analysis suggests that previous TAE impaired significantly surgical outcomes and pathologic findings of completion TME as compared with primary TME. First transanal approach during completion TME might be evaluated in order to decrease technical difficulties.