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Master Thesis

Cancers de bas rectum localement avancés : comment changer le type de chirurgie après traitement neoadjuvant ?

Abstract : Purpose: The surgical approach for low rectal cancer can be standardized using a low rectal classification. We aimed to demonstrate that by using this standardized approach we can perform more sphincter-sparing surgery following radiochemotherapy. Patients and methods: Low rectal cancers were classified by magnetic resonance imaging into 4 types dedicated to 4 distinct surgical procedures: type I supra-anal (> 1 cm from the anal sphincter) had low anterior resection (LAR), type II juxta-anal (< 1 cm) had partial intersphincteric resection (pISR), type III intra-anal (internal sphincter invasion) had total intersphincteric resection (tISR) and type IV trans-anal (external sphincter or levator ani invasion) had abdominoperineal resection (APR). Tumors were reclassified after radiochemotherapy with a second magnetic resonance imaging, which determined surgery. Results: Fifty patients had a low rectal cancer treated by radiochemotherapy. Tumors were classified type I/II/III/IV in 0/1/7/42 patients before treatment vs. 10/27/6/7 after treatment; resulting in a 86% (43/50) migration in staging. This correlated well with the 90% (45/50) of migration of surgical procedure, including 8 LAR, 29 pISR, 8 tISR and 5 APR. After a median follow-up of 30 months, the rate of local recurrence was 6% and the 5-year survival was 78%. The continence was good or acceptable in 76% of the patients. Conclusions: By using a new surgical classification of low rectal cancer and reclassification after treatment, we demonstrated that radiochemotherapy can modify type of low rectal cancer and therefore surgery, avoiding abdominoperineal resection in 90% of patients with low rectal cancer without compromising oncologic outcome.
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Master Thesis
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Contributor : Bu Carreire Université de Bordeaux <>
Submitted on : Monday, December 8, 2014 - 9:19:20 AM
Last modification on : Wednesday, August 23, 2017 - 4:41:04 PM
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  • HAL Id : dumas-01091958, version 1



Bertrand Célérier. Cancers de bas rectum localement avancés : comment changer le type de chirurgie après traitement neoadjuvant ?. Médecine humaine et pathologie. 2014. ⟨dumas-01091958⟩



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