C. Boutanos, . Md, C. *. Maylis-capdepont, M. Svrcek, F. Md° et al.,

N. Md-§, . Guedj, F. Md**, . Poizat, F. Md°° et al.,

*. Chu-bordeaux, Service de Pathologie, Place Amélie Raba-Léon, 33076 Bordeaux cedex, France ; °CHU Saint-Antoine APHP

A. , , p.75012

F. Lille,

*. Beaujon, A. , and S. De-pathologie, , vol.100

G. Leclerc, . Clichy, ;. France, and . Paoli-calmettes,

§. ,

S. Montpellier and . De-pathologie, 208 Avenue des Apothicaires, p.34298

*. Aquitaine, , p.33185

L. Haillan, ;. France, L. °°°chu-de, and . Salpêtrière, , pp.47-83

?. Oncopole, Service de Pathologie, 1 Avenue Irène Joliot-Curie, p.64100, 31100.

§. Chu-rouen, Service de Pathologie

. Bergonié, Service de Pathologie, 229 Cours de l'Argonne, p.33000

*. Chu,

S. Grenoble, ;. De-pathologie, . Grenoble, ;. France, and A. Chu-ambroise-paré, , pp.217-38043

. *-#-laboratoire-d'anatomie, ;. De-cytologie-pathologiques, . §#, and . Pau, , vol.43, p.64000

F. Pau,

°. Caen, , p.33110

°. Chu-kremlin-bicêtre, , p.94270

L. Kremlin, , p.66

F. Bicêtre and . Libourne, , p.33500

F. Libourne,

?. Périgueux, , p.24000

F. Périgueux and . Corresponding,

A. Rullier and C. Pellegrin, , vol.33000

, Email : anne.rullier@chu-bordeaux.fr Sources of support: none Disclosure of funding: none Conflicts of Interest: none Key words: Rectal cancer -pathology report -quality report -neoadjuvant the information was given. A template was used as a pathology report in 59% (579/983) of the cases

, Characteristics of rectal tumors, overall and according to treatment

, Overall, the median number of lymph nodes retrieved in rectal specimen was 15 (IQR 11-21) and the rate of centers having ? 12 LN was 81% (18/22) (Fig 1). The rate of VI, 21% of the cases

, The extramural location was noted in 71% (207/292) of cases. In 5% (45/983) of cases, complementary analysis using immunohistochemistry (43/45) or orcein stain (2/45) were performed to highlight vascular invasion. The CRM was analyzed in 87% of the cases and was negative in 87% of the cases (Table 1). The mesorectum was analyzed in 66% cases and was complete or almost complete in 61% of cases. In the group with neoadjuvant treatment, TRG was specified in 66% (404/617) of cases. The main classifications used were Dworak, When VI was detected, the type of structure involved (lymphatic or vein) was mentioned in 27% (78/292), p.15

R. S. Swanson, C. C. Compton, and A. K. Stewart, The Prognosis of T3N0 Colon Cancer Is Dependent on the Number of Lymph Nodes Examined, Ann. Surg. Oncol, vol.10, pp.65-71, 2003.

E. Morris, N. J. Maughan, and D. Forman, Identifying Stage III Colorectal Cancer Patients: The Influence of the Patient, Surgeon, and Pathologist, J. Clin. Oncol, vol.25, pp.2573-2579, 2007.

J. D. Brierley, M. K. Gospodarowicz, and C. Wittekinf, TNM Classification of Malignant Tumors, 2017.

M. B. Loughrey, P. Quirke, and N. A. Shepherd, Dataset for colorectal cancer histopathology reports, 2017.

S. Lim, C. S. Yu, and S. J. Jang, Prognostic significance of lymphovascular invasion in sporadic colorectal cancer, Dis. Colon Rectum, vol.53, pp.377-384, 2010.

S. Kakar, C. Shi, M. D. , and M. E. , Protocol for the Examination of Specimens From Patients With Primary Carcinoma of the Colon and Rectum, 2017.

G. Puppa, P. Maisonneuve, and A. Sonzogni, Pathological assessment of pericolonic tumor deposits in advanced colonic carcinoma: relevance to prognosis and tumor staging, Mod. Pathol, vol.20, p.843, 2007.

N. A. Shepherd, K. J. Baxter, and S. B. Love, The prognostic importance of peritoneal involvement in colonic cancer: a prospective evaluation, Gastroenterology, vol.112, pp.1096-1102, 1997.

J. H. Lefevre, L. Mineur, and S. Kotti, Effect of Interval (7 or 11 weeks) Between Neoadjuvant Radiochemotherapy and Surgery on Complete Pathologic Response in Rectal Cancer: A Multicenter, Randomized, Controlled Trial (GRECCAR-6), J. Clin. Oncol, vol.34, pp.3773-3780, 2016.
URL : https://hal.archives-ouvertes.fr/hal-01903754

I. D. Nagtegaal, C. Van-de-velde, and E. Van-der-worp, Macroscopic Evaluation of Rectal Cancer Resection Specimen: Clinical Significance of the Pathologist in Quality Control, J. Clin. Oncol, vol.20, pp.1729-1734, 2002.

L. Sobin, M. Gospodarowicz, and C. Wittekind, TNM Classification of Malignant Tumours, 2009.

, Mise à jour 2011 des comptes-rendus d'anatomopathologie: données minimales à renseigner pour une tumeur primitive. Traitements, soins et innovations, 2011.

M. B. Loughrey, P. Quirke, and N. A. Shepherd, Dataset for colorectal cancer histopathology reports, 2014.

O. Dworak, L. Keilholz, and A. Hoffmann, Pathological features of rectal cancer after preoperative radiochemotherapy, Int. J. Colorectal Dis, vol.12, pp.19-23, 1997.

C. Rödel, P. Martus, and T. Papadoupolos, Prognostic Significance of Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer, J. Clin. Oncol, vol.23, pp.8688-8696, 2005.

B. Glimelius, E. Tiret, and A. Cervantes, Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up, Ann. Oncol, vol.24, pp.81-88, 2013.

P. Quirke, Training and quality assurance for rectal cancer: 20 years of data is enough, Lancet, vol.4, pp.695-702, 2003.

Q. Li, L. Liang, and L. Gan, Effect of Lymph Node Count on Pathological Stage III Rectal Cancer with Preoperative Radiotherapy, Ann. Surg. Oncol, vol.5, pp.386-395, 2011.

R. Mechera, T. Schuster, and R. Rosenberg, Lymph node yield after rectal resection in patients treated with neoadjuvant radiation for rectal cancer: A systematic review and metaanalysis, Eur. J. Cancer, vol.72, pp.84-94, 2017.

A. Rullier, C. Laurent, and M. Capdepont, Lymph nodes after preoperative chemoradiotherapy for rectal carcinoma: number, status, and impact on survival, Am J Surg Pathol, vol.32, pp.45-50, 2008.

A. H. Scheel, R. A. Reineke, and T. Sprenger, Comprehensive lymph node morphometry in rectal cancer using acetone compression, J. Clin. Pathol, vol.68, pp.458-464, 2015.

C. F. Lindboe, Lymph node harvest in colorectal adenocarcinoma specimens: the impact of improved fixation and examination procedures: LYMPH NODE HARVEST IN COLORECTAL CANCER, APMIS, vol.119, pp.347-355, 2011.

D. E. Messenger, D. K. Driman, and R. Kirsch, Developments in the assessment of venous invasion in colorectal cancer: implications for future practice and patient outcome, Hum. Pathol, vol.43, pp.965-973, 2012.

S. Yu, D. Tait, and I. Chau, MRI Predictive Factors for Tumor Response in Rectal Cancer Following Neoadjuvant Chemoradiation Therapy -Implications for Induction Chemotherapy?, Int. J. Radiat. Oncol, vol.87, pp.505-511, 2013.

I. D. Nagtegaal and P. Quirke, What Is the Role for the Circumferential Margin in the Modern Treatment of Rectal Cancer?, J. Clin. Oncol, vol.26, pp.303-312, 2008.

A. Rullier, S. Gourgou-bourgade, and M. Jarlier, Predictive factors of positive circumferential resection margin after radiochemotherapy for rectal cancer: The French randomised trial ACCORD12/0405 PRODIGE 2, Eur. J. Cancer, vol.49, pp.82-89, 2013.
URL : https://hal.archives-ouvertes.fr/hal-01797382

J. Faucheron, E. Rullier, P. S. Liang, T. Chen, and E. Giovannucci, Cancer du rectum. Monographies de l'Association Française de Chirurgie. Rapport présenté au 111ème congrès français de chirurgie, International Journal of Cancer, vol.124, issue.10, pp.2406-2421, 2009.

A. G. Renehan, M. Tyson, M. Egger, R. F. Heller, and M. Zwahlen, Body-mass index and incidence of cancer: a systematic review and meta-analysis of prospective observational studies, Lancet, vol.371, p.10, 2008.

P. E. Miller, S. M. Lesko, J. E. Muscat, P. Lazarus, and T. J. Hartman, Dietary Patterns and Colorectal Adenoma and Cancer Risk: A Review of the Epidemiological Evidence, Nutrition and Cancer, vol.62, issue.4, pp.413-437, 2010.

P. Ferrari, M. Jenab, T. Norat, A. Moskal, N. Slimani et al., Lifetime and baseline alcohol intake and risk of colon and rectal cancers in the European prospective investigation into cancer and nutrition (EPIC), International Journal of Cancer, vol.121, issue.9, pp.2065-72, 2007.

R. Fornaro, M. Caratto, E. Caratto, G. Caristo, F. Fornaro et al., Colorectal Cancer in Patients With Inflammatory Bowel Disease: The Need for a Real Surveillance Program, Clinical Colorectal Cancer, vol.15, issue.3, pp.204-216, 2016.

N. N. Andersen and J. T. , Has the risk of colorectal cancer in inflammatory bowel disease decreased ?, World J Gastroenterol, vol.19, issue.43, pp.7561-7569, 2013.

V. Bonadona, B. Bonaïti, E. Yhuel, C. Lasset, and C. Bonaïti-pellié, Estimation des risques tumoraux dans le syndrome de Lynch : résultats de l'étude française ERISCAM. Revue d'Epidémiologie et de Santé Publique 58S, pp.51-98, 2010.

J. H. Lefèvre, Génétique et expression phénotypique des polyposes liées à APC et MUTYH. La Lettre de l'Hépato-gastroentérologue, vol.XVI, p.5, 2013.

F. T. Bosman, F. Carneiro, R. H. Hruban, and T. , WHO Classification of Tumours of the Digestive System, 2010.

D. K. Mcgregor, T. Wu, A. Rashid, R. Luthra, and S. R. Hamilton, Reduced Expression of Cytokeratin 20 in Colorectal Carcinomas With High Levels of Microsatellite Instability, The American Journal of Surgical Pathology, vol.28, issue.6, pp.712-720, 2004.

J. Young, L. A. Simms, K. G. Biden, C. Wynter, V. Whitehall et al., Features of Colorectal Cancers with High-Level Microsatellite Instability Occurring in Familial and Sporadic Settings, The American Journal of Pathology, vol.159, issue.6, pp.2107-2123, 2001.

M. J. Mäkinen, Colorectal serrated adenocarcinoma, Histopathology, vol.50, issue.1, pp.131-50, 2007.

J. Guinney, R. Dienstmann, X. Wang, . Reyniès-a-de, A. Schlicker et al., The consensus molecular subtypes of colorectal cancer, Nature Medicine, vol.21, issue.11, pp.1350-1356, 2015.

C. Bokemeyer, I. Bondarenko, A. Makhson, J. T. Hartmann, J. Aparicio et al.,

L. Fluorouracil and O. , With and Without Cetuximab in the First-Line Treatment of Metastatic Colorectal Cancer, Journal of Clinical Oncology, vol.27, issue.5, pp.663-71, 2009.

J. Douillard, S. Siena, J. Cassidy, J. Tabernero, R. Burkes et al.,

. Randomized, Phase III Trial of Panitumumab With Infusional Fluorouracil, Leucovorin, and Oxaliplatin (FOLFOX4) Versus FOLFOX4 Alone As First-Line Treatment in Patients With Previously Untreated Metastatic Colorectal Cancer: The PRIME Study, Journal of Clinical Oncology, vol.28, issue.31, pp.4697-705, 2010.

M. J. Overman, R. Mcdermott, J. L. Leach, S. Lonardi, H. Lenz et al., Nivolumab in patients with metastatic DNA mismatch repair-deficient or microsatellite instability-high colorectal cancer (CheckMate 142): an open-label, multicentre, phase 2 study, The Lancet Oncology, vol.18, issue.9, pp.1182-91, 2017.

G. Brown, S. Davies, G. T. Williams, M. W. Bourne, R. G. Newcombe et al., Magnetic resonance imaging for the clinical management of rectal cancer patients: recommendations from the 2012 European Society of Gastrointestinal and Abdominal Radiology (ESGAR) consensus meeting, European Society of Gastrointestinal and Abdominal Radiology, vol.91, issue.1, pp.1465-75, 2004.

J. H. Lefevre, P. Afchain, J. Cazejust, R. Coriat, F. Huguet et al., Recommandations pour la pratique clinique Cancer du rectum: Question 1 Comment choisir les thérapeutiques néo-adjuvantes ?, Côlon & Rectum, vol.10, issue.1, pp.4-11, 2016.

E. Rullier, P. Rouanet, J. Tuech, A. Valverde, B. Lelong et al., Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial, The Lancet, vol.390, pp.469-79, 2017.
URL : https://hal.archives-ouvertes.fr/hal-01682165

V. Bridoux, C. De-chaisemartin, L. Beyer, N. Goasguen, C. Sabbagh et al., Recommandations pour la pratique clinique Cancer du rectum: Question 2 Quels sont les critères de qualité de l'exérèse chirurgicale ?, Côlon & Rectum, vol.10, issue.1, pp.12-27, 2016.

R. J. Heald, A new approach to rectal cancer, Br J Hosp Med, vol.22, issue.3, pp.277-81, 1979.

W. Van-gijn, C. A. Marijnen, I. D. Nagtegaal, E. Kranenbarg, H. Putter et al., Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial, The Lancet Oncology, vol.12, issue.6, pp.575-82, 2011.

R. Sauer, T. Liersch, S. Merkel, R. Fietkau, W. Hohenberger et al., Preoperative Versus Postoperative Chemoradiotherapy for Locally Advanced Rectal Cancer: Results of the German CAO/ARO/AIO-94 Randomized Phase III Trial After a Median Follow-Up of 11 Years, Journal of Clinical Oncology, vol.30, issue.16, pp.1926-1959, 2012.

K. Peeters, C. Marijnen, I. D. Nagtegaal, E. K. Kranenbarg, H. Putter et al., The TME Trial After a Median Follow-up of 6 Years: Increased Local Control But No Survival Benefit in Irradiated Patients With Resectable Rectal Carcinoma, Annals of Surgery, vol.246, issue.5, pp.693-701, 2007.

C. Laurent and E. Rullier, Traitement des cancers du bas rectum, Hépato-gastro, vol.14, p.9, 2007.

A. Wibe, A. Syse, E. Andersen, S. Tretli, H. E. Myrvold et al., Oncological Outcomes After Total Mesorectal Excision for Cure for Cancer of the Lower Rectum: Anterior vs, Abdominoperineal Resection. Diseases of the Colon & Rectum, vol.47, issue.1, pp.48-58, 2004.

N. P. West, P. J. Finan, C. Anderin, J. Lindholm, T. Holm et al., Evidence of the Oncologic Superiority of Cylindrical Abdominoperineal Excision for Low Rectal Cancer, Journal of Clinical Oncology, vol.26, issue.21, pp.3517-3539, 2008.

P. P. Tekkis, A. G. Heriot, J. Smith, M. R. Thompson, P. Finan et al., Comparison of circumferential margin involvement between restorative and nonrestorative resections for rectal cancer, Colorectal Disease, vol.7, issue.4, pp.369-74, 2005.

I. D. Nagtegaal, C. Van-de-velde, C. Marijnen, J. Van-krieken, and P. Quirke, Low Rectal Cancer: A Call for a Change of Approach in Abdominoperineal Resection, Journal of Clinical Oncology, vol.23, issue.36, pp.9257-64, 2005.

M. B. Loughrey, P. Quirke, and N. A. Shepherd, Standards and datasets for reporting cancers

I. D. Nagtegaal, C. Van-de-velde, E. Van-der-worp, E. Kapiteijn, P. Quirke et al., Macroscopic Evaluation of Rectal Cancer Resection Specimen: Clinical Significance of the Pathologist in Quality Control, Dataset for colorectal cancer histopathology reports, vol.34, pp.1729-1763, 2002.

N. P. West, C. Anderin, K. Smith, T. Holm, and P. Quirke, Multicentre experience with extralevator abdominoperineal excision for low rectal cancer, British Journal of Surgery, vol.97, issue.4, pp.588-99, 2010.

B. J. Moran, T. Holm, G. Brannagan, H. Chave, P. Quirke et al., The English National Low Rectal Cancer Development Programme: key messages and future perspectives, Colorectal Disease, vol.16, issue.3, pp.173-181, 2014.

H. Ueno, H. Mochizuki, Y. Hashiguchi, H. Shimazaki, A. S. Hase et al., Risk factors for an adverse outcome in early invasive colorectal carcinoma, Gastroenterology, vol.127, issue.2, pp.385-94, 2004.

, The Paris endoscopic classification of superficial neoplastic lesions: esophagus, stomach, and colon, Participants in the Paris Workshop, vol.58, pp.3-43, 2003.

R. C. Haggitt, R. E. Glotzbach, E. E. Soffer, and L. D. Wruble, Prognostic factors in colorectal carcinomas arising in adenomas: Implications for lesions removed by endoscopic polypectomy, Gastroenterology, vol.89, issue.2, pp.328-364, 1985.

L. M. Wang, R. Guy, E. Fryer, C. Kartsonaki, P. Gill et al., The Ueno method for substaging pT1 colorectal adenocarcinoma by depth and width measurement: an interobserver study, Colorectal Disease, vol.17, issue.8, pp.674-81, 2015.

R. Ryan, D. Gibbons, J. Hyland, D. Treanor, A. White et al., Pathological response following long-course neoadjuvant chemoradiotherapy for locally advanced rectal cancer, Histopathology, vol.47, issue.2, pp.141-147, 2005.

I. C. Talbot, S. Ritchie, M. Leighton, A. O. Hughes, H. Bussey et al., Invasion of veins by carcinoma of rectum: method of detection, histological features and significance, Histopathology, vol.5, issue.2, pp.141-63, 1981.

, Molecular testing strategies for Lynch syndrome in people with colorectal cancer | Guidance and guidelines | NICE 2017

J. D. Brierley, M. K. Gospodarowicz, and C. Wittekind, TNM Classification of Malignant Tumors, 2017.

L. Sobin, M. Gospodarowicz, and C. Wittekind, TNM Classification of Malignant Tumours, p.90, 2009.

. Serment-d'hippocrate,

, Au moment d'être admise à exercer la médecine, je promets et je jure d'être fidèle aux lois de l'honneur et de la probité

, Mon premier souci sera de rétablir, de préserver ou de promouvoir la santé dans tous ses éléments, physiques et mentaux

, Je respecterai toutes les personnes, leur autonomie et leur volonté, sans aucune discrimination selon leur état ou leurs convictions. J'interviendrai pour les protéger si elles sont affaiblies, vulnérables ou menacées dans leur intégrité ou leur dignité. Même sous la contrainte

, Je ne tromperai jamais leur confiance et n'exploiterai pas le pouvoir hérité des circonstances pour forcer les consciences

, Je donnerai mes soins à l'indigent et à quiconque me les demandera. Je ne me laisserai pas influencer par la soif du gain ou la recherche de la gloire

, Admise dans l'intimité des personnes, je tairai les secrets qui me seront confiés. Reçue à l'intérieur des maisons, je respecterai les secrets des foyers et ma conduite ne servira pas à corrompre les moeurs

, Je ferai tout pour soulager les souffrances. Je ne prolongerai pas abusivement les agonies. Je ne provoquerai jamais la mort délibérément

, Je n'entreprendrai rien qui dépasse mes compétences. Je les entretiendrai et les perfectionnerai pour assurer au mieux les services qui me seront demandés

, J'apporterai mon aide à mes confrères ainsi qu'à leurs familles dans l'adversité

, Que les hommes et mes confrères m'accordent leur estime si je suis fidèle à mes promesses

, que je sois déshonorée et méprisée si j'y manque