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Master Thesis

Impact de la conversion sur la morbi-mortalité et sur les résultats oncologiques des patients opérés d'une proctectomie carcinologique : expérience sur 214 patients au CHU de Caen

Abstract : The role of laparoscopy is controversial in the management of rectal cancer with conversion rates of up to 30% depending series. The aims of our work was to evaluate the impact of conversion, delay and cause on postoperative morbimortality and oncologic results. A meta-analysis on the impact of coelioconversion was realized, and secondly a analysis on our series. Patients undergoing laparoscopic proctectomy between February 2001 and Decembre 2016 at the CHU of Caen were included and divised into 2 groups: LAP (non converted) and CONV (converted). The CONV group was divided according to the conversion timpe to CP (early conversion) and CT (late conversion) and according to the cause in RC (reactive conversion) and PC (preemptive conversion). 12 studies (6050 patients) were included in the meta-analysis: anastomotic fistula rate (OR= 0.38, IC95%= 0.170.81, p=0.01), scar abscess (OR=0.41, IC95%=0.29-0.57, p<0.00001), overall morbidity (OR=0.55, IC95%= 0.470.64, p<0.00001) was significantly reduced in laparoscopy. In our series, 214 patients were included, including 57 converted patients (26.6%). The rate of complete resection, local and general recurrence did not differ significantly among groups. Overall survival was significantly better in the LAP group. CT increased the mean operative time (260 vs 195 min, p= 0.0007) and the rate of surgical site infection compared with CP (32.1% vs 10.3%, p=0.04). CP mitigates the impact of conversion.
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https://dumas.ccsd.cnrs.fr/dumas-02310898
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Submitted on : Thursday, October 10, 2019 - 3:09:21 PM
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Morgane Finochi. Impact de la conversion sur la morbi-mortalité et sur les résultats oncologiques des patients opérés d'une proctectomie carcinologique : expérience sur 214 patients au CHU de Caen. Médecine humaine et pathologie. 2019. ⟨dumas-02310898⟩

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