Résumé
L’exérèse rectale avec exérèse du mésorectum est le traitement de référence du cancer du rectum. Si l’exérèse locale constitue une alternative séduisante avec des résultats opératoires excellents sans risque de séquelles fonctionnelles digestives, elle fait l’impasse pourtant sur un éventuel envahissement ganglionnaire. Ainsi, il faut impérativement rechercher sur la pièce opératoire les critères histopronostiques défavorables (c’est-à-dire corrélés à un risque élevé de métastase ganglionnaire): infiltration profonde de la sous muqueuse (T1sm3), marges de résection envahies, emboles vasculaires et/ou lymphatiques. Une proctectomie complémentaire doit être proposée en cas de présence d’au moins un ou plusieurs critères défavorables. La microchirurgie endoscopique (TEM) permet l’exérèse locale de tumeurs du moyen et haut rectum, inaccessibles par voie transanale conventionnelle avec une meilleure qualité d’exérèse chirurgicale.
Abstract
Rectal resection with mesorectum excision is the standard operation for rectal tumors. Local surgery is an alternative with excellent operative results and no risk of functional troubles but with no lymph nodes staging. Then, unfavorable pathologic criteria must be assessed on local rectal specimen: depth of submucosal invasion (T1sm3), positive resection margins, vascular and/or lymphatic invasion. Further radical surgery is required in case of unfavorable criteria. Transanal endoscopic microsurgery (TEM) allows locally complete excision of rectal tumors with high surgical excision quality (R0 resection), especially for mid and upper lesions, which are inaccessible by conventional local surgery.
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Bretagnol, F. Quelles sont les bonnes indications d’exérèse locale des petits cancers du rectum ?. Colon Rectum 6, 114–117 (2012). https://doi.org/10.1007/s11725-012-0378-x
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DOI: https://doi.org/10.1007/s11725-012-0378-x