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Hépato-Gastro & Oncologie Digestive

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Rectal localization of hereditary colorectal cancer syndromes: what medico-surgical management in daily practice? Volume 23, issue 3, Mars 2016

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Authors
1 Hôpital La Pitié-Salpêtrière,
Université Paris 6, service d’hépato-gastroentérologie et oncologie digestive,
47-83 boulevard de l’Hôpital,
75013 Paris, France
2 Hôpital La Pitié-Salpêtrière,
Université Paris 6, Service de chirurgie digestive,
47-83 boulevard de l’Hôpital,
75013 Paris, France
3 Hôpital La Pitié-Salpêtrière,
Université Paris 6, département d’oncogénétique,
47-83 boulevard de l’Hôpital,
75013 Paris, France
4 Hôpital La Pitié-Salpêtrière,
Réseau PRED-IdF,
47-83 boulevard de l’Hôpital,
75013 Paris, France
* Tirés à part

Rectal localization in hereditary colorectal syndromes raises many relevant questions of management in our daily practice. Medico-surgical decision has to be taken in oncogenetic dedicated multidisciplinary staffs. Regarding Lynch syndrome, in case of colic cancer, a colo-proctectomy with ileo-anal anastomosis is not indicated. In rectum cancer although, patient's age, comorbidities, cancer stage and patient's compliance to future endoscopic procedures have to be taken into account for conservative surgery. Regarding familial adenomatous polyposis, prophylactic surgery is indicated around 20 of age. Surgery has to be sooner in case of symptoms, severe polyposis, large polyps >1 cm, and high grade of dysplasia. Choice of surgical technique, made after loyal information to the patient, between ileo-anal and ileo-rectal anastomosis mainly depends on rectal disease. Endoscopic surveillance with indigo-carmin coloration, whatever the syndrome and surgical technique, is warranted after surgery.