Résumé
Il est habituellement admis qu’un certain mode de surveillance post-opératoire doit être programmé après résection colique, en principe curative, pour cancer. L’endoscopie est d’habitude considérée comme l’élément primordial de ce programme de surveillance.
Nous avons suivi pendant cinq ans 178 patients ayant subi une chirurgie colique pour cancer. Les critères d’inclusion furent un âge situé entre 40 et 75 ans ; une résection tumorale en principe curative ; et l’exécution d’une coloscopie totale dans la période périopératoire. Une pancoloscopie a été effectuée respectivement 6 et 12 mois après l’intervention chirurgicale et ensuite avec des intervalles d’un an.
En tout 623 examens endoscopiques ont été réalisés (3,5 par patient) et la pancoloscopie fut réalisable 602 fois (96,6 %).
Les lésions néoplasiques détectées pendant la période de surveillance furent : huit cancers synchrones (4,5 %) : tous les patients ont subi une autre cure chirurgicale radicale ; 15 récidives anastomotiques (8,4 %) : six sur dix étaient asymptomatiques et furent soumis à une nouvelle résection contre une seule chez les cinq patients symptomatiques ; 77 polypes néoplasiques (chez 39 patients) : tous réséqués par voie endoscopique ; un cancer métachrone Dukes’A (42 mois après intervention chirurgicale) : traité par résection.
En fin d’étude, 44 patients (30,3 %) ont été perdus de vue et 84 (47,2 %) étaient encore en vie.
Nos observations appuient les conclusions suivantes : 1) les récidives locales ont fréquemment un mauvais pronostic ; la seule chance de traitement consiste en un diagnostic précoce à un stade asymptomatique ; 2) la prévention par exérèse des lésions précancéreuses est la meilleure approche du cancer métachrone ; 3) les lésions pré-malignes, c’est-à-dire les adénomes, continuent à se développer, indépendamment du temps écoulé depuis l’intervention chirurgicale ; 4) la compliance des patients vis-à-vis du protocole de surveillance constitue un facteur qui influence gravement la valeur clinique et pronostique d’un tel schéma de prise en charge.
Summary
It is generally agreed that some form of post-operative surveillance must be programmed after potentially curative colonic resection for cancer. Endoscopy is commonly thought to be an essential part of any follow-up program.
A five year follow-up was carried out on 178 patients who had undergone colonie surgery for cancer. Inclusion criteria were age ranging between to 40 and 75 years ; potentially curative tumour resection ; perioperative total colonoscopy. A total colonoscopy was done 6 and 12 months after surgery and then at yearly intervals.
Overall 623 endoscopic examinations were performed (3.5 per patient) pancolonoscopy was possible 602 times (96.6 %).
Neoplastic lesions detected during follow-up were : eight synchronous cancers (4.5 %) : all patients had another radical operation ; 15 anastomotic recurrences (8.4 %) : six out of ten asymptomatic could be submitted to re-resection in contrast with one out of five symptomatic ; 77 neoplastic polyps (in 39 patients) : all removed endoscopically ; one Dukes’A metachronous cancer (42 months after surgery) : resected for cure.
At the end of the study 44 patients (30.3 %) were lost at follow-up and 84 (47.2 %) were still alive.
Our findings support the following conclusions : 1) local recurrences frequently have a poor outcome ; the only chance of cure may be related to early diagnosis at an asymptomatic stage ; 2) prevention by eradicating the precursors is the best approach toward metachronous cancer ; 3) new premalignant lesions, i.e. adenomas, continue to develop, irrespective of time elapsed from surgery ; 4) patients compliance to the protocol constitutes a factor that heavily influences the clinical and prognostic value of any follow-up program.
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Russo, A., Giannone, G., Magnano, A. et al. Surveillance endoscopique après résection curative pour cancer colo-rectal. Résultats d’une étude prospective sur 5 ans. Acta Endosc 17, 145–155 (1987). https://doi.org/10.1007/BF02968600
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DOI: https://doi.org/10.1007/BF02968600