Minimally invasive approaches to rectal cancer and diverticulitis: Does less mean more?
Menés respectivement sur 402 et 486 patients atteints d'un cancer rectal, ces deux essais comparent l'efficacité d'une résection laparoscopique et d'une intervention chirurgicale par voie ouverte
The high local recurrence rates customarily accepted after curative resection of rectal cancer were challenged when an association between the circumferential resection margin (CRM) and local recurrence was recognized. In the current era, careful sharp dissection within the anatomical planes leads to excision of an intact mesorectum with uninvolved margins and local recurrence rates as low as 5%.3 Similarly, recent evidence refutes historical dogma that maintained 2 episodes of uncomplicated diverticulitis warranted an elective operation, and peritonitis secondary to complicated disease requires a Hartmann procedure (ie, resection of perforated sigmoid colon, closure of distal bowel, and creation of colostomy). Surgeons now commonly counsel against an elective colectomy for recurrent uncomplicated diverticulitis and often perform urgent resection with diverted anastomosis for complicated disease with peritonitis.4 Just as knowledge has evolved, so has technology. More than half of elective operations performed for colorectal cancer at National Comprehensive Cancer Network centers from 20105 and for diverticulitis in the Nationwide Inpatient Sample database from 20096 were minimally invasive in their approach.
JAMA , éditorial, 2014