[What's new in rectal cancer?]

In recent years, multidisciplinary therapeutic management of rectal cancer has evolved. This progress had interest radio and chemotherapy. Aim: To describe the main spots of the progress in the therapeutic strategies of the disease, surgical techniques and standardization of these techniques, particularly regarding locoregional extension in the mesorectum. Literature review. Treatment of rectal cancer is multidisciplinary. On the surgical field, excision of the mesorectum [total mesorectal excision [TME]] has reduced local recurrence and the genitourinary sequelae. Meanwhile, chemoradiotherapy has become important. The standard now is to indicate to T3 T4 N+ tumors to decrease local recurrence without improving survival, however. Advances in the management of rectal cancer with both imaging progress and therapeutic modalities have improved the prognosis and survival of this cancer

[Laparoscopy for perforated duodenal ulcer: conversion and morbidity factors: retrospective study of 290 cases]

Feasibility and advantages of laparoscopic approach in performed duodenal ulcer have no longer to be demonstrated. Laparoscopic suture and peritoneal cleaning expose to a conversion rate between 10 and 23%. However less than laparotomy, morbidity of this approach is not absent. This study aim to analyze factors exposing to conversion after laparoscopic approach of perforred duodenal ulcer. We also aim to define the morbidity of this approach and predictive factors of this morbidity. Retrospective descriptive study was conducted referring all cases of perforated duodenal ulcer treated laparoscopically over a period of ten years, running from January 2000 to December 2010. All patients were operated by laparoscopy with or without conversion. We have noted conversion factors. A statistical analysis with logistic regression was performed whenever we have sought to identify independent risk factors for conversion verified as statistically significant in univariante. The significance level was set at 5%. Analytic univariant and multivariant study was performed to analyze morbidity factors. 290 patients were included. The median age was 34ans.T he intervention was conducted completely laparoscopically in 91.4% of cases. The conversion rate was 8.6%. It was selected as a risk factor for conversion: age> 32 years, a known ulcer, progressive pain, renal function failure, a difficult peritoneal lavage and having a chronic ulcer. Postoperative morbidity was 5.1%. Three independent risk factors of surgical complications were selected: renal failure, age> 45 years, and a chronic ulcer appearance. Laparoscopic treatment of perforred duodenal ulcer expose to a conversion risk. Morbidity is certainly less than laparotomy and a better Knowledge of predictif's morbidity factors become necessary for a better management of this disease