Patient management after primary rectal cancer diagnosis. Special focus on surgical treatment for non-metastatic disease.

Background: Rectal cancer is a public health priority. Primary objectives of this study were to evaluate the quality of care for non-metastatic rectal cancer using process and outcome indicators. Delay of management, length of stay and readmission rate, sphincter preservation, morbidity, number of examined lymph nodes, mortality, overall and disease-free survivals were evaluated. Secondary objectives were to estimate the relationship between possible predictive parameters for (1) anastomotic leakage (logistic regression), (2) overall or disease-free survivals (cox regression).Methods: We performed a retrospective study on 312 consecutive patients diagnosed with primary rectal cancer between 2016 and 2019. We focused on the 163 patients treated by surgery for non-metastatic cancer.Results: The treatment began within 33 days (range 0-264) after incidence, resection rate was 67%. Digestive continuity rate in lower, middle and upper rectum was 30%, 87% and 96%. Median of 14 lymph nodes (range 1-46) was analyzed. Length of stay and readmission rate were 11 days (range 3-56) and 4%, respectively. Within 90 postoperative days, clinical anastomotic leakage occurred in 9.2% of cases, major morbidity rate was 17%, mortality 1.2%. Multivariate analysis revealed that stoma decreased the risk of anastomotic leakage [hazard ratio: 0.16; 95% confidence intervals: 0.04-0.63; p = 0.008]. The 5-year overall survival after surgery was 85 ± 4%, disease-free survival 83 ± 4%. Patients with major complications, male gender and R1/R2 resection margin had a poorer prognosis.Conclusion: This work showed encouraging results in rectal cancer treatment in our institution, our results were in line with recommendations at the time.

[Cholelithiasis and cholecystectomy in infants]. / Lithiases vésiculaires et cholécystectomie chez le nourrisson.

Cholelithiasis is rare in children and even more so in infants. We report the case of a 3-month-old patient with cholestatic jaundice secondary to an obstruction of the terminal portion of the bile duct. The treatment applied in this patient was a cholecystectomy with trans-cystic cholangiography and common bile duct clearance. The evolution was excellent. The current literature on biliary lithiasis in children and infants is poor in large cohort studies. The various treatments proposed, if necessary, include biliary lavage by percutaneous puncture, endoscopic retrograde cholangiopancreatography with sphincterotomy and laparoscopic or open cholecystectomy with intraoperative cholangiography. None of these procedures has shown superiority over the others. Therefore, no treatment algorithm is currently defined. Patients are treated on a case-by-case basis according to their symptoms, previous history and the level of expertise of each centre for these rare, difficult and specific procedures.

La pathologie lithiasique biliaire est rare chez l'enfant et encore plus chez le nourrisson. Nous exposons le cas d'une jeune patiente de 3 mois présentant un ictère cholestatique secondaire à un obstacle de la portion terminale du cholédoque. Le traitement appliqué chez cette patiente a été une cholécystectomie avec cholangiographie trans-cystique et désobstruction du cholédoque. L'évolution a été excellente. La littérature actuelle sur la pathologie lithiasique biliaire de l'enfant et du nourrisson est pauvre en études de grande cohorte. Les différents traitements proposés, si nécessaire, comportent le lavage biliaire par ponction percutanée, la cholangiopancréatographie rétrograde endoscopique avec sphinctérotomie et la cholécystectomie par voie laparoscopique ou ouverte avec cholangiographie peropératoire. Aucune de ces procédures n'a montré de supériorité par rapport aux autres. Aucun algorithme de traitement n'est donc actuellement défini. Les patients sont traités au cas par cas selon leurs symptômes, leurs antécédents et le niveau d'expertise de chaque centre pour ces procédures rares, difficiles et spécifiques.

Angiosarcoma associated with radiation therapy after treatment of breast cancer. Retrospective study on ten years.

PURPOSE: The breast sarcoma induced by radiation therapy is rare but increasing, given the increased long-term survival of patients receiving radiation therapy. Fibrosarcoma, histiocytofibroma and angiosarcoma are the most common breast sarcoma. Angiosarcoma is the most common after breast cancer treated by radiation therapy, often diagnosed too late, with a severe prognosis and a high rate of recurrence. However, because of the low incidence of angiosarcoma associated with radiation therapy (AAR), the benefit of radiation therapy in breast cancer treatment outweighs the risk to develop angiosarcoma. The aim of this study is to evaluate these rare cases of AAR diagnosed in eastern Belgium in comparison to the data from the literature. PATIENTS AND METHODS: Nine cases of AAR after radiation for breast ductal carcinoma were included in this retrospective study. AAR was diagnosed according to Cahan criteria between January 2007 and December 2016. Latency, incidence, management and prognosis are comparable to the literature. RESULTS, CONCLUSION: The median latency was 10 (4-24) years, the incidence of AAR in the East Belgian area was 0.09% of the patients irradiated on the same period. Patients were treated by surgery with wide local excision with or without reconstructive surgery, without radiotherapy and chemotherapy treatment. Kaplan-Meier analysis showed median overall survival of 61.8 months, patient survival of 55.6% at one year and 29.6% at five years. With the constant progress of medicine and its technologies, it would be possible to limit the occurrence of AAR or to diagnose it at an earlier stage.

[Horner's syndrome revealing a spontaneous carotid artery dissection]. / Le cas clinique du mois. Syndrome de Claude Bernard-Horner révélant une dissection carotidienne spontanée.

We report a case of spontaneous carotid artery dissection suspected by the appearance of Horner's syndrome. Under medical treatment, the intramural hematoma resolved within 3 months. The patient had an uneventful recovery, without any residual neurologic deficit. Spontaneous arterial dissection is responsible for a hematoma in the arterial wall without significant trauma. The pathogenesis remains unknown. Predisposing factors seem to exist. The clinical presentation is variable mainly due to local compression of adjacent structures which can precede a transient or permanent neurological deficit. The diagnosis is confirmed by Doppler US, CT angiography or magnetic resonance angiography, the best optional investigations. The treatment mainly consists of stroke prevention by anticoagulation versus antiplatelet therapy. The role of surgery and/or endovascular techniques has not yet been confirmed.

Pancreatic ectopia: a case report.

Pancreas ectopia / Ectopic pancreas (EP) is a rare congenital disease, most typically diagnosed in asymptomatic patients by incidental detection during surgery or at autopsy. It is defined by the presence of pancreatic tissue localized in various places drifting from the foregut or mesentery. It is subject to the same various inflammatory or neoplastic disorders that may affect the orthotopic pancreas, e.g. pancreatitis or pancreatic tumours. Upper GI endosonography is a key examination (tool) in detecting and defining gastroduodenal ectopic pancreas. However its diagnosis remains difficult. The final diagnosis relies on histopathologic analysis of the resected tumor required to confirm the diagnosis. Its treatment is based on patients' condition and symptoms as well as the kind of surgery depending on the location of the ectopic pancreatic tissue.

[Clinical case of the month. Cystic lymphangioma of the mesentery]. / Le cas clinique du mois. Le lymphangiome kystique du mésentère.

Cystic lymphangioma of the mesentery is a benign condition, probably of malformative origin, and frequently appearing in infancy. Its symptomatology can be very polymorphic. Its diagnosis is suspected by ultrasonography and computed tomography, and definitely confirmed by pathology. About a recent case of cystic lymphangioma of the mesentery diagnosed and operated on at the university hospital of Liège in an adult patient, the authors review its classification and its therapeutic strategy. Surgical resection is indicated in symptomatic cystic lymphangioma.

[Giant lipoma on the back]. / Lipome géant dorsal.

Solitary lipoma is the most frequent soft tissue tumor, often appearing between 40 and 60 years of age. It is described as "giant" beyond 1 kg of weight and 10 cm of diameter. Its volume is the source of a good many problems in social life (camouflage, difficulties to dress) and causes multiple health problems such as pain, difficulties to sleep, compressions of nerves or vital structures, infections, etc. The diagnosis is primarily clinical. However, it is necessary to systematically exclude a malignant process. Surgical biopsy is recommended if the diagnosis cannot be asserted by the clinic or an imagery. The therapeutic attitude is abstention in case of small volume without functional impairment. Otherwise, total surgical excision is indicated with pathological analysis. We describe the clinical history of a patient suffering from a giant dorsal lipoma.