Influence of social deprivation and remoteness on the likelihood of sphincter amputation for rectal cancer: a high-resolution population-based study.

BACKGROUND: Medical care in rectal cancer is subject to social inequality. According to the last French guidelines, a 1-cm distal margin below the lower pole of the rectal tumor is now considered sufficient. This extends the limits of the current sphincter preservation gold standard. Like for other innovative technics, the dissemination of such technics is often subject to social and geographical inequalities. The objective was to analyze whether sphincter preservation in rectal cancer is subject to social or geographical inequality. METHODS: The odds of sphincter preservation was modeled by logistic regression among the 1453 patients in the Calvados digestive cancer registry between 1 January 1997 and 31 December 2015 by examining some of the variables that could influence it: social inequalities and geographical remoteness, sex, age, and stage. RESULTS: A total of 69.4% of the population received sphincter preservation. Patients in the more deprived quintiles had a significantly higher probability of having sphincter amputation (odds ratio (OR) = 1.469 (1.046-2.064)). This result was no longer significant after adjustment on stage and travel time. There was a dose-effect pattern of geographical remoteness on likelihood of sphincter preservation with a progressive increase in OR between patients living the nearest and the furthest from the reference center (p-trend = 0.0178). CONCLUSION: This study shows that the probability of receiving sphincter preservation is influenced by the social environment and strongly influenced by remoteness. Although management guidelines have had a huge impact on the rates of sphincter preservation, they have not reduced the influence of the social and geographical environment on sphincter preservation.

[Experience of the single scrotal approach for recurrent undescended testis after primary orchiopexy or inguinal surgery]. / Expérience de l'abord scrotal unique dans les abaissements testiculaires après chirurgie inguinale ou échec d'orchidopexie préalable.

OBJECTIVE: To report our experience of the unique scrotal incision for the redo cases of orchiopexy after previous inguinal surgery or orchiopexy for undescended testis with a special attention regarding the place of the single scrotal approach. PATIENTS AND METHODS: Thirty-six patients operated between January 2003 and September 2015 in our surgical unit for secondary orchiopexy after previous inguinal surgery or orchiopexy for undescended testis (UDT) were included in a retrospective study. The secondary surgical procedure was initiated by a scrotal incision (Bianchi). In cases of difficulty by the scrotal incision an inguinal approach by the prior skin inguinal incision was performed. Patients were divided in two groups a group 1 of 10 patients with reascending testis following inguinal hernia repair and a group 2 of 26 patients with reascending testis after previous orchiopexy for UDT. A good result was defined as testis in scrotal position without evidence of atrophy. RESULTS: All the patients of group 1 were treated by a unique scrotal incision. In group 2, seven patients required a complementary inguinal approach. One hematoma complicated a scrotal procedure leading to a testicular atrophy. A good result was achieved in 35/36 patients (97%). CONCLUSION: Single scrotal incision is an efficient and easy way to perform secondary orchiopexy after hernia repair. After surgery for UDT, as for primary cases, it cannot be an exclusive approach, higher testis need a combined or an inguinal approach. LEVEL OF EVIDENCE: 5.