Elective subtotal colectomy with ileosigmoid anastomosis for colon cancer preserves bowel function and quality of life.

AIM: We report on our experience of elective subtotal colectomy and ileosigmoid anastomosis for colon cancer with focus on postoperative results, function and quality of life. METHOD: Between 1998 and 2011, 106 consecutive patients with colonic malignancy underwent this procedure electively. Function and quality of life (EORTC QLQ-C30) were evaluated retrospectively with questionnaires sent to all patients free of recurrence. RESULTS: There were 62 men and 44 women (mean age 63 years). Postoperative mortality and morbidity rates were 1.9 and 26.4%, respectively. Persistent ileus was the main early complication (16%). After a mean follow-up of 67 ± 36 months, 50 (78.1) out of 64 patients have been evaluated for function and quality of life. The mean number of bowel movements per 24 h was 3 ± 2 and significantly lower when the length of the remaining sigmoid colon was more than 15 cm (P = 0.049). Compared with a European reference population for EORTC QLQ-C30 results, our patients had significantly more diarrhoea (26 vs 3, P = 0.0002) but less pain (10 vs 25, P < 0.0001) and better global quality of life (77 vs 62, P < 0.0001). CONCLUSION: Elective subtotal colectomy for colon cancer is safe and associated with good function and quality of life. Ileosigmoid anastomosis should be discussed when extended colectomy is required, providing the rectosigmoid junction and its vascular supply can be oncologically preserved. For tumours located in the transverse colon or at the splenic flexure, this procedure may be the best surgical option.

[Analysis of asbestos bodies and nude fibres in the lung parenchyma of operated lung cancers. A retrospective monocentric study of 73 cases]. / Analyse de corps asbestosiques et de fibres nues dans le parenchyme pulmonaire de cancers du poumon opérés. Étude monocentrique rétrospective de 73 cas.

We report on a study concerning a retrospective monocentric series of 73 lung cancers operated on between July 2004 and December 2009. All patients had a mineralogical analysis of a sample of lung tissue combined with an occupational questionnaire. This combination enables us to suggest a declaration of occupational exposure in almost one third of cases. We suggest that a healthy parenchymal fragment is to be obtained by biopsy routinely in cases of lung cancer surgery. The analysis should be carried out if the occupational survey does not demonstrate any evident exposure and if the patient is not known to be presenting a pleuropulmonary disease following asbestos exposure (pleural plaques and asbestosis).

[Pulmonary manifestations of hereditary hemorrhagic telangiectasia]. / Manifestations vasculaires pulmonaires de la maladie de Rendu-Osler.

INTRODUCTION: Osler-Weber-Rendu disease (hereditary hemorrhagic telangiectasia) is an autosomal dominant genetic disorder with variable penetrance. It is estimated to affect at least one in ten thousand of the population in France. The diagnosis is clinical and depends on the association of epistaxis, telangiectasia, visceral manifestations of the disease, and familial occurrence. STATE OF THE ART: Pulmonary arterio-venous malformations (AVM) which occur in about 15-30% of patients with this condition represent the main visceral complication of the disease. Infectious and ischaemic neurological manifestations due to paradoxical embolism may occur and may be the presenting feature. The high frequency of neurological complications even in asymptomatic patients justifies systematic screening for pulmonary AVMs, using chest radiography, contrast echocardiography, and/or chest CT. Treatment is based on percutaneous transcatheter coil vaso-occlusion of the feeding artery. CONCLUSION: Pulmonary arterial hypertension is rare. It may be due to systemic arteriovenous shunting in the liver increasing cardiac output, or be similar to idiopathic pulmonary hypertension.

[Pulmonary vascular manifestations in hereditary hemorrhagic telangiectasia]. / Manifestations vasculaires pulmonaires de la maladie de Rendu-Osler.

Hereditary hemorrhagic telangiectasia (Osler-Rendu-Weber disease) is a genetic disorder with autosomal dominance, variable penetrance, and an estimated prevalence of 1/10,000 inhabitants in France. Diagnosis is based on clinical criteria including epistaxis, telangiectasia, visceral manifestations, and familial occurrence. Pulmonary arteriovenous malformations, present in 15-33% of patients, are its primary visceral complications. The disease may be revealed by infectious and ischemic neurological manifestations due to paradoxical embolism. The high frequency of neurologic complications even in asymptomatic patients justifies systematic screening for pulmonary arteriovenous malformations. Treatment of these malformations is based on percutaneous transcatheter coil embolization of the feeding artery. Pulmonary arterial hypertension is rare in this disease. It may be due to systemic arteriovenous shunting in the liver, which increases cardiac output, or be similar to idiopathic pulmonary hypertension.