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Background In colon cancer (CC), surgery remains the mainstay of treatment with curative intent. Despite several clinical trials comparing open and laparoscopic approaches, data on long-term outcomes for stage III CC are lacking. Methods This post-hoc analysis of the European PETACC8 randomized phase 3 trial included patients from 340 sites between December 2005 and November 2009, with long follow-up (median 7.56 years). Patients were randomly assigned to FOLFOX or FOLFOX+cetuximab after colonic resection. The surgical approach was left to the referring surgeon's discretion. Results Among 2555 patients included, 1796 (70.29%) were operated on by open surgery and 759 (29.71%) by laparoscopy. The 5-year OS rate was better after laparoscopic resection (85.4%, 95%CI 82.5–87.7) than after open surgery (80.2%, 95%CI 78.2–82.0; p = 0.002). The 5-year DFS rate was also better after laparoscopy (p = 0.016). However, in multivariate analysis using a propensity matching, the surgical approach was not found to be an independent prognostic factor for OS or DFS. OS (p = 0.0243) and DFS (p = 0.035) were increased after laparoscopic surgery in KRAS/BRAF WT sub-group Conclusion We showed that laparoscopic resection has comparable long-term outcomes to open surgery in patients with stage III CC. For those with RAS and BRAF WT CC, laparoscopic colectomy may favorably impact survival.

The Bacillus Calmette-Guerin (BCG) is a life-attenuated form of Mycobacterium bovis widely used as immunotherapy for localized bladder cancer. Adverse reactions to intravesical BCG instillations are rare. We describe a 70-year-old man with a history of an aortobifemoral bypass graft, placement of a synthetic mesh for treatment of a ventral hernia and, most recently, superficial bladder cancer treated with BCG therapy. Ten months after his final intravesical BCG instillation, he complained of fever and asthenia. After 12 months of investigation, he was diagnosed with Mycobacterium bovis infection of his aortobifemoral bypass graft and abdominal mesh, with Streptococcus intermedius superinfection. The bypass graft was excised and replaced with an in situ arterial allograft, the abdominal mesh was removed, and treatment started with amoxicillin, isoniazid, rifampicin and ethambutol. Several additional vascular interventions were needed for allograft degradation, but 12 months after the final procedure, outcome was good. Among 35 cases of mycotic aneurysm reported after BCG therapy in the last 10 years, only one involved a vascular prosthesis. Surgical repair of such aneurysms using prosthetic grafts is commonly performed, associated with anti-mycobacterial treatment. Prognosis is poor with mortality of 14% (4/35) and a 26% rate of aneurysm recurrence under treatment (9/35).

One-anastomosis gastric bypass/mini-gastric bypass (OAGB/MGB) remains controversial because it may cause chronic biliary reflux (BR). The risk of developing esogastric cancer due to BR after OAGB/MGB is based on the results of experimental rat studies using esojejunostomy (EJ). The aim of this study was to analyze the potential long-term consequences of BR on the esogastric mucosae in OAGB/MGB-operated rats and to compare these results to those from the use of EJ. Wistar rats received OAGB/MGB (n = 16), EJ (n = 16), and sham (n = 8) operations. Mortality and weight changes were evaluated throughout the experiment. BR was measured using magnetic resonance imaging (MRI). Rats received follow-ups for 30 weeks. A double-blinded histological analysis was performed in the esogastric segments. BR was diagnosed in OAGB/MGB and EJ rats using the MRI technique; no BR occurred in the sham group. After a 30-week follow-up, no incidences of dysplasia or cancer were observed in the three groups. Additionally, esophageal intestinal metaplasia and mucosal ulcerations were observed in 41.7% and 50% of EJ rats, respectively, and no incidences of these conditions were observed in OAGB/MGB and sham rats. The incidence of esophagitis was significantly higher and more severe in the EJ group compared to those in the OAGB/MGB and sham groups (EJ = 100%, OAGB/MGB = 16.7%, sham = 8.3%; p

People suffering from extreme obesity may be exposed to delayed diagnosis and treatment of cancer. A 37-year-old woman (weight = 245 kg, body mass index (BMI) = 79 kg/m2), presented a sepsis associated with nonspecific abdominal pain for 4 months. After several unsuccessful attempts due to her weight and a large waist circumference, abdominal CT scan was finally successfully performed and showed a large retroperitoneal mass. An ultrasound-guided core needle biopsy was performed and was in favor of a liposarcoma. Surgery was performed to remove the entire tumor of an estimated weight of 98 kg, a giant retroperitoneal dedifferentiated liposarcoma. This case highlights the difficulties to screen, diagnose, and manage cancers encountered in patients suffering from massive obesity.

Background Ampullary adenocarcinoma (AA) originates from either intestinal (INT) or pancreaticobiliary (PB) epithelium. Different prognostic factors of recurrence have been identified in previous studies. Methods In 91 AA patients of the AGEO retrospective multicentre cohort, we evaluated the centrally reviewed morphological classification, panel markers of Ang et al. including CK7, CK20, MUC1, MUC2 and CDX2, the 50-gene panel mutational analysis, and the clinicopathological AGEO prognostic score. Results Forty-three (47%) of the 91 tumours were Ang-INT, 29 (32%) were Ang-PB, 18 (20%) were ambiguous (Ang-AMB) and one could not be classified. Among these 90 tumours, 68.7% of INT tumours were Ang-INT and 78.2% of PB tumours were Ang-PB. MUC5AC expression was detected in 32.5% of the 86 evaluable cases. Among 71 tumours, KRAS, TP53, APC and PIK3CA were the most frequently mutated genes. The KRAS mutation was significantly more frequent in the PB subtype. In multivariate analysis, only AGEO prognostic score and tumour subtype were associated with relapse-free survival. Only AGEO prognostic score was associated with overall survival. Conclusions Mutational analysis and MUC5AC expression provide no additional value in the prognostic evaluation of AA patients. Ang et al. classification and the AGEO prognostic score were confirmed as a strong prognosticator for disease recurrence.

International audience; In the world, among all type of cancers, colorectal cancer (CRC) is the third most commonly diagnosed in males and the second in females. In most of cases, (RP1) patients’ prognosis limitation with malignant tumors can be attributed to delayed diagnosis of the disease. Identification of patients with early-stage disease leads to more effective therapeutic interventions. Therefore, new screening methods and further innovative treatment approaches are mandatory as they may lead to an increase in progression-free and overall survival rates. For the last decade, the interest in extracellular vesicles (EVs) research has exponentially increased as EVs generation appears to be a universal feature of every cell that is strongly involved in many mechanisms of cell-cell communication either in physiological or pathological situations. EVs can cargo biomolecules, such as lipids, proteins, nucleic acids and generate transmission signal through the intercellular transfer of their content. By this mechanism, tumor cells can recruit and modify the adjacent and systemic microenvironment to support further invasion and dissemination. This review intends to cover the most recent literature on the role of EVs production in colorectal normal and cancer tissues. Specific attention is paid to the use of EVs for early CRC diagnosis, follow-up, and prognosis as EVs have come into the spotlight of research as a high potential source of ‘liquid biopsies’. The use of EVs as new targets or nanovectors as drug delivery systems for CRC therapy is also summarized.

People suffering from extreme obesity may be exposed to delayed diagnosis and treatment of cancer. A 37-year-old woman (weight = 245 kg, body mass index (BMI) = 79 kg/m

The most dreadful complication after sleeve gastrectomy (SG) is staple line leak. Its rate varies between 1 and 2%. With the development of interventional endoscopy, its treatment is currently fairly standardized and allows healing in the majority of cases without revisional surgery. However, if endoscopic treatment fails, surgical treatment becomes unavoidable. Fistulojejunostomy is a surgical option in the management of chronic fistula after SG. Laparoscopic fistulojejunostomy in a patient with chronic fistula after SG is difficult but feasible. This procedure allows complete healing and nutritional recovery in the case of failure of other endoscopic modalities.

In some cases, in addition to the usual difficulties that the bariatric surgeon may encounter during standard bariatric procedures, anatomical anomalies such as situs inversus can pose an additional technical challenge. A 58-year-old patient with total situs inversus underwent Roux-en-Y gastric bypass (RYGB) surgery in our department. The main difficulty was the realization of a mirrored RYGB. Laparoscopic RYGB in a patient with situs inversus totalis is feasible but requires significant concentration and three-dimensional coordination to perform the mirrored procedure.

Objective To assess the feasibility of 3D modelisation of fetal anatomy by using the Computer-assisted anatomic dissection (CAAD) based on immunolabeled histologic slices and MRI slices with a specific 3D software. Study design For pelvis and lower limbs, subjects came from legal abortion, medical pregnancy termination, or late miscarriage. Specimens were fixed in 10 % formalin, then embedded in paraffin wax and serially sectioned. The histological slices were stained using HES and Masson Trichrome. Protein S-100 and D2−40 markers were used for immuno-labelling. Serial transverse sections were digitalized and manually aligned. Fetal brain slices were obtained from in utero or post-mortem MRI. Results CAAD was performed on 10 fetuses: pelvis was modelised with 3 fetuses of 13, 15 and 24 W G, lower limbs with 2 fetuses of 14 and 15 W G and brain with 5 fetuses aged between 19 and 37 W G. Fetal pelvis innervation was analysed after immunolabelling and nerves appeared proportionally bigger than in adults with the same topography. Lower limbs analysis revealed that nerve development was guided by vascular development: the sciatic nerve along the big axial vein, the saphen nerve along the big saphen vein and the sural nerve along the small saphen vein. Fetal brain study allowed to describe the gyration process and the lateral ventricle development. Conclusion CAAD technique provides an accurate 3D reconstruction of fetal anatomy for lower limbs and pelvis but has to be improved for brain model since midline structures were not amendable for analysis. These results need to be confirmed with larger series of specimens at different stages of development.

The aim of this study was to determine the threshold values of pelvimetry by scanning and to evaluate the ability of the pelvimetry alone to diagnose a fetal-pelvic disproportion. It was an observational retrospective study on 410 pregnant women who had a scanner pelvimetry for any reasons. Based on the fetal presentations, two subgroups (breech and cephalic -others) have been defined. Measurements of the main obstetric diameters (promonto-retropubic, median transverse and dual sciatica) were taken. The 5th and 10th percentile were calculated as well as the 90th and 95th to determine the threshold values of pelvimetry by scanner. The scanner values found on CT were compared with the standard X ray pelvimetry values. Referring to extreme values obtained by pelvimetry scanner, some pathological pelvic brim were reconstructed in 3D. Moreover, the delivery prognostic was analyzed by crossing the pelvic inlet dimensions (Magnin index) and pelvic outlet dimensions (bi-sciatic diameter) with the outcome of the delivery. The mean values of the scanno-pelvimetry measurement in our series were:m12,39 cm (± 1) for the promonto-retropubic diameter, 12.88 cm (± 1.01) for the transverse median diameter and 11 cm (± 1.32) for the bi-sciatic diameter. These measurements provided an accuracy less than 1 cm compared to the standard ray pelvimetry. Although Magnin index at 23 allows a vaginal delivery, 51% of oursample have failed. Moreover, for the Magnin index at 24 and 25, the vaginal delivery failure rate remains high:45.1% and 39.61% respectively. Compared to classical pelvimetry, pelvimetry by scanner provides additional precision and allows to study the geometry of the basin. However, the pelvimetry alone could not be effective to establish the prognosis of vaginal delivery.Keywords: scanno-pelvimetry, prognosis, delivery

Post-laparoscopic sleeve gastrectomy (LSG) fistula is a major complication, responsible for high morbidity. Endoscopic treatment represents an alternative to surgical management, with variable approaches and success rates. In this study, we aimed to evaluate the efficacy of endoscopic treatment in a tertiary care center. Between March 2010 and March 2015, all patients referred to our center for endoscopic treatment of fistula related to laparoscopic sleeve gastrectomy were included. The primary endpoint was defined as a complete closure of the fistula without recurrence within the 2 months. A total of 26 patients were retrospectively included (73% female). The mean time between fistula diagnosis and first endoscopy was 27.4 days (± 22). Twenty-three (88.4%) patients had a complete fistula closure after endoscopic treatment. The healing delay was 76.4 days (± 42.8), and an average of 3.5 (± 1.4) endoscopic procedures were required. Clinical efficacy was 100% when the endoscopic treatment was performed within the first 3 weeks, or 70% afterwards (p = 0.046). The fistula closure rate was similar between patients with endoscopic drainage (with or without other endoscopic techniques) and patient with closing techniques alone (85.7% vs. 89.5%, respectively). Endoscopic treatment of fistula after LSG is efficient but requires early procedures within the first 3 weeks. Endoscopic strategies involving closing procedure or drainage procedure seem to be similar, but these data must be confirmed in large prospective clinical studies.

Reconstruction of the extensor tendons remains a therapeutic challenge. Tendon transfers and grafts are a potential source of morbidity at the donor site, and the graft stock is limited. In the index finger, the tendon of the extensor indicis proprius can be anastomosed to the tendon of the extensor digitorum, and then the extensor digitorum tendon turned over after being cut at the forearm. We assessed the feasibility of this reconstruction on 12 upper limbs from 6 cadavers and we report the case of a 24-year-old patient who suffered destruction of the extensor apparatus in the index and middle fingers. For the cadaver study, in each case, the tendon could be moved onto the proximal interphalangeal joint, after having done an anastomosis downstream of the extensor retinaculum. The mean graft length was 13cm (9.7-15.2). This method was used in one clinical case with an excellent outcome. This is a simple technique that is without consequences since the tendons used are already cut, therefore saving a tendon graft. This technique should be part of our therapeutic arsenal.

Since the MOSAIC study, oxaliplatin-based adjuvant chemotherapy has been the standard treatment of stage III colon cancer. Combination therapy with fluoropyrimidines and oxaliplatin has improved overall survival (OS) and reduced the risk of recurrence in patients with resected stage III colon cancer. However, only 20% of patients really benefit from adjuvant chemotherapy, exposing 80% of patients to unnecessary toxicity. Recent analyses of large multicenter adjuvant studies have focused on the prognostication of OS and disease-free survival in stage III colon cancer in order to reduce over-treatment and to find more accurate prognostic tools than those used for adjuvant treatment decision-making in stage II disease. Indeed, clinical and pathological prognostic factors, although important, are not sufficient to decide which stage III patients will benefit from adjuvant therapy, and biomarkers will help select patient that need adjuvant treatment. Molecular markers such as microsatellite status and BRAF and KRAS mutations have recently been explored, and molecular signatures have been identified as promising prognostic factor for OS. Furthermore, recent studies have highlighted the prognostic value of immune infiltration. This review focuses on pathologic, immunologic and molecular prognostic markers for stage III colon cancer that could help clinicians tailor adjuvant treatment in a comprehensive transversal approach.

Intraoperative enteroscopy (IOE) to explore obscure gastrointestinal bleeding is now rarely indicated. IOE allows complete small bowel exploration in 57% to 100% of cases, finds a bleeding source in 80% of cases, allows the recurrence-free management of gastrointestinal bleeding in 76% of cases, but carries a high morbidity and mortality. IOE only remains indicated to guide the intraoperative treatment of preoperatively identified small bowel lesions when nonoperative treatments are unavailable and/or when intraoperative localization by external examination is impossible.

Background Surgery appears to be the best treatment option for a chronic fistula after laparoscopic sleeve gastrectomy (LSG). Conservative procedures (conversion into a Roux-en-Y gastric bypass, Roux-limb placement) have proven their feasibility and efficacy, but an open total gastrectomy (TG) is sometimes required in challenging situations. Objectives To assess outcomes from 12 consecutive patients who underwent surgery for a post–sleeve gastrectomy chronic fistula (PSGCF) between January 2004 and February 2012. Setting University public hospital, France. Methods Patients with a PSGCF who underwent surgery were included in this retrospective study. Mortality, morbidity (i.e., Clavien–Dindo score), weight loss, and nutritional status were assessed. Results Twelve of 57 patients (21%) with a post-LSG leak developed a PSGCF. There were 3 men (25%). Mean age was 39±9 years and mean preoperative body mass index was 35±5 kg/m2. All 12 patients underwent an open total gastrectomy with an esojejunostomy (TG). Conservative procedures were considered but not possible. The mean follow-up period was 38±11 months. The mean delay between LSG and TG was 12±6 months. Intraoperative discovery of multiple (>2) gastric fistulas was reported in 9 patients (75%). There were no deaths, but morbidity rate was 50%. Early postoperative fistula occurred in 3 patients (anastomosis n = 1, duodenal stump n = 2). None of these patients required further surgery. The median healing time of the fistula was 37 days (range 24–53). Promising results from weight loss and nutritional status were found at the end of the follow-up. Conclusion A salvage open TG is a well-tolerated and reproducible salvage procedure for cases of a PSGCF, when conservative procedures are not possible.

More than half the patients with rectal cancer present with locally advanced rectal disease at diagnosis with a high risk of recurrence. Preoperative chemoradiotherapy and standardized radical surgery with total mesorectal excision have been established as the 'gold standard' for treating these patients. Pathological staging using the ypTNM classification system to decide on adjuvant chemotherapy (ACT) is widely used in clinical practice, but the delivery of ACT is still controversial, as many discrepancies persist in the conclusions of different trials, due to heterogeneity of the inclusion criteria between studies, lack of statistical power, and variations in preoperative and adjuvant regimens. In 2014, a meta-analysis of four randomized phase-III trials (EORTC 22921, I-CNR-RT, PROCTOR-SCRIPT, CHRONICLE) failed to demonstrate any statistical efficacy of fluorouracil (5FU)-based ACT. Three recent randomized trials aimed to compare 5FU with 5FU plus oxaliplatin-based chemotherapy. Two of them (ADORE, CAO/ARO/AIO-04) appeared to find a disease-free survival benefit for patients treated with the combination therapy. Thus, while awaiting new data, it can be said that, as of 2015, patients with yp stage I tumors or histological complete response derived no benefit from adjuvant therapy. On the other hand, the FOLFOX chemotherapy regimen should be proposed for yp stage III patients, and may be considered for yp stage II tumors in fit patients with high-risk factors. Nevertheless, well-designed and sufficiently powered clinical trials dedicated to adjuvant treatments for rectal cancer remain justified in future to achieve a high level of proof in keeping with evidence-based medical standards.

Objectifs L’efficacite de la chirurgie aortique endovasculaire reside dans la precision de l’imagerie peroperatoire. A partir d’un angioscanner, la fusion d’images permet un reperage peroperatoire de la morphologie aortique sous fluoroscopie sans necessiter l’injection de produit de contraste. Cependant, la morphologie de l’aorte abdominale est modifiee lors de la chirurgie endovasculaire par l’introduction de materiel rigide dans sa lumiere. Le but de cette etude est de quantifier les deformations aortiques lors de l’exclusion endovasculaire des anevrismes et d’etablir une correlation avec la morphologie aortique. Methodes L’imagerie par fluoroscopie peroperatoire de patients ayant beneficies d’une exclusion d’un anevrisme de l’aorte abdominale par endoprothese ont ete revus retrospectivement par trois operateurs independants. La morphologie aorto-iliaque (diametres, longueurs, angulations, tortuosite, calcifications, presence de thrombus) a ete etudiee pour chaque patient. Les differences entre l’image de l’aorte preoperatoire et de l’aorte « deformee » peroperatoire » ont ete mesurees. Ces differences ont ete quantifiees en separant la part « rigide » (translationnelle) de la part « non-rigide » (distorsion) de la deformation totale de l’aorte durant l’intervention. Resultats Les angioscanners preoperatoires et l’imagerie par fluoroscopie avec fusion de 41 patients (40 hommes, âge moyen 74 ans ± 9, indice de masse corporelle moyen 27,7 kg/m2) ayant beneficie d’une exclusion d’un anevrisme de l’aorte abdominale par endoprothese ont ete etudies. La deformation totale, non-rigide et rigide etaient de 4,82 mm (±1,98) ; 2,10 (±1,02) et 4,42 (±1,84) respectivement. Les longueurs des arteres iliaques droite et gauche etaient correlees significativement avec le niveau de deformation total (a droite 0,468, p = 0,002 ; a gauche 0,395, p = 0,011), non-rigide (a droite 0,384, p = 0,013 ; a gauche 0,330, p = 0,035) et rigide (a droite 0,464, p = 0,002 ; a gauche 0,391, p = 0,011). Conclusion La morphologie de l’aorte influence sa deformation. La quantification de la deformation non-rigide est indispensable pour comprendre et anticiper ces deformations.

Introduction La prise en charge moderne de l’ischemie mesenterique d’origine athero-thrombotique (IMA) s’inscrit dans une strategie de sauvetage intestinal et repose essentiellement sur la revascularisation endovasculaire par stent de l’artere mesenterique superieure (AMS). Cette pathologie rare impose au chirurgien vasculaire la maitrise de l’anatomie chirurgicale, mais aussi de plus en plus celle de l’anatomie endovasculaire de l’AMS. L’objectif de cette etude etait de decrire l’anatomie endovasculaire de l’AMS dans la maladie occlusive de facon a definir des criteres morphologiques pertinents pour le catheterisme et le choix des implants endovasculaires. Methodes Dix-neuf patients consecutifs pris en charge pour IMA dans un centre expert et traites par stent de l’AMS ont ete inclus. A partir des angio-scanners preoperatoires, une cartographie anatomique 2D a ete realisee au moyen du logiciel Endosize, avec reconstruction arterielle par ligne centrale. Resultats La longueur mediane de l’AMS de l’ostium a la naissance du tronc ileo-caeco-appendiculaire (ICA) etait 66 mm (61–69). La longueur mediane de l’ostium a la 1re collaterale etait 37 mm (35–42). Le diametre ostial median etait 6,8 mm (6,8–7,8). L’angulation horaire moyenne de l’origine AMS etait de 9,9° ± 10,5°. Le nombre median de collaterales millimetriques entre l’ostium et l’ICA etait 6 (4–7). L’angle aorte-AMS moyen etait de 32° ± 12°. L’AMS naissait en regard du 1/3 inferieur du corps de L1 dans 85 % des cas. Aucune difference significative n’etait observee en fonction de l’âge, du sexe, de l’IMC et du nombre de facteurs de risque cardiovasculaire. Conclusion La morphologie endovasculaire de l’AMS est relativement constante dans la population specifique des patients ayant une IMA. Une connaissance precise de la morphometrie endovasculaire de l’AMS permettra de guider le catheterisme, la voie d’abord et le choix de l’endoprothese la plus adaptee.

During right-sided colectomies, surgeons encounter major anatomical variations at the level of the right colon, leading to morbidity. Due to the confusion surrounding the colonic arterial vessels emerging from the superior mesenteric artery (SMA) to vascularize the right part of the colon, this review aimed to describe the arterial vessels found in the mesocolic structures of the ascending colon, the hepatic flexure and the right transverse colon. A review of the literature was performed using the MEDLINE database. Only human studies were included. All dissection, angiographic, arterial cast and corrosion studies were analyzed. This review demonstrates that the right colon, the hepatic flexure and the right transverse colon are vascularized by three significant arteries emerging from the SMA and forming one peripheral paracolic arc: (1) the ileocolic artery (ICA), the most constant vessel (99.8%) with low variability; (2) the right colic artery (RCA), the most inconstant vessel (2/3 of cases) with high variability in its origin; and (3) the middle colic artery (MCA), a constant vessel (95%) with variation in its origin and its number. The marginal artery is almost constant (100%) and represents the only peripheral arterial arc at the level of the right side of the colon. Three arteries emerging from the superior mesenteric artery exist: the ICA, the RCA and the MCA. The ICA and the MCA are the most constant. Knowledge of this vascular anatomy is essential for performing right-sided colectomies.

Gastric fistula is a severe complication following sleeve gastrectomy (SG). Chronic gastric fistula can progress to complex anatomical situations, such as esogastro-bronchial and/or esogastro-pleural (EGBP) fistulas. We decided to analyze the anatomical characteristics of these EGBP fistulas after SG. Our work consisted of an analysis of the clinical, endoscopic, and radiological data of patients treated for EGBP fistulas after SG at the Georges Pompidou European Hospital from May 2009 to November 2017. A total of 11 patients were retrospectively included with available complete clinical, endoscopic, and radiological data. The origin of the fistula was mostly at the top of the staple line. The fistula’s termination was pleural in 5 patients (45%) and bronchial in 6 (55%). In bronchial fistulas, 2 were proximal and 4 were distal, with the left pulmonary posterolateral segment (S10) being reached in each case. The trans-diaphragmatic passage was through the left cupola in 9 out of 11 patients (82%). In 2 patients, the passage was trans-hiatal (18%). Interestingly, the 2 eso-bronchial fistulas had a trans-hiatal passage with a termination in the proximal bronchus, while the 4 gastro-bronchial fistulas had a trans-diaphragmatic passage with a termination in the distal bronchus. All pleural fistulas were gastric with a trans-diaphragmatic passage. Esogastro-bronchial and gastro-pleural fistulas after SG originated mostly at the top of the staple line. Eso-bronchial fistulas had a trans-hiatal passage with a proximal bronchial termination, while gastro-bronchial fistulas had a trans-diaphragmatic passage with a distal bronchial termination.

One anastomosis gastric bypass (OAGB) was suggested as an option in the management of weight loss failure after sleeve gastrectomy (SG). In parallel, the length of the biliopancreatic limb (BPL) is currently debated. To evaluate morbidity and efficiency of the conversion of SG to OAGB using two lengths of BPL (150 cm versus 200 cm). Retrospective analysis of a prospectively collected database on 72 patients operated on between 2007 and 2017: (200-cm BPL before 2014 versus 150-cm BPL since 2014). At revision, the mean body mass index (BMI) was 43.6 ± 7 kg/m2. Sixteen patients (20%) had type 2 diabetes (T2D) and 23 (29%) had obstructive sleep apnea (OSA). Early morbidity rate was 4.2% (n = 3). Mean BMI were 33.7 ± 6 and 34.8 ± 9 at 2 and 5 years, respectively. At 5 years, the rate of lost of follow-up was 34%. T2D and OSA improved in 80% (n = 12) and 70% (n = 16) of the patients, respectively. At revision, the mean BMI were 46 ± 8 kg/m2 and 41 ± 6 kg/m2 for patients with 200-cm BPL (n = 38) and 150-cm BPL (n = 34), respectively. Two years after conversion, the mean BMI were 34 ± 1 kg/m2 for 200-cm BPL and 32 ± 7 kg/m2 for 150-cm BPL. The rate of gastroesophageal reflux disease (GERD) and diarrhea was 13% and 5% in patients with 200-cm BPL versus 3% and 0% in patients with 150-cm BPL. This study shows that the conversion of SG to OAGB is feasible and safe allowing significant weight loss and improvement in comorbidities. Weight loss seems comparable between the 150-cm and 200-cm BPL.

In the last decade, extensive efforts have been made to understand the physics of submarining and its consequences in terms of abdominal injuries. For that purpose, 27 Post Mortem Human Subject (PMHS) tests were performed in well controlled conditions on a sled and response corridors were provided to assess the biofidelity of dummies or human body models. All these efforts were based on the 50th percentile male. In parallel, efforts were initiated to transfer the understanding of submarining and the prediction criteria to the THOR dummies. Both the biofidelity targets and the criteria were scaled down from the 50th percentile male to the 5th percentile THOR female. The objective of this project was to run a set of reference PMHS tests in order to check the biofidelity of the THOR F05 in terms of submarining. Three series of tests were performed on nine PMHS, the first one was designed to avoid submarining, the second and third ones were designed to result in submarining. In the first configuration, no submarining was observed in 3 cases out of 4 and only one iliac wing fracture occurred in one subject. In the second and third configurations, all subjects but one sustained submarining. In addition, two subjects out of three in the third configuration sustained substantial iliac wing fractures. Nevertheless, all configurations can be represented by at least one or several cases without any pelvis fracture. Corridors were constructed for the external forces and the PMHS kinematics. They are provided in this paper as new experimental references to assess the biofidelity of small female human surrogates in different configurations where submarining did or did not occur.

The EuroSID-2re (ES-2re) Anthropomorphic Test Device (ATD) commonly known as the crash test dummy is also used in the military domain to assess the risk of injury of armored vehicles occupants from lateral impact. The loading conditions range from low velocity - long duration impacts (4 m/s - 50 ms) similar to the automotive domain, to high velocity - short duration impacts (28 m/s - 3 ms) corresponding to cases where the panel deforms under an explosion. The human shoulder response to lateral impact was investigated at bounds of the loading condition spectrum previously mentioned, and also at intermediate conditions (14 m/s - 9 ms) in previous studies. The aim of the current study is to provide additional insight at the intermediate loading conditions which are not found in the literature. Eight pure lateral shoulder impact tests were performed on Post Mortem Human Subjects (PMHS) using an 8.1 kg rigid impactor at velocities ranging from 3.3 m/s to 8.8 m/s with the duration ranging from 25 ms to 35 ms. The PMHS were instrumented with accelerometers attached to the sternum, and the upper thoracic spine (T1 vertebra). Strain gages were glued onto the right and left clavicles and ribs 2 to 6. The shoulder force was measured at the interface with the impactor and the impact was filmed by high speed cameras (5000 fps) to track the YZ displacements of the impactor, T1 vertebra, and sternum in the laboratory frame. Three shoulders out of the eight sustained AIS 2 injuries which included a clavicle fracture. The impactor forces ranged from 1200 to 4600 N. The PMHS accelerations ranged from 44 to 163 g at the sternum, and from 17 to 60 g at the T1 vertebra. The analysis of the strain gage signals revealed that the clavicle fractures occurred at the beginning of the impact and coincided with a peak force. An estimate of the acromion-to-shoulder compression (Cmax) was computed. It ranged from 0% to 15% for the non-injured shoulders, and from 19% to 28% for the injured shoulders. This new PMHS test series will be used in a future work to develop a shoulder injury criterion for the ES-2re ATD that is relevant for the whole loading conditions spectrum of the military domain.

Recurrence patterns in stage III colon cancer (CC) patients according to molecular markers remain unclear. The objective of the study was to assess recurrence patterns according to microsatellite instability (MSI), RAS and BRAFV600E status in stage III CC patients. All stage III CC patients from the PETACC-8 randomized trial tested for MSI, RAS and BRAFV600E status were included. The site and characteristics of recurrence were analyzed according to molecular status. Survival after recurrence (SAR) was analyzed. A total of 1650 patients were included. Recurrence occurred in 434 patients (26.3%). Microsatellite stable (MSS) patients had a significantly higher recurrence rate (27.2% vs. 18.7%, P = 0.02) with a trend to more pulmonary recurrence (28.8% vs. 12.9%, P = 0.06) when compared to MSI patients. MSI patients experienced more regional lymph nodes compared to MSS (12.9% vs. 4%, P = 0.046). In the MSS population, the recurrence rate was significantly higher in RAS (32.2%) or BRAF (32.3%) patients when compared to double wild-type patients (19.9%) (p

Background On November 13th, 2015, terrorist bomb explosions and gunshots occurred in Paris, France, with 129 people immediately killed, and more than 300 being injured. This article describes the staff organization, surgical management, and patterns of injuries in casualties who were referred to the Teaching European Hospital Georges Pompidou. Methods This study is a retrospective analysis of the pre-hospital response and the in-hospital response in our referral trauma center. Data for patient flow, resource use, patterns of injuries and outcomes were obtained by the review of electronic hospital records. Results Forty-one patients were referred to our center, and 22 requiring surgery were hospitalized for >24 h. From November 14th at 0:41 A.M. to November 15th at 1:10 A.M., 23 surgical interventions were performed on 22 casualties. Gunshot injuries and/or shrapnel wounds were found in 45%, fractures in 45%, head trauma in 4.5%, and abdominal injuries in 14%. Soft-tissue and musculoskeletal injuries predominated in 77% of cases, peripheral nerve injury was identified in 30%. The mortality rate was 0% at last follow up. Conclusion Rapid staff and logistical response, immediate access to operating rooms, and multidisciplinary surgical care delivery led to excellent short-term outcomes, with no in-hospital death and only one patient being still hospitalized 45 days after the initial event.

Radical hysterectomy (RH) is an effective treatment for early-stage cervical cancer IA2 to IIA1 but RH is often associated with several significant complications such as urinary, anorectal and sexual dysfunction due to pelvic nerve injuries. Pelvic autonomic nerves including the superior hypogastric plexus (SHP), hypogastric nerves (HN), pelvic splanchnic nerves (PSN), sacral splanchnic nerves (SSN), inferior hypogastric plexus (IHP) and efferent branches of the IHP. We aimed to precise the neuroanatomy of the female pelvis in order to provide key-points of surgical anatomy to improve NSRH for cervical cancer. The SHP could be injured during periaortic lymph node dissection and its preservation necessitates an approach on the right side of the aorta and a blunt dissection of the promontory before lomboaortic lymphadenectomy. Injuries to HN can occur during the resection of USL at the posterior pelvic wall and of rectovaginal ligaments and to preserve HN only the medial fibrous part of the uterosacral ligament should be resected. The middle rectal artery, the deep uterine vein and the ureter should be identified to preserve PSN and IHP during resection of paracervix. Vesical branches can be preserved by blunt dissection of the posterior layer of the vesicouterine ligament after identifying the inferior vesical vein. In most of cases, NSRH for cervical cancer can be performed. Anatomical landmarks as middle rectal artery, deep uterine vein, inferior vesical vein and ureter and the respect of nervous part of uterine ligament and of parametrium provide to surgeon a safe preservation of pelvic innervation without compromising oncological outcomes.

Background & Aims Kupffer cells (KC) play a key role in the onset of inflammation in non-alcoholic steatohepatitis (NASH). The glucocorticoid receptor (GR) induces glucocorticoid-induced leucine zipper (GILZ) expression in monocytes/macrophages and is involved in several inflammatory processes. We hypothesized that the GR-GILZ axis in KC may contribute to the pathophysiology of obesity-induced liver inflammation. Methods By using a combination of primary cell culture, pharmacological experiments, mice deficient for the Gr specifically in macrophages and transgenic mice overexpressing Gilz in macrophages, we explored the involvement of the Gr-Gilz axis in KC in the pathophysiology of obesity-induced liver inflammation. Results Obesity was associated with a downregulation of the Gr and Gilz, and an impairment of Gilz induction by lipopolysaccharide (LPS) and dexamethasone (DEX) in KC. Inhibition of Gilz expression in isolated KC transfected with Gilz siRNA demonstrated that Gilz downregulation was sufficient to sensitize KC to LPS. Conversely, liver inflammation was decreased in obese transgenic mice specifically overexpressing Gilz in macrophages. Pharmacological inhibition of the Gr showed that impairment of Gilz induction in KC by LPS and DEX in obesity was driven by a downregulation of the Gr . In mice specifically deficient for Gr in macrophages, Gilz expression was low, leading to an exacerbation of obesity-induced liver inflammation. Conclusions Obesity is associated with a downregulation of the Gr-Gilz axis in KC, which promotes liver inflammation. The Gr-Gilz axis in KC is an important target for the regulation of liver inflammation in obesity.

Introduction La fistule œsogastro-bronchique et/ou pleurale (OGBP) apres sleeve gastrectomie (SG ou gastrectomie en manchon) est une complication grave et meconnue. Nous avons decide d’etudier les bases anatomiques de ce type de fistule complexe. Methode Notre travail a consiste en l’analyse clinique, endoscopique et radiologique des fistules OGBP apres sleeve gastrectomy afin de comprendre leur anatomie et les organes impliques dans le trajet fistuleux. Resultats Onze patients ont ete inclus avec des donnees completes cliniques, endoscopiques et radiologiques. L’origine de la fistule etait le plus souvent le cardia (cardia n = 7, medio-gastrique n = 2, œsophage n = 2). La terminaison de la fistule etait pleurale chez cinq patients (45 %) et bronchique chez six (55 %). Dans les fistules bronchiques, deux etaient proximales alors que les quatre autres etaient distales avec une atteinte dans tous les cas du segment pulmonaire postero-basal gauche (S10). Neuf patients (82 %) avaient un passage trans-diaphragmatique a travers la coupole diaphragmatique gauche. Chez les deux autres patients (18 %), le passage etait trans-hiatal. De facon interessante, les deux fistules œso-bronchiques avaient un passage trans-hiatal avec une terminaison dans la bronche souche gauche, alors que les quatre fistules gastro-bronchiques avaient un passage trans-diaphragmatique gauche avec une terminaison dans une bronche distale (S10). Discussion Les OGBP apres sleeve gastrectomie sont principalement originaire du haut de la ligne d’agrafes (cardia ou œsophage). Les fistules œso-bronchiques ont un passage trans-hiatal avec une terminaison dans la bronche souche gauche, alors que les fistules gastro-bronchiques ont un passage trans-diaphragmatique gauche avec une terminaison dans une bronche distale.

There is confusion regarding the names, the number, and the exact location of the colonic arterial arches which provide connections between the superior and inferior (IMA) mesenteric arteries at the level of the left colic angle. The aim of this review was to delineate the “true” colic arches arising in the meso of the left colic angle and to describe their surgical implications. A systematic review of the literature was performed using the MEDLINE database. The search included only human studies between 1913 and 2018. All dissection, angiographic, arterial cast and corrosion studies were analyzed. The terms “Riolan arch”, “marginal artery of Drummond”, “meandering mesenteric artery” and “Villemin’s arch” must no longer be used in the scientific literature. Three arterial arches were found at the level of the left colic angle, permitting the communication between the two arterial mesenteric systems: (1) the Marginal Artery (the most peripheral, found in 100% of cases); (2) the “V” termination of the ascending branch of the left colic artery (LCA), existing in more than 2/3 of cases; and (3) the inter-mesenteric trunk, found more centrally located and existing in less than 1/3 of cases. Three arterial arches exist at the level of the left colic angle: (1) the Marginal Artery, (2) the “V” termination of the ascending branch of the LCA, and (3) the inter-mesenteric trunk. The knowledge of this anatomy is essential for performing colorectal surgeries involving ligation of the IMA.

Background/Aims: This study aims to describe the autonomic nervous network of the female pelvis with a 3D model and to provide a safe plane of dissection during radical hysterectomy for cervical cancer. Methods: Pelvises of 3 human female fetuses were studied by using the computer-assisted anatomic dissection. Results: The superior hypogastric plexus (SHP) was located at the level of the aortic bifurcation in front of the sacral promontory and divided inferiorly and laterally into 2 hypogastric nerves (HN). HN ran postero-medially to the ureter and in the lateral part of the uterosacral ligament until the superior angle of the inferior hypogastric plexus (IHP). IHP extended from the anterolateral face of the rectum, laterally to the cervix and attempted to the base of the bladder. Vesical efferences merged from the crossing point of the ureter and the uterine artery and ran through the posterior layer of the vesico-uterine ligament. Conclusions: The SHP could be injured during paraaortic lymphadenectomy. Following the ureter and resecting the medial fibrous part of the uterosacral ligament may spare the HN. No dissection should be performed under the crossing point of the ureter and the uterine artery.

Anastomotic leakage (AL) is a potential feared complication after colorectal resection, which is associated with an increased risk of postoperative mortality and frequently requires additional surgery. The aim of this study was to assess major independent risk factors for AL after elective colonic resection for cancer, including anastomotic location. Among 1940 consecutive patients referred to our institution for colorectal adenocarcinoma, 1025 patients had elective colonic resection with intraperitoneal anastomosis without diverting stoma. Risk factors were assessed among preoperative, operative, and histological data. Clinical AL was observed in 36 patients (3.5%) with 24 patients requiring revisional surgery (67%). In multivariate analysis, endoscopic impassable tumor and colo-colic or ileo-colic anastomosis were independent risk factors for AL. The occurrence of AL was associated with poor overall (43.1 months vs. 146.4 months; p

This study aims to provide a set of reference post-mortem human subject tests which can be used, with easily reproducible test conditions, for developing and/or validating pedestrian dummies and computational human body models against a road vehicle. An adjustable generic buck was first developed to represent vehicle front-ends. It was composed of four components: two steel cylindrical tubes screwed on rigid supports in V-form represent the bumper and spoiler respectively, a quarter of a steel cylindrical tube represents the bonnet leading edge, and a steel plate represents the bonnet. These components were positioned differently to represent three types of vehicle profile: a sedan, a SUV and a van. Eleven post-mortem human subjects were then impacted laterally in a mid-gait stance by the bucks at 40 km/h: three tests with the sedan, five with the SUV, and three with the van. Kinematics of the subjects were recorded via high speed videos, impact forces between the subjects and the bucks were measured via load cells behind each tube, femur and tibia deformation and fractures were monitored via gauges on these bones. Based on these tests, biofidelity corridors were established in terms of: 1) displacement time history and trajectory of the head, shoulder, T1, T4, T12, sacrum, knee and ankle, 2) impact forces between the subjects and the buck. Injury outcome was established for each PMHS via autopsy. Simplicity of its geometry and use of standard steel tubes and plates for the buck will make it easy to perform future, new post-mortem human subject tests in the same conditions, or to assess dummies or computational human body models using these reference tests.

Morbid obesity and type-2 diabetes mellitus (T2DM) are both major public health problems. Bariatric surgery is a proven and effective treatment for these conditions; laparoscopic Roux-en-Y gastric bypass (RYGB) is currently the gold-standard treatment. One-anastomosis gastric bypass (OAGB) is described as a simpler, safer, and non-inferior alternative to RYGB to treat morbid obesity. Concerning T2DM, experts of the OAGB procedure report promising metabolic results with good long-term remission of T2DM; however, heterogeneity within the literature prompted us to analyze this issue. OAGB has gained popularity given its safety and long-term efficacy. Concerning the effect of OAGB for the treatment of T2DM, most reports involve non-controlled single-arm studies with heterogeneous methodologies and a few randomized controlled trials. However, this available literature supports the efficacy of OAGB for remission of T2DM in obese and non-obese patients. Two years after OAGB, the T2DM remission and improvement rate increased from 67 to 100%. The results were improved and stable in the long term. The 5-year T2DM remission rate increased from 82 to 84.4%. OAGB is non-inferior compared with RYGB and even superior to other accepted bariatric procedures, such as sleeve gastrectomy and adjustable gastric banding. OAGB is an efficient, safe, simple, and reversible procedure to treat T2DM. The literature reveals interesting results for T2DM remission in non-obese patients. High-level comparative studies are required to support these data.

Resume Objectifs Description du trajet du nerf dorsal du clitoris (NDC) chez l’adulte apres une revue de la litterature afin d’optimiser l’approche chirurgicale de cette region. Materiel et methode Recherche bibliographique dans plusieurs bases de donnees sur Internet, notamment Medline via PubMed, en utilisant les mots cles suivants : « anatomie du clitoris », « anatomy of clitoris », « nerf dorsal du clitoris », « dorsal nerve of clitoris », « reparation clitoridienne », « transposition clitoridienne », « surgery of the clitoris », « clitoridoplasty ». Cette revue de la litterature a comporte des series de dissections, des etudes par imagerie par resonance magnetique, des reconstructions anatomiques en 3D et des etudes immuno-histochimiques. Resultats Le NDC provient du nerf pudendal. Il passe le long de la branche ischio-pubienne puis penetre dans les piliers du clitoris. Il reapparait sous la symphyse pubienne, perfore le ligament suspenseur du clitoris. Il chemine alors sur le corps clitoridien a 11 h et 1 h. Il donne de nombreuses ramifications faisant un dense reseau nerveux sur les faces anterolaterales du corps clitoridien. Il se termine en profondeur dans le gland. Conclusion Le NDC peut etre lese chirurgicalement (i) sous la symphyse pubienne, a l’union des 2 piliers du clitoris et (ii) a la face dorsale du corps clitoridien. La disposition dorsale des fibres du NDC permet un abord chirurgical ventral du clitoris en toute securite, sans prendre le risque de le leser. La distance entre ce nerf et la symphyse pubienne implique en cas d’abord dorsal de rester au ras de la symphyse pubienne afin d’eviter de le blesser. La dissection de ses fibres terminales au niveau corporeo-glandulaire apparait illusoire et dangereuse, etant donne les rapports intimes du NDC avec le clitoris dans cette portion.

Background Leakage after one-anastomosis gastric bypass (OAGB) is fortunately rare ( Objectives To analyze the results from patients who presented with acute intra-abdominal sepsis (AIAS) caused by leakage after OAGB. Setting A university public hospital in France. Methods Between October 2006 and February 2016, 17 consecutive patients with a diagnosis of AIAS caused by leakage after OAGB were included. Preoperative characteristics, clinical symptoms, radiologic findings, management, morbidity, and mortality were assessed. Results All 17 patients were included in the study. There were 4 men (23.5%), the median age was 48 years, and median preoperative body mass index (BMI) was 51 kg/m 2 . The most frequent clinical sign was tachycardia (65%). An oral contrast computed tomography scan was performed in 15 patients (88%) and showed a diagnosis of AIAS in 93% of cases. The median time between OAGB and leak diagnosis was 4 days. A gastrojejunal anastomosis (GJA) leak was the most frequent origin (41%). Sixteen patients (94%) were managed surgically (laparotomy n=11, laparoscopy n=5) and one medically. There were no deaths. The overall morbidity rate was 47% (major = 41%). Six patients underwent an emergency conversion into Roux-en-Y gastric bypass (RYGB) (in cases of GJA, gastric-tube, and biliary-limb leakages) and were compared to 6 patients who did not undergo conversion but who could have benefited. We observed a tendency toward a reduced overall morbidity rate (16.7% versus 83.3%, P = .08) and shorter lengths of stay in the "conversion to RYGB" group. Conclusion The management of AIAS caused by leakage after OAGB was safe, effective, and mostly surgical. Emergency conversion to RYGB in cases of GJA, gastric-tube, or biliary-limb perforation was feasible and safe.

Intraoperative enteroscopy (IOE) to explore obscure gastrointestinal bleeding is now rarely indicated. IOE allows complete small bowel exploration in 57% to 100% of cases, finds a bleeding source in 80% of cases, allows the recurrence-free management of gastrointestinal bleeding in 76% of cases, but carries a high morbidity and mortality. IOE only remains indicated to guide the intraoperative treatment of preoperatively identified small bowel lesions when nonoperative treatments are unavailable and/or when intraoperative localization by external examination is impossible.

The aim of this study was to investigate the sacroiliac joint injury mechanism. Two test configurations were selected from full scale car crashes conducted with the WorldSID 50th dummy resulting in high sacroiliac joint loads and low pubic symphysis force, i.e. severe conditions for the sacroiliac joint. The two test conditions were reproduced in laboratory using a 150-155 kg guided probe propelled respectively at 8 m/s and 7.5 m/s and with different shapes and orientations for the plate impacting the pelvis. Nine Post Mortem Human Subject (PMHS) were tested in each of the two configurations (eighteen PMHS in total). In order to get information on the time of fracture, eleven strain gauges were glued on the pelvic bone of each PMHS. Results - In the first configuration, five PMHS out of nine sustained AIS2+ pelvic injuries. All five presented sacroiliac joint injuries associated with pubic area injuries. In the second configuration, four specimens out of nine sustained AIS2+ pelvic injuries. Two of them presented sacroiliac joint fractures associated with pubic area injuries. The other two presented injuries at the pubic area and acetabulum only. The strain gauges signals suggested that the pubic fractures occurred before the sacroiliac joint fractures in the great majority of the cases (five cases out of seven). Conclusions - Even in the oblique impact conditions of the present study, the pubic symphysis area was observed to be the weakest zone of the pelvis and its failure the predominant cause of sacroiliac joint injuries. It was hypothesized that the failure of the pubic rami allowed the hemi-pelvis to rotate inward, and that this closing-book motion induced the failure of the sacroiliac joint.

Introduction/Objectifs Le but de cette etude etait de decrire la topographie et la frequence des differentes lesions d’endometriose pelvienne profonde. Materiels et methodes Revue de litterature de 2003 a 2017 en utilisant les mots cles suivants : « anatomical distribution », « deeply infiltrating endometriosis », « deep endometriosis », « surgery », sur PubMed via Medline. Resultats Quinze articles sur 45 correspondant a l’objectif de l’etude ont ete analyses. Mille trois cent soixante-dix-neuf patientes presentaient 2265 lesions histologiquement prouvees. Les lesions d’endometriose etaient localisees aux ligaments utero-sacres (41 % ; 925), au septum recto-vaginal (13,6 % ; 309), au niveau de la jonction rectosigmoidienne (13,2 % ; 298), au vagin (9 % ; 212), au cul-de-sac de douglas (5,6 % ; 128), a la vessie (3,1 % ; 72) et a l’uretere (2,5 % ; 57). Cent cinquante-six patientes (11,3 %) presentaient au moins 2 lesions avec notamment une atteinte simultanee des ligaments utero-sacres et du rectum (62 patientes) et une atteinte simultanee des ligaments utero-sacres et du cul de sac de Douglas (31 patientes). Conclusions L’endometriose pelvienne profonde interesse principalement les ligaments utero-sacres et le septum recto-vaginal. Les atteintes multifocales doivent etre recherchees lors du bilan pre operatoire afin de garantir l’exhaustivite de l’exerese chirurgicale qui conditionne le succes.

But Analyser le site de recidive des patients traites pour un cancer du colon (CdC) stade III en fonction du statut moleculaire. Methodes les patients traites pour un CdC de stade III issus de l’etude PETACC-8 et testes pour les statuts microsatellite (MSS ou MSI), RAS et BRAFont ete inclus. Les sites de recidive et la survie apres recidive (SAR) ont ete analyses. Resultats Sur 1650 patients inclus, 434 ont presente une recidive (26,3 %). Les patients MSS avaient un taux de recidive superieur aux patients MSI (27,2 % vs.18,7 %, p = 0,02) avec une tendance a plus de recidives pulmonaires. Les patients MSI eux presentaient plus de recidives ganglionnaires locoregionales (12,9 % vs. 4 %, p = 0,046). Dans la population MSS, il existait un taux de recidives plus important chez les patients RAS et BRAF mutes par rapport aux patients non-mutes (p Conclusions Les statuts microsatellitaire, RAS et BRAF influencent le taux de recidive, mais seul le statut microsatellitaire semble etre associe a un site de recidive particulier. La SAR est influencee par le nombre et la localisation des recidives.

Introduction Il existe une confusion dans la denomination, le nombre et la localisation des arcades coliques permettant la connexion entre l’artere mesenterique superieure (AMS) et l’artere mesenterique inferieure (AMI) au niveau du colon transverse gauche et de l’angle colique gauche. Methodes Une revue systematique de la litterature scientifique a ete realisee a partir de la base de donnees PubMed. Seules les litteratures francaise et anglo-saxonne ont ete analysees. Resultats Les termes « arcade de Riolan », « artere marginale de Drummond », « meandering mesenteric artery » ne doivent plus etre utilises. Les principales structures arterielles retrouvees a l’angle colique gauche sont l’artere marginale, la branche gauche de l’artere colique moyenne, la branche ascendante de l’artere colique gauche (ACG), ainsi que les communications centrales entre l’AMS et l’AMI. Ces structures vasculaires donnent naissance a trois arcades au niveau du meso de l’angle colique gauche : – une arcade de premier ordre, l’artere marginale qui est la plus peripherique et constante (100 %) ; – une arcade de second ordre, la terminaison en V de la branche ascendante de l’ACG, presente dans 63 a 100 % des cas, et enfin ; – une arcade de troisieme ordre, plus centrale, le tronc inter-mesenterique, present dans 12 a 18 % des cas. La fonction de suppleance du tronc inter-mesenterique reste a demontrer alors qu’il est maintenant clair que la terminaison en V de la branche ascendante de l’ACG peut ponter et suppleer une artere marginale discontinue ou insuffisante. Conclusion Les communications inter-mesenteriques retrouvees au niveau de l’angle colique gauche sont au nombre de trois : – l’artere marginale (100 % des cas) ; – la terminaison en V de la branche ascendante de l’artere colique gauche (> deux tiers des cas) ; – le tronc inter-mesenterique ( La connaissance de cette anatomie est necessaire dans la chirurgie colo-rectale pour cancer avec ligature de l’artere mesenterique inferieure.