Le profil épidémiologique et la prise en charge des cancers du rectum ont ils changé

Abstract

Objective: The incidence of rectal cancer is increasing in Western countries. What is it for us, do we have more rectal cancer? The change of our way of life, the aging population could be risk factors. Furthermore the management of rectal cancer has considerably progressed. The purpose of this study is to compare the epidemiological profil and the management of rectal cancer between two series collected to 20 years of interval. Methods : It is about two retrospective cases, the first one, collected from 1981 to 1985 (serie A), includes 80 patients. The second one, recent, collected from 2005 to 2011 (serie R), includes 94 patients. We analyzed for the epidemiological profile, the middle number of case per year, age, sex, seat of the tumor, histological type, metastatique stage. We analyzed for the management: operability rate, resection rate, type of intervention. Results : The middle number of cancer of the rectum hospitalized per year in our formation is respectively 16±4.06 and 18±4.14 in serie A and the serie R (p = 0.91). The mean age of patients was 49.5±14.7 for serie A and 48.6 ± 13.3 for serie R (p = 0.674). There is a masculine predominance in the two series (p = 0.7). The three segments of the rectum are reached in the same proportions in the two series (p = 0.8). The low rectum represented half of the cases (54.5% serie A, 56.9% serie R). The metastatique stage is more frequent in serie R (32 (22.7%) vs 18 (34%) (p = 0.14). Resection rate represents respectively in serie A and serie R, 68.9% and 84% (p = 0.428). Abdomino-perineal amputation has been achieved in 45% of the cases in serie A and 30.3% of the cases serie R (p = 0.003). Discussion : The study found that the incidence of rectal cancer has not increased in our training in the space of 20 years, however, in two series, 25% of patients are aged less than 25. The management of this cancer was marked by systematic preoperative radiotherapy in the serie R for low rectal cancers, by reducing the safety margin to 2 cm and by reducing the number of abdominoperineal resection. Conclusion : Pidemiological profile did not change. However, the management of rectal cancer been influenced by the new data of the rectal surgery. This study showed that rectal cancer in Morocco had different characteristics than that in West country. Environmental and genetic studies may explain this difference.