[Lymph nodes and rectal cancer].

Nodal invasion is a major prognostic factor of rectal cancer. Lymphatic extension of rectal cancer usually involves the mesorectal nodes then the inferior mesenteric chain but in 14% of patients, particularly with cancer of the lower rectum, metastasic nodes can be observed in the internal or lumboaortic chains situated beyond the usual territory of nodal dissection. On average, 30 nodes are examined on a proctectomy specimen, but with wide interindividual variation.

[Management of anastomotic fistula following excision of rectal cancer].

The risk of anastomotic leak after resection of cancers of the mid or low rectum with mesorectal excision is about 10%--the lower the colo-rectal or colo-anal anastomosis, the higher the risk of leak. If the fistula is asymtomatic and the leak is walled off, it is best to defer the closure of the diverting ileostomy for 2-3 months and to proceed only when a radiologic contrast study shows the fistula to have disappeared. More commonly, the anastomotic fistula presents as a pelvic abscess.

[Management of familial polyposis coli].

Familial Multiple Polyposis Coli is an autosomal dominant hereditary illness characterized by the appearance in childhood of hundreds of colorectal polyps which inexorably undergo malignant transformation. It is accompanied by extracolonic manifestations some of which may also be life-threatening. Total colectomy should not be postponed beyond age 20 except in rare cases of an attenuated form of the disease (AAPC).