title: [Advanced rectal cancer: attitudes of French surgeons].
abstract: OBJECTIVE
  French guidelines recommended the treatment of locally advanced rectal cancers. Our aim was first to describe therapeutic decision of digestive surgeons related to clinical cases and then to measure their knowledge of french guidelines.
  
  
  METHODS
  Two vignettes were mailed to 183 french surgeons, randomly selected. The first one dealt with a man, 46-years-old, with a rectal cancer T3N0M0. The second one dealt with a woman, 50-years-old, with a rectal cancer complicated by a rectovaginal fistula. Questions covered the decision modality and the therapeutic choice.
  
  
  RESULTS
  We received back 124 responses (67%). The decision modality was multidisciplinary for half of the surgeons. For the former case, the therapeutic choice fits with guidelines--radiotherapy followed by conservative surgery--for 69% of surgeons. For the latter case, more than half of the surgeons chose an association of radiotherapy-surgery-chemotherapy. Age appeared to be a limiting factor for a curative surgery. Surgeons therapeutics attitudes meet with changes in practice already observed in 1990, but 1/3 of surgeons still did not follow the guidelines. Chemotherapy was chosen while its efficacy has not been demonstrated.
  
  
  CONCLUSIONS
  There is few overlapping between attitudes, and optimal surgical practices. Quality of surgery, in the art of debate, may improve thanks to the rulemaking of therapeutic decisions and thanks to the evolution of the state-of-the-art among multidisciplinary committees or professional networks.
authors.affiliation: Inserm U 379, 232, boulevard Sainte-Marguerite, 13273 cedex 9, Marseille, France. arnaud@marseille.inserm.fr <arnaud@marseille.inserm.fr>
authors.forename: S
authors.initials: S
authors.lastname: Arnaud
authors.forename: G
authors.initials: G
authors.lastname: Houvenaeghel
authors.forename: C
authors.initials: C
authors.lastname: Julian-Reynier
authors.forename: V
authors.initials: V
authors.lastname: Moutardier
authors.forename: J R
authors.initials: JR
authors.lastname: Delpero
authors.forename: J P
authors.initials: JP
authors.lastname: Moatti
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003657:Decision Making; D005260:Female; D005602:France; D019983:Guideline Adherence; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*