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Introduction Sleep disturbances are commonly observed in schizophrenia and are associated with worse psychotic symptoms and poorer clinical outcomes. This has generated considerable interest in characterizing the relationship between disturbed sleep and schizophrenia. Objectives The aim of this study is to assess sleep quality in patients recently diagnosed with schizophrenia that are antipsychotic-naïve and to analyze their association with sociodemographic and clinical data in the same patient group. Methods We conducted a cross-sectional, descriptive and analytical study among patients in the psychiatry department "G" at Razi Hospital, over a period of six months. Three scales were used: the Global Assessment of Functioning (GAF) Scale, the Positive and Negative Syndrome Scale (PANSS) and the Pittsburgh Sleep Quality Index (PSQI). Results The mean age of patients was 26.8 years and 65% were male. The mean age of onset of the disease in patients included in our study was 24.8 years. The majority of patients (96.3%, n=52) were considered poor sleepers (PSQI threshold value >5). We objectified a negative and statistically significant association between patient functioning (total GAF score) and sleep quality (r= -0.277, p=0.043). The PSQI total score was positively and significantly correlated with the negative scale scores (r=0.315, p=0.021), the general psychopathology scale scores (r=0.411, p=0.002) and the PANSS total score (r=0.378, p=0.005); while no significant association was objectified with scores of the positive scale. Conclusions Our study has demonstrated a high prevalence of sleep disorders during the first episode of schizophrenia, as well as their association with the severity of symptoms. Disclosure of Interest None Declared

Introduction Substance abuse is a common problem associated with significant morbidity and mortality, but is often underdiagnosed and unrecognized in geriatric patient populations. Objectives to determine the prevalence of substance use disorders geriatricic inpatient population. Methods Data from 2010 to 2020 were retrospectively reviewed from a clinical database. 148 admissions of patients older than 60 years were identified. Descriptive statistics were used to group patients with and without a diagnosis of substance use, which included intoxication, withdrawal, abuse, dependence, and substance-induced disorders. Results There were 148 hospital admissions for patients over 60 years of age, with a mean age of 72.38 ± 5.64 years and a mean length of stay of 13.91 ± 14.15 days. Of all admissions, 44% (n=64) were associated with at least one substance use diagnosis. In this group of 64 patients, the most frequently used substance was tobacco with associated disorders ( 65% N=42). The prevalence of other substance use diagnoses was as follows: sedative-hypnotic abuse/dependence 32% (N=21), cannabis abuse 10% (N=6), alcohol-related disorder 12.5% (N=8). Compared with patients without a substance abuse diagnosis, these patients were significantly younger, had shorter lengths of stay, were less likely to be readmitted, and were more likely to be single men Conclusions Given the inherent difficulties in diagnosing substance use disorders and the retrospective nature of this study, the true prevalence of substance use disorders in elderly psychiatric inpatients is likely higher than found. Cross-sectional or cohort studies are more appropriate to shed light on this condition. Disclosure of Interest None Declared

Introduction Data on the differences between young and elderly patients with bipolar disorder and between elderly patients with early and late age of onset are limited. Objectives to study the clinical differencies between bipolar patients with an onset in old age and other bipolar patients. Methods This is a retrospective study of 420 bipolar patients. In this study, patients with onset after age 60 (n=37) were compared to other patients with early-onset bipolar (EOB) (<>50 years; n=383). Results In the year before recruitment, older patients more frequently reported a rapid course of the illness, but fewer suicide attempts , more often a single psychotropic medication and had less severe manic and psychotic symptoms, atypical antipsychotics were administered less frequently. but no difference in depressive symptomatology was observed. Conclusions Elderly bipolar patients differ from younger bipolar patients in course and treatment. Medication use and the occurrence of rapid cycling in elderly bipolar patients deserve careful investigation. Disclosure of Interest None Declared

Introduction Despite the projected growth of the geriatric population, there is currently no clear treatment framework for these patients. This treatment requires specific training for psychiatrists in the field of geriatric psychiatry. Objectives to evaluate the attitudes of psychiatric residents in Tunisia with regard to gerontopsychiatry. Methods All psychiatry residents at Razi Hospital in Tunis in April 2022 were asked to complete an anonymous online survey with questions related to previous experience with the elderly, exposure to geriatric psychiatry patients during medical school, future career plans and interest in pursuing a geriatric psychiatry rotation, and factors involved in their decision. Results 55 of 72 (76%) residents responded, of whom 63 (n=34)% were in their second year of residency. 69% (n=38) of residents reported no exposure to geriatric psychiatry patients during medical school, but of those who had, 70% (n=24) had a positive experience. Only four residents (7%) reported considering a career in geriatric psychiatry. With respect to the geriatric psychiatry curriculum, all residents felt that changes were needed in geriatric psychiatry education and career path. Conclusions Residents’ interest in further training in geriatric psychiatry is low. The most common reason is the perception of a poor prognosis for this patient population. Future studies are needed to develop strategies to increase interest in this field. Disclosure of Interest None Declared

Introduction During the course of COVID-19 pandemic, the respiratory system is the most commonly affected while many neuropsychiatric manifestations of the disease have been observed. Objectives Emphasize the importance of detecting psychiatric symptoms in patients infected with Covid 19. Methods Presentation of case report Results A 44-year-old woman with no personal history of chronic diseases and with no psychiatric family history. About her experience with covid 19, her mother died as a result of covid 19 infection and our patient had been hospitalized for 17 days for pulmonary infection covid 19, during her hospitalization in COVID 19 unit she presented insomnia and anxiety without behavioural disorders. She had a good evolution of the respiratory symptoms and she was discharged under corticotherapy and anticoagulants. She was admitted in our department after 45 days of her covid 19 infection for acute behavioural disorders. On physical examination: she was hemodynamically stable and well oriented. Neurological examination was with no abnormalities. Cerebral CT scan was normal and lumbar puncture was indicated and the analysis of the CSF did not reveal any anomalies. At the psychiatric interview she was extremely agitated, anxious and hallucinated, she had disorganised speech with derailment and neologisms, she was disinhibited and her mood was exalted. She presented also a delusion of grandeur and delusion of persecution. Conclusions In individuals presenting with COVID-19 infection, consideration should be made for psychiatric manifestations because COVID-19 diagnosis predispose vulnerable patients to psychosis. Disclosure of Interest None Declared

Introduction The diagnosis of leukemia in a child is a difficult moment for the therapist and for the parents. Nevertheless, this moment is crucial and determining in the course of care and the therapeutic relationship. Objectives Determine the quality of diagnosis announcement among mothers of children with leukemia. Methods A cross-sectional study was conducted at Aziza Othmana hospital department of haematology in Tunisia between June and July 2021. We have questioned the mothers about the announcement of the diagnosis: the space frame, the time provided and the availability of the doctor. Results We included 31 mothers, their middle age was 41 years old. Acute lymphoblastic leukemia is the most frequent type of cancer in our sample (94%). According to 4 mothers (13.3%), the diagnosis of leukemia was not announced before the start of treatment. The quality of the diagnostic announcement was judged to be good in 40% of cases (n=12), average in 12.7% (n=8) and mediocre in 20% of mothers (n=6). The space frame of the announcement was perceived as appropriate with respecting confidentiality in 18 mothers (69.2%). The time provided for the announcement was considered sufficient for 17 mothers (65.4%). The doctor who announced the diagnosis was described as available by 69.2% of the mothers and unavailable by 30.8% of the mothers. Conclusions The quality of the diagnosis announcement amoung mothers of children with leukemia in our context is not optimal. Oncologists must be trained in diagnostic announcement and must be aware of the importance of this moment in the subsequent therapeutic relationship. Disclosure of Interest None Declared

Introduction The evolution of schizophrenia with age remains poorly studied. The prevalence of negative symptoms in elderly people with schizophrenia is even less described in the literature. Objectives to evaluate the prevalence of remission of negative symptoms in the elderly and to study the sociodemographic and clinical variables associated with this remission. Methods The sample consisted of 83 subjects aged 55 years and over, followed at the psychiatry department "G" of the Razi hospital in Tunis and suffering from schizophrenia according to the DSM5 criteria. Global remission was defined as a score below 4 on the seven negative symptom items of the PANSS. A questionnaire was administered to each patient to collect epidemiological and anamnestic data. Results 59% of the sample showed remission of global negative symptoms. 84% and 60% were in remission on the emotional and cognitive subscales, respectively. The existence of remission was correlated with lower PANSS global score, more preserved cognitive functioning, later age of onset, more family and social support, and the absence of a concomitant somatic illness. Conclusions This study showed that measures to optimize treatment of positive symptoms and cognitive functioning may have an impact on negative symptoms. Similarly, quality of social network in later life impacts the level of negative symptoms. Disclosure of Interest None Declared

Introduction Announcing a diagnosis of leukemia is a difficult process, especially for a vulnerable population of children. Objectives Determine the attitude of caregivers in the announcement of diagnosis of leukemia among children. Methods A cross-sectional study was conducted at Aziza Othmana hospital department of haematology in Tunisia between June and July 2021. We have questioned the mothers about the announcement of the diagnosis of leukemia to their children. Results We included 31 children with leukemia, 71% of these children were male. Their average age was 10 years ±4.5 with extremes from 4 to 17 years of age. The majority of the children (80.6%) were of school age. The three children who were six years old were not able to integrate into a school and fifteen children stopped their studies because of their disease. Acute lymphoblastic leukemia was the most frequent type of cancer (94%). Fifty five per cent (55%) of these children were not informed of their disease according to their mothers. Conclusions The provision of adapted information, through individualized assessments of each child’s needs, can contribute to the improvement of the child’s experience of the disease. Disclosure of Interest None Declared

Introduction Patients with chronic schizophrenia experience significant disturbances in the quality and quantity of their sleep and it had been mainly attributed to severity of symptoms and antipsychotic use. Recent studies suggested that antipsychotic-naïve early course patients with schizophrenia and their non-psychotic first-degree relatives also show altered sleep quality. Objectives In this study we aimed to compare sleep parameters in antipsychotic-naive first-episode schizophrenia patients to their healthy siblings and age- and sex-matched healthy controls. Methods We conducted a cross-sectional, descriptive case-control study in the Psychiatry « G » department at Razi Hospital, for a period of six months. Our sample consisted of three groups: a group of schizophrenic patients, a group of their healthy siblings and a group of healthy controls. The three groups were matched by age and sex. The Positive and Negative Syndrome Scale (PANSS) was used to assess the severity of symptoms in patients with schizophrenia. The Morningness-Eveningness Questionnaire (MEQr), Epworth Sleepiness Scale (ESS), and Pittsburgh Sleep Quality Index (PSQI) were used in the three groups to assess Circadian preference, daytime sleepiness and sleep quality. Results There was no significant difference between the groups regarding the chronotype. Patients had significantly higher daytime sleepiness compared to siblings (p=0.001) and controls (p

Introduction Psychiatric admissions of elderly subjects with mental disorders is a difficulty in management and treatment. This problem is essentially related to somatic comorbidities of this population. Objectives To compare the demographic characteristics, comorbid conditions and functional status of younger and older individuals with major mental illnesses admitted to psychiatry. Methods Using the records of patients admitted between 2015 and 2020 to the psychiatric department "G" of Razi Hospital, we collected the demographic characteristics, comorbid conditions and functional impairments for patients admitted to psychiatry and aged over 65 years. We compared these characteristics to those collected in the total population of admitted patients. Results The study population consisted of 75 elderly patients. Compared to the youngest patients there was a greater male majority, a higher rate of severe cognitive impairment, higher rates of chronic medical illnesses, such as congestive heart failure. Conclusions Our findings suggest an urgent need for integrated psychiatric and medical care for elderly subjects with major mental illness. Future research is needed to adapt evidence-based integrated models of collaborative mental health care. Disclosure of Interest None Declared

Introduction Charles Bonnet Syndrome (CBS) is an age-related disorder characterized by complex visual hallucinations in older persons with vision loss and underlying ocular pathology. The management of these symptoms is imprecise and combines psychological measures with psychotropic drugs. Objectives to discuss the non-pharmacological management of Bonnet syndrome through a case report. Methods We report a case of atypical CBS in a 76-year-old male patient presenting with visual and auditory hallucinations that were improved by reassurance. Results The past medical history was significant for diabetic retinopathy, difficulty hearing due to bilateral sensorineural hearing loss. He recognized these visions as unreal and felt distressed by them. No cognitive impairment was observed on several neuropsychological tests. He was reassured of the false nature of the visual experiences after explanations that he had no mental illness and that the problem could disappear. He was taught how to keep the images away by closing his eyes for sometimes and repeated blinking. After six weeks of psychological intervention, the visual experiences had disappeared without using any drug Conclusions In the management of CBS drug treatments remain partially satisfactory. Nonpharmacological interventions focus on the reduction of the visual pathway deprivation. This therapeutic alternative seems to provide positive benefits. Disclosure of Interest None Declared

Introduction Nowadays, the smartphone use is increasing, similar is the trend among medical students and professionals. The problematic use of mobile phone has become a major public health concern as it may lead to its addiction and other disorders such as sleep disorders, depression and decreased life satisfaction. Objectives This study aims to determine the association between mobile phone usage, Insomnia and depressive symptoms among medical students and medical professionals. Methods We conducted a descriptive and analytical study among 40 medical students and doctors. They were asked to fill out an anonymous online survey. Problematic Use of Mobile Phones (PUMP) scale was used to assess mobile phone usage. Insomnia Severity Index (ISI) was used to screen for insomnia and the Patient Health Questionnaire-9 (PHQ-9) to screen for depression. Results The mean age of participants was 27,8 years, with a sex ratio of 1/3. The mean of the duration of mobile phone use was 3.4 hours per day. We found that 77% of participants spend most of their time on social media (Facebook, Instagram, Tik Tok) when using their mobile phones. In our study, participants with higher problematic use of mobile phone (PUMP) score were significantly more likely to present symptoms of insomnia (p=0.031) and depression (p=0.023) according to ISI and PHQ-9 scales. Furthermore, a significant association was found between the duration of mobile phone use, Insomnia and depression. In fact, the Odds Ratio (OR) of Insomnia was 1.66 in participants who used mobile phone more than 2 hours per day compared to those who used mobile phone < 2 hours per day. Similarly, the OR of depressive symptoms was significantly increased with prolonged mobile phone use (>= 2 hours per day) compared to those who used it

Introduction During the course of COVID-19 pandemic, The respiratory system is the most commonly affected while many neuropsychiatric manifestations of the disease have been observed. Objectives Emphasize the importance of eliminating the diagnosis of covid 19 infection in a pandemic context face to first episode psychosis. Methods Presentation of case report Results A 29-year-old woman unemployed married with no personal medical history and with psychiatric family history. She wasn’t exposed to subject with covid 19 in her family circle. She was admitted in psychiatric care for acute behavioural disorders during five days. On physical examination: she was afebrile, eupneic and tachycardiac. Oxygen saturation was 96% and blood pressure was 100/50 mmHg. Specialized neurological examination was normal and cerebral CT scan was without abnormalities. At the psychiatric interview she was extremely agitated. She was distressed her speech was incoherent. She had auditory and visual hallucinations and a multi-thematic delirium. One day after her admission she died suddenly, the autopsy found positive RT PCR covid test and bilateral basal pneumonia. Conclusions In individuals presenting with new-onset psychosis in areas endemic to COVID-19, consideration should be made for neuropsychiatric manifestations of Covid 19 from where the importance to push the explorations and to test the patients. Disclosure No significant relationships.

Introduction Bipolar disorder is a frequent and particularly severe psychiatric pathology that causes significant morbidity and mortality. The rapid cycling forms are more severe in terms of their expression, evolutionary course, therapeutic responses and associated comorbidities. Objectives The aim of this study is to conduct a descriptive assessment of therapeutic characteristics in patients with rapid cycling bipolar disorder. Methods Our work involved a population of 97 patients followed for bipolar disorder diagnosed according to DSM5 criteria, including 37 patients meeting the specification “with rapid cycles”. The patients were divided into two groups: - Group of patients with bipolar disorder with rapid cycles (TBCR) - Group of patients with bipolar disorder without rapid cycling (TBNCR). We compared the therapeutic features among these two groups. Results The dominant polarity was depressive in patients with rapid cycles. They required more mood stabilizers. A greater proportion of them had received treatment with serotonin reuptake inhibitor antidepressants. They were more likely to use hypnotics such as antihistamines and zolpidem. Conclusions Rapid cycling TB is a relatively common clinical modality that should be investigated and identified.The use of antidepressants is associated with this course of the disease. Their utilization in the treatment of bipolar depression must be thoughtful and well studied Disclosure No significant relationships.

Introduction The epidemic of COVID-19 has affected the psychological health of people, especially frontline medical and paramedical staff. Several coping strategies have been used to combat the impact of this virus on their lives. Objectives Describe the impact of coronavirus on mental health and identify coping strategies Methods We carried out a cross-sectional, descriptive and analytical study, conducted over a period of two months ( september and october 2020), in 22 hospitals in Tunisia, including frontline medical and paramedical staff. To evaluate anxiety and depression, we used the Beck Inventory. To identify coping strategies, we used the Brief COPE. Results We collected 78 professionals. The mean age was 29.86+-5.4. The majority were medical residents (67.9%) working in covid units in 39.7% of cases. The rythm of work was daily in almost half of the cases, giving direct care to the patients tested positive in 76.9%. More than half had not received adequate training, and protective equipment was available in only 50% of cases. We found 35.9% of the staff who had to move for fear of infecting their families. More than half of the frontline staff were victims of stigma (57.7%). Depression and anxiety were tested minor in 40%. The most used coping strategy in the face of this distressing virus was social support (64.1%) followed by emotion-focused mechanisms (53,8%). Social support strategy was significantly correlated with prevention of anxiety (p=0.048) Conclusions Participants practiced and recommended various coping strategies to deal with stress, depression and anxiety emerging from COVID-19 pandemic. Disclosure No significant relationships.

Introduction The diagnosis of leukemia in a child is traumatic life experience that negatively affects parents and especialy the mother which is the “caregiver” who assists and coordinates all stages of treatment. Objectives To determine the prevalence of psychological distress among mothers of tunisian children with leukemia and to investigate their coping strategies. Methods A cross-sectional study was conducted at Aziza Othmana hospital department of pedo-oncology in Tunisia between June and July 2021. HADS scale was used to estimate the prevalence of anxiety and depression and coping strategies were measured via arabic version of the brief cope scale. Results We included 31 mothers, their middle age was 41 years old. In this study we didn’t include mothers with psychiatric history. Acute lymphoblastic leukemia was the most frequent type of cancer in our sample (94%). The middle age of the children was 10 years old and all of them were under chemotherapy. Clinically significant levels of anxiety and depression were reported by 58% and 49% of mothers, respectively. In our study, 81% of the participants practiced prayer and all mothers turned to religion as a coping strategy. Approach coping styles (especially acceptance and planning) were more frequently used than avoidant coping styles (especially substance use and denial). Conclusions Mothers are profoundly affected by a child’s cancer diagnosis, they should have early assessment of their mental health needs to have access to appropriate interventions. Disclosure No significant relationships.

Introduction Antisocial personality disorder (ASPD) is characterized by a long term pattern of disregard for, or violation of the rights of others that occurs in childhood or early adolescence and continues into adulthood. This disorder remains unknown in women. Objectives The aim of this study was to describe socio-demographic, clinical, psychometric and therapeutic characteristics of women with ASPD hospitalized in psychiatric ward. Methods A cross-sectional and descriptive study was conducted in G psychiatry department, in Razi hospital. It included 20 women with ASPD and hospitalized in psychiatric ward. Socio-demographic, clinical and therapeutic characteristics were assessed. A psychometric evaluation was carried out by the application of six scales: BIS 11, HCR 20, VRAG, PCL-R, ENFP and PID5-BF. Results The mean age of the patients was 34 ± 9 years. Patients with a personal history of suicide attempt accounted for 45% of the study population. Patients with a criminal history accounted for 67.5% of the study population. A substance-related disorder was found in 85% of the patients. Adjustment Disorder was retained in 42.5% of the patients and Psychotic Disorder was diagnosed in 32.5% of the population. The average score at VRAG was 6.18 ± 5.8. The mean score at PCL R was 24 ± 4.2. High impulsivity scores were found. Conclusions ASPD represents a major concern for clinicians in psychiatric wards. A better knowledge of the characteristics of this trouble in women could improve their quality of care. Disclosure No significant relationships.

Introduction Anxiety has become a topical issue since the arrival of the coronavirus pandemic, especially for frontline healthcare professionals as they deal with patients affected by the Covid-19. Objectives Objectify anxiety in frontline medical and paramedical staff and study its associated factors. Methods We conducted a national descriptive and analytical cross-sectional study via a survey over a 2-month period from September to October 2020. We used “Beck Anxiety Inventory” to screen anxiety as well as “Brief Cope Scale” to detect probable correlations between anxiety and coping mechanisms. Results We collected 78 persons. The mean age was 29.86 years. 35.9% moved out of home. 39.7% worked in Covid units. 7.7% had personal psychiatric history. 76.9% provided direct care to patients with Coronavirus. The frontline staff reported that only 29.5% of patients were stables. Only 48.4% received adequate training of protection against Covid-19. 64.1% of professionals did PCR test and only 16.7% of them tested positive. We objectified an increase of 6.4% in the anxiolytics use. Stigma affected 57.7% of professionals. We highlighted a link between anxiety and social support strategy (p=0.048). 92.3 % of the staff suffered from anxiety according to Beck Anxiety Inventory. Conclusions Screening anxiety among frontline medical and paramedical staff might enhance their productivty and thus provide patients with the best care. Disclosure No significant relationships.

Introduction Tinnitus is an auditory perception of a “phantom” nature with highly changing features. There is an established correlation between anxiety, depression, sleep disorders and tinnitus. Objectives To evaluate the prevalence of sleep disorders and emotional disorders during tinnitus and their correlation to the severity of the symptomatology Methods A descriptive cross-sectional study of 60 patients consulting for subjective tinnitus. For each patient we collected epidemiological data and performed an ENT and general examination, an audiometric and psychoacoustic evaluation and a psychometric evaluation. To evaluate the severity of the tinnitus we used the visual analog scale VAS and the subjective tinnitus severity test (STSS). Disability was assessed by the Tinnitus Handicap Inventory (THI). Anxiety and depression were assessed by: the Hamilton anxiety Rating scale and the Beck depression inventory. Results The prevalence of emotional disorders was: 21.7% for depression, 48.33% for generalized anxiety disorder, 11.67% for dysthymia, 5% for agoraphobia 16.67% for panic disorder and 1.67% for social phobia. The intensity of tinnitus was correlated with more panic disorder (p=0.008). Subjective severity of tinnitus was correlated with disability (p=0.0001), awareness of tinnitus in relation to sleep duration (p=0.006) and disturbed sleep (p=0.047). Disability was correlated with subjective tinnitus severity (p=0.0001), panic disorder (p=0.0007), generalized anxiety disorder (p=0.033), and poor sleep quality (p=0.005). Conclusions Our results emphasize the importance of emotional disorders as well as sleep disorders in chronic “tinnitus”. These disorders should be systematically investigated and eventually treated in order to optimize the management of the patients. Disclosure No significant relationships.

Introduction Marfan syndrome is an autosomal dominant systemic disorder with connective tissue defects in multiple organ systems. Cardinal manifestations of this syndrome involve the cardiovascular, the skeletal and the ocular system. Interestingly, many cases of patients with Marfan syndrome and schizophrenia have been reported. Objectives Discuss the etiological link between Marfan syndrome and schizophrenia Methods Presentation of a clinical case illustrating the comorbidity between schizophrenia and marfan syndrome. A search was conducted in PubMed database using the terms : schizophrenia AND Marfan syndrome. Results Ms JW a 36-year- old single women, she had schizophrenia since the age of 20 years, she was hospitalized in our service for psychotic relapse in a context of treatment discontinuation. She had a personal history of persistence of the ductus arteriosus for which she had been operated during her childhood, a scoliosis operated and multiple pathological fractures. On mental status examination, she was distressed and hallucinated, She had disorganized thought processes and a paranoid delirium. On physical examination, she had features suggestive of Marfan syndrome such as crowded teeth, a high arched palate, arachnodactyly , hyperlaxity and a high myopia. We don’t dispose genetic evaluation for marfan syndrom because of the nonavaibility of facilities to perform genetic analysis. Several studies have indicated that psychiatric symptoms might be part of the clinical profiles of marfan syndrom. However, their relationship and underlying pathogenesis are not easily clarified. Conclusions Co-occurrence of marfan syndrom and schizophrenia might be explained by some shared etiological pathways between both disorders. Disclosure No significant relationships.

Introduction The current coronavirus pandemic is a unique and unusual situation. It is putting the general population under severe strain. However, frontline medical and paramedical staff remain particularly vulnerable to depression because of its close contact with patients. Objectives The aim of this work was to screen and evaluate depression in the frontline professionals during the pandemic and to study their associated factors . Methods In this study , we conducted a national descriptive and analytical cross-sectional study over a 2-month period from September to October 2020. We used “Beck Depression Inventory” to assess depression and “Brief Cope Scale” to detect a possible correlation between depression and coping mechanisms. Results We collected 78 professionals. The mean age was 29.86 years. 2/3 of workers were women. 67.9% of the staff were residents. 39.7% worked in Covid units. 7.7% had personal psychiatric history. 56.4% of the staff worked daily and 76.9% of them provided direct care to patients with Coronavirus. 52.6% of workers did not receive adequate training of protection against Covid-19.The staff reported 66.7% of death among their patients. 42.3% suffered from minor depression and only 2.3% suffered from severe depression. During this period we objectified an increase of 14.1% in the psychoactive substances use. Stigma affected 57.7% of professionals. We didn’t objectify a significant correlation between Depression and coping mechanisms . Conclusions Screening depression among healthcare professionals should be considered in order to prevent it, ensure continuity of care and avoid sick leaves. Disclosure No significant relationships.

Introduction Mental disorders of pregnancy or postpartum correspond to all the psychopathological states linked to the period of the pregnancy-puerperium. They are the subject of prevention and screening and are currently a public health priority Objectives Describe the socio-demographic characteristics of the patients who presented mental disorders during pregnancy and/or postpartum. Identify the various risk factors predisposing to these disorders Methods We carried out a retrospective descriptive analytical study including patients who presented mental disorders during their pregnancy or postpartum and who were hospitalized during the period from January to October 2020.We collected 20 patients. Results The average age was 39.84 years. Mental disorders were present in 73.7% during the postpartum period. The patients had a personality disorder in 47.7%. They were smokers in 57% of cases. Pregnancy was desired in 73.7% with regular follow-up in 84.2%. Pregnancy was complicated by toxemia in 22% of cases and gestational diabetes in 27% of cases. Delivery was by caesarean section in 68.4% with primiparity in 50%. According to the DSM5, the psychic disorder most often found during pregnancy was the characterized depressive disorder 43%, and during the postpartum we found the brief psychotic episode 42.1%. The treatment was in half of the cases association between antidepressants and antipsychotics. Mental disorders were significantly correlated with the presence of stressful life events during pregnancy (p =0.02) Conclusions Mental disorders during pregnancy and postpartum are frequent and important to detect. Early diagnosis and adequate care are the two essential elements that should allow these women to fully experience their motherhood

Introduction Bipolar disorder is a frequent and serious psychiatric disease. Antipsychotics are habitually required for its management especially during an acute manic episode. The association of cancer with bipolar disorder may impact psychiatric management. The choice of the adequate antipsychotic drug remains a challenge in this case. The clinical benefit of tamoxifen is obtained after the hepatic metabolism with cytochrome P450 2D6 which generates endoxifen, the potent metabolite of tamoxifen. Evidence has emerged that antipsychotics may potentially inhibit the CYP2D6. Study data supporting this interaction are rare. Objectives In this work, we aimed to illustrate the modalities of care of bipolar disorder in a patient receiving tamoxifen. Methods Presentation of a clinical case of a patient treated by Tamoxifen for her breast cancer and who was admitted in our department for acute mania with psychotics features, followed by a literature review. Results A 53-year-old woman with past history of breast cancer diagnosed in 2018, treated with lumpectomy and radiation, followed by tamoxifen. She has been admitted in 2019 in our department for an acute mania with psychotics features. Olanzapine was prescribed with good clinical evolution. The psychiatric and oncologic status of the patient was stable after one year under tamoxifen and olanzapine. Conclusions Psychiatrists must be aware that some of the prescribed medications co-administered with tamoxifen interfere with the CYP2D6 function, which may potentially increase the risk of breast cancer recurrence. A close collaboration between psychiatrists and oncologists is required to adapt therapeutic protocols.

Introduction Tamoxifen is an antioestrogen agent used in breast cancer treatment. According to some guidelines, this molecular was also proposed for the treatment of acute mania. In fact, Tamoxifen inhibits the intracellular action of the protein kinase C (PKC), which is the direct target in the treatment of mania episodes. Lithium and valproate have also the same action. Objectives We aimed to show the case of an acute mania under an inhibitor PKC treatment and insisted that other studies are recommended. Methods Case report description and research on medline, pubmed with the keywords: Tamoxifen, Bipolar disorder, protein kinase C,mania. Results We reported a case of a 53-year-old woman with past history of unipolar depression. In 2018 when she was diagnosed with breast cancer. She received antidepressant drugs but she interrupted the treatment after a few months. She was treated for her breast cancer with mastectomy, radiotherapy, and 20 mg per day of Tamoxifen prescribed since Mars 2018. She had been admitted in June 2019 in our department for acute mania. The patient received Tamoxifen as it was prescribed. She was not taking any concomitant medications. No history of drug abuse was reported. Medical examination, laboratory, and radiological investigations did not indicate any medical pathology. Conclusions In our case, Tamoxifen had not ovoid the acute mania in spite of its Known anti-manic properties as reported in the literature. Possible neurobiological effect of tamoxifen on the nervous system should be studied to evaluate the safety of this treatment mainly in patients with bipolar disorder.

Aim: Laparoscopic surgery is widely used for small gastric gastrointestinal stromal tumors (GISTs) (≤ 5 cm) but remains a controversial approach for larger gastric GISTs (> 5 cm). This study aims to compare short- and long-term outcomes of laparoscopic resection in comparison with open resection for gastric GISTs measuring over 5 cm., Method: All patients receiving surgery for gastric GIST > 5 cm between 2000 and 2021 in a single tertiary hospital were included. Data were collected from prospectively maintained records. Kaplan-Meier method and log rank test were used to compare survival outcomes., Results: Among 108 included patients, 59 patients had minimally invasive (MI) surgery (54.6%) whereas 49 patients had open surgery (46.4%). The rate of overall postoperative morbidity was 14.8% and the median length was significantly shorter in the MI group [4 (range 2-30) vs. 7 (range 4-33) days; P = 0.007]. The overall R0 resection rate was 98.2% and the rate of tumor rupture was 13%, not different between the two groups. Recurrence occurred in 24% of the whole population without any difference between groups (20.3% vs. 28.7%, p = 0.31). Minimally invasive surgery was not found as a negative prognostic disease-free survival factor., Conclusion: Laparoscopic surgery could be a safe and feasible alternative to open surgery in large gastric GIST, bringing the benefits of minimally invasive surgery without compromising oncologic results., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

The treatment of superficial rectal cancers (local excision, or proctectomy with total mesorectal excision (TME) remains controversial. Endoscopy and endorectal ultrasonography are essential for the precise initial definition of these small cancers. During endoscopy, the depth of the lesion can be estimated using virtual chromoendoscopy with magnification, thereby aiding the assessment of the possibilities of local excision. Current international recommendations indicate completion proctectomy after wide local excision for cases where the pathologic examination reveals poorly-differentiated lesions, lymphovascular invasion, grade 2 or 3 tumor budding, and incomplete resection. But debate persists regarding whether the depth of submucosal invasion can accurately predict the risk of lymph node spread. Recent data from the literature suggest that the depth of submucosal invasion should no longer, by itself, be an indication for additional oncological surgery. Adjuvant radio-chemotherapy could be an alternative to completion proctectomy in patients with pT1 rectal cancer and unfavorable histopathological criteria. A Dutch randomized controlled trial is underway to validate this strategy., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: In the decision to perform elective surgery, it is of great interest to have data about the outcomes of surgery to individualize patients who could safely undergo sigmoid resection. The aim of this study was to provide information on the outcomes of elective sigmoid resection for sigmoid diverticular disease (SDD) at a national level., Methods: All consecutive patients who had elective surgery for SDD (2010-2021) were included in this retrospective, multicenter, cohort study. Patients were identified from institutional review board-approved databases in French member centers of the French Surgical Association. The endpoints of the study were the early and the long-term postoperative outcomes and an evaluation of the risk factors for 90-day severe postoperative morbidity and a definitive stoma after an elective sigmoidectomy for SDD., Results: In total, 4617 patients were included. The median [IQR] age was 61 [18.0;100] years, the mean ± SD body mass index (BMI) was 26.8 ± 4 kg/m 2 , and 2310 (50%) were men. The indications for surgery were complicated diverticulitis in 50% and smoldering diverticulitis in 47.4%. The procedures were performed laparoscopically for 88% and with an anastomosis for 83.8%. The severe complication rate on postoperative day 90 was 11.7%, with a risk of anastomotic leakage of 4.7%. The independent risk factors in multivariate analysis were an American Society of Anesthesiologists (ASA) score ≥ 3, an open approach, and perioperative blood transfusion. Age, perioperative blood transfusion, and Hartmann's procedure were the three independent risk factors for a permanent stoma., Conclusions: This series provides a real-life picture of elective sigmoidectomy for SDD at a national level., Trial Registration: Comité National Information et Liberté (CNIL) (n°920361)., (© 2024. Springer Nature Switzerland AG.)

Purpose: No biomarker capable of improving selection and monitoring of patients with rectal cancer managed by watch-and-wait (W&W) strategy is currently available. Prognostic performance of the Immunoscore biopsy (IS B ) was recently suggested in a preliminary study., Methods: This international validation study included 249 patients with clinical complete response (cCR) managed by W&W strategy. Intratumoral CD3+ and CD8+ T cells were quantified on pretreatment rectal biopsies by digital pathology and converted to IS B . The primary end point was time to recurrence (TTR; the time from the end of neoadjuvant treatment to the date of local regrowth or distant metastasis). Associations between IS B and outcomes were analyzed by stratified Cox regression adjusted for confounders. Immune status of tumor-draining lymph nodes (n = 161) of 17 additional patients treated by neoadjuvant chemoradiotherapy and surgery was investigated by 3'RNA-Seq and immunofluorescence., Results: Recurrence-free rates at 5 years were 91.3% (82.4%-100.0%), 62.5% (53.2%-73.3%), and 53.1% (42.4%-66.5%) with IS B High, IS B Intermediate, and IS B Low, respectively (hazard ratio [HR; Low v High], 6.51; 95% CI, 1.99 to 21.28; log-rank P = .0004). IS B was also significantly associated with disease-free survival (log-rank P = .0002), and predicted both local regrowth and distant metastasis. In multivariate analysis, IS B was independent of patient age, sex, tumor location, cT stage (T, primary tumor; c, clinical), cN stage (N, regional lymph node; c, clinical), and was the strongest predictor for TTR (HR [IS B High v Low], 6.93; 95% CI, 2.08 to 23.15; P = .0017). The addition of IS B to a clinical-based model significantly improved the prediction of recurrence. Finally, B-cell proliferation and memory in draining lymph nodes was evidenced in the draining lymph nodes of patients with cCR., Conclusion: The IS B is validated as a biomarker to predict both local regrowth and distant metastasis, with a gradual scaling of the risk of pejorative outcome.

Objectives: Little is known about how to perform the endoscopic ultrasound (EUS)-directed transgastric endoscopic retrograde cholangiopancreatography (ERCP; EDGE) in patients with gastric bypass using lumen-apposing metal stents (LAMS). The aim was to assess the risk factors of anastomosis-related difficult ERCP., Methods: Observational single-center study. All patients who underwent an EDGE procedure in 2020-2022 following a standardized protocol were included. Risk factors for difficult ERCP, defined as the need of >5 min LAMS dilation or failure to pass a duodenoscope in the second duodenum, were assessed., Results: Forty-five ERCPs were performed in 31 patients (57.4 ± 8.2 years old, 38.7% male). The EUS procedure was done using a wire-guided technique (n = 28, 90.3%) for biliary stones (n = 22, 71%) in most cases. The location of the anastomosis was gastro-gastric (n = 24, 77.4%) and mainly in the middle-excluded stomach (n = 21, 67.7%) with an oblique axis (n = 22, 71%). The ERCP technical success was 96.8%. There were 10 difficult ERCPs (32.3%) due to timing (n = 8), anastomotic dilation (n = 8), or failure to pass (n = 3). By multivariable analysis adjusted by two-stage procedures, the risk factors for a difficult ERCP were the jejuno-gastric route (85.7% vs. 16.7%; odds ratio [OR a ] 31.875; 95% confidence interval [CI] 1.649-616.155; P = 0.022), and the anastomosis to the proximal/distal excluded stomach (70% vs. 14.3%; OR a 22.667; 95% CI 1.676-306.570; P = 0.019). There was only one complication (3.2%) and one persistent gastro-gastric fistula (3.2%) in a median follow-up of 4 months (2-18 months), with no weight regain (P = 0.465)., Conclusions: The jejunogastric route and the anastomosis with the proximal/distal excluded stomach during the EDGE procedure increase the difficulty of ERCP., (© 2023 The Authors. Digestive Endoscopy published by John Wiley & Sons Australia, Ltd on behalf of Japan Gastroenterological Endoscopy Society.)

For early distal gastric cancers, a proximal margin (PM) > 2-3 cm might probably be sufficient. For advanced tumors, many confounding factors have a prognostic impact on survival and recurrence and negative margin involvement may be more relevant than negative margin length., Introduction: In gastric cancer surgery, microscopic positive margin is a poor prognostic factor whereas complete resection with tumor-free margins remains a challenging issue. European guidelines recommended a macroscopic margin of 5 or even 8 cm for diffuse-type cancers to achieve R0 resection. However, it is unclear if the length of negative proximal margin (PM) could have a prognostic impact on survival. We aimed to perform a systematic review of the literature analyzing PM length and its prognostic impact in gastric adenocarcinoma., Material and Methods: Pubmed and Embase databases were searched for "gastric cancer" or "gastric adenocarcinoma," combined with "proximal margin," between January 1990 and June 2021. English-written studies that specified PM length were included. Survival data, in relation to PM, were extracted., Results: Twelve retrospective studies, with a total number of 10,067 patients, met inclusion criteria and were analyzed. Mean length of proximal margin on the whole population varied from 2.6 to 5.29 cm. Three studies found minimal PM cut-off to improve overall survival in univariate analysis. Concerning recurrence-free survival analysis, only 2 series showed better results with PM > 2 or > 3 cm, using Kaplan-Meier method. Multivariate analysis demonstrated an independent impact of PM on overall survival in 2 studies., Conclusion: For early distal gastric cancers, a PM > 2-3 cm might probably be sufficient. For advanced or proximal tumors, many confounding factors have a prognostic impact on survival and recurrence and negative margin involvement may be more relevant than negative margin length., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Treating older adults with cancer is increasingly important in modern oncology practice. However, we currently lack the high-quality evidence needed to guide optimal management of this heterogeneous group. Principally, historic under-recruitment of older adults to clinical trials limits our understanding of how existing evidence can be applied to this group. Such uncertainty is particularly prevalent in the management of colon cancer (CC). With CC being most common in older adults, many patients also suffer from frailty, which is recognised as being strongly associated with poor clinical outcomes. Conducting clinical trials in older adults presents several major challenges, many of which impact the clinical relevance of results to a real-world population. When considering this heterogeneous group, it may be difficult to define the target population, recruit participants effectively, choose an appropriate trial design, and ensure participants remain engaged with the trial during follow-up. Furthermore, after overcoming these challenges, clinical trials tend to enrol highly selected patient cohorts that comprise only the fittest older patients, which are not representative of the wider population. FOxTROT1 was the first phase III randomised controlled trial to illustrate the benefit of neoadjuvant chemotherapy (NAC) in the treatment of CC. Patients receiving NAC had greater 2-year disease-free survival compared to those proceeding straight to surgery. Outcomes for older adults in FOxTROT1 were similarly impressive when compared to their younger counterparts. Yet, this group inevitably represents a fitter subgroup of the older patient population. FOxTROT2 has been designed to investigate NAC in a full range of older adults with CC, including those with frailty. In this review, we describe the key challenges to conducting a robust clinical trial in this heterogeneous patient group, highlight our strategies for overcoming these challenges in FOxTROT2, and explain how we hope to provide clarity on the optimal treatment of CC in older adults., Competing Interests: Disclosure ZC has received grants from Celgene, MSD, Amgen, and Takeda (via institution). MS has received a grant from Yorkshire Cancer Research to support provision of a clinical trial (via institution). MB has received payment/honoraria from Laboratoires Pierre Fabre, Amgen, and Servier, is Co-lead of Audit for the National Bowe Cancer Audit (England and Wales), and author of the National Institute for Health and Care Excellence (NICE) Colorectal Cancer Guideline. JR has received grants from Bristol Meyers Squibb, Laboratoires Pierre Fabre, Servier, HUB Organoids, and Cleara Biotech (via institution), consulting fees from Bayer, Bristol Meyers Squibb, Merck-Serono, Laboratoires Pierre Fabre, and Servier (via institution), payment/honoraria from Bristol Meyers Squibb, Laboratoires Pierre Fabre, and Servier (via institution), and support for attending meetings from Servier. JR is also a member of advisory boards for the PelvEx and MEND-IT trials, and a member of the ONCODE clinical advisory board. CP has received consulting fees from Nordic Pharma (via institution). JT has received payment/honoraria from Astellas Pharma Inc., Bristol Meyers Squibb, MSD, Merck & Co., Roche, Laboratoires Pierre Fabre, Novartis, and Servier, support for attending meetings from Laboratoires Pierre Fabre, MSD, and Servier, and is a member of advisory boards for Bristol Meyers Squibb, MSD, Merck & Co., Roche, Laboratoires Pierre Fabre, Novartis, and Servier. JB has received grants from Cancer Research UK, the National Institute for Health and Care Research, Medical Research Council, and Roche, and is Chair of the advisory board for the NIHR By-Band-Sleeve trial and the NIHR Health Technology Assessment General Funding Committee. DAC has received grants from Yorkshire Cancer Research (via institution) and support for attending meetings from Celgene. JFS has received consulting fees from Seagen, payment/honoraria from Laboratoires Pierre Fabre, Merck-Serono, and Servier, and support for attending meetings from Servier and Bristol Meyers Squibb. JFS is also a member of advisory boards for Elevation Oncology, Laboratoires Pierre Fabre, and Zentalis Pharmaceuticals. JFS, JB, and DM have received support from Yorkshire Cancer Research for the FOxTROT 2 trial, on which this manuscript is based (via institution). All other authors have declared no conflicts of interest., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Over the past decades, liver cancer's minimally invasive approach has primarily become as a new standard of oncological care. Colorectal liver metastases (CRLM) are one of the most developed indications of laparoscopic liver resection (LLR). CRLM resection is still the best treatment known in terms of survival. As multiple CRLM are found in up to 80% of cases at diagnosis (Manfredi S. and al, Annals of Surgery 2006), a lot of possible technical management approaches are described. With the development of the parenchymal-sparing strategy, multiple concomitant laparoscopic liver resections (LLR) are gaining acceptance. However, no recommendation is available regarding its indications and feasibility. Also, laparoscopic two-stage hepatectomy is developing for bilobar CRLM, and this also does not have established recommendation. The purpose of this paper was to highlight novelty and updates in the field of multiple minimally invasive liver resections. A review of the international literature was performed. The feasibility of laparoscopic concomitant multiple LLR and two-stage hepatectomy for CRLM as well as their outcomes were discussed. These clarifications could further guide the implementation of minimal resection in multiple colorectal liver metastases therapies.

Objective: To describe the management of pathogenic CDH1 variant carriers (pCDH1vc) within the FREGAT (FRench Eso-GAsTric tumor) network. Primary objective focused on clinical outcomes and pathological findings, Secondary objective was to identify risk factor predicting postoperative morbidity (POM)., Background: Prophylactic total gastrectomy (PTG) remains the recommended option for gastric cancer risk management in pCDH1vc with, however, endoscopic surveillance as an alternative., Methods: A retrospective observational multicenter study was carried out between 2003 and 2021. Data were reported as median (interquartile range) or as counts (proportion). Usual tests were used for univariate analysis. Risk factors of overall and severe POM (ie, Clavien-Dindo grade 3 or more) were identified with a binary logistic regression., Results: A total of 99 patients including 14 index cases were reported from 11 centers. Median survival among index cases was 12.0 (7.6-16.4) months with most of them having peritoneal carcinomatosis at diagnosis (71.4%). Among the remaining 85 patients, 77 underwent a PTG [median age=34.6 (23.7-46.2), American Society of Anesthesiologists score 1: 75%] mostly via a minimally invasive approach (51.9%). POM rate was 37.7% including 20.8% of severe POM, with age 40 years and above and low-volume centers as predictors ( P =0.030 and 0.038). After PTG, the cancer rate on specimen was 54.5% (n=42, all pT1a) of which 59.5% had no cancer detected on preoperative endoscopy (n=25)., Conclusions: Among pCDH1vc, index cases carry a dismal prognosis. The risk of cancer among patients undergoing PTG remained high and unpredictable and has to be balanced with the morbidity and functional consequence of PTG., Competing Interests: The authors report no conflicts of interest., (Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.)

Colorectal cancer management has been dramatically impacted by molecular profiling these last years. Among these molecular subgroups, patients with microsatellite instability (MSI) are of particular interest, owing to the prognostic and predictive value of this tumor biomarker. This review article explains the molecular abnormalities underlying MSI phenotype and the consequences of such molecular abnormalities on carcinogenesis, genetic instability and immune infiltration. It details the diagnostic methods for identifying MSI colorectal cancer patients and describes how the prognostic and theranostic values of this marker are impacting treatment decision-making for these patients in 2022., Competing Interests: Declaration of Competing Interest Clémence Flecchia, Widad Lahlou, Debora Basile, Chloé Broudin, Lorenzo Pilla, Mehdi Karoui and Gilles Manceau have no conflict of interest. Aziz Zaanan declares consulting and/or advisory boards for Amgen, Lilly, Merck, Roche, Sanofi, Servier, Baxter, MSD, Pierre Fabre, Havas Life, Alira Health, Zymeworks, Daïchi Sankyo. Claire Gallois has participated in consulting and/or advisory boards for Servier and Sanofi and has received support for meetings from Amgen and MSD. Julien Taieb has received honoraria for speaker or advisory role from Amgen, Astellas, BMS, Merck-Serono, MSD, Novartis, Pierre Fabre, Roche and Servier., (Copyright © 2022. Published by Elsevier Masson SAS.)

Background: Hepatic arterial infusion (HAI) of chemotherapy is an option for the treatment of patients with liver metastases from colorectal cancer (LMCRC). Though HAI with oxaliplatin (HAI-Ox) is generally used, intravenous (IV) 5-fluoro-uracil (5FU)-oxaliplatin-irinotecan HAI (HAI-Folfirinox) is feasible and leads to curative-intent surgery in 30% of pretreated patients. We compared the efficacy and safety of HAI-Ox and HAI-Folfirinox., Methods: Patients who underwent HAI chemotherapy for LMCRC were retrospectively included from 2008 to 2019 from six French expert centers., Results: Data were collected from 273 previously treated patients with LMCRC. Patients received HAI-Folfirinox ( n = 52) or HAI-Ox ( n = 221) combined with IV chemotherapy. The objective response rate (ORR) was 43.2% in patients with HAI-Folfirinox and 45.9% (ns) in patients with HAI-Ox. Median overall survival (OS) was 17 months (95% CI: 15-32.3) with HAI-Folfirinox and 26.2 months (95% CI: 19.4-34.4; p = 0.1) with HAI-Ox. Median progression-free survival (PFS) was 7.9 months (95% CI: 4.9-10.3) with HAI-Folfirinox and 6.4 months (95% CI: 6.0-7.7; p = 0.6) with HAI-Ox. The secondary liver resection rate was 35.6% with HAI-Folfirinox and 16.7% with HAI-Ox ( p = 0.007). Grade 2 and above toxicities were significantly more frequent with HAI-Folfirinox. In the global population, only 2 factors were prognostic for OS in multivariable analyses: liver-only disease [hazard ratio (HR): 0.4; 95% CI 0.20-0.83; p = 0.013] and local complications of the catheter (HR: 3.8; 95% CI 1.6-9.0; p = 0.002)., Conclusion: Hepatic arterial infusion results in high response rates, secondary resections, and long survival in pretreated patients with LMCRC., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Randrian, Pernot, Sionneau, Smith, Lim, Touchefeu, Gallois, Turpin, Javed, Guimbaud, Rivera, Karoui, Auclin and Taieb.)

The pre-operative work-up for non-metastatic colon cancer includes colonoscopy and thoraco-abdomino-pelvic computed tomography (CT) with intravenous (IV) contrast. Colonoscopic determination of the anatomical location of the tumor may be erroneous, particularly with a long redundant colon (dolichocolon), and the search for synchronous colon neoplasms is limited when the endoscope cannot traverse the tumor-bearing segment. While computed tomography colonography angiography (CTC-A) makes it possible to assess distant tumor metastasis, it remains limited for the assessment of loco-regional extension. CTC-A requires specific colonic preparation, controlled colonic insufflation with CO 2 , and an injection of IV contrast. CTC-A provides a 3-D view of the overall morphology of the colon and precisely localizes the site of the colonic tumor. Merging the images of the colon with those of mesenteric and colonic vessels provides a representation of anatomical vascular variations. This information could help the surgeon to better plan the colectomy. The use of two-dimensional images of CTC-A with sections perpendicular to the major axis of the tumor-bearing colonic segment can provide precise information on the degree of parietal extension and be useful in evaluating the value of neo-adjuvant chemotherapy., (Copyright © 2021 Elsevier Masson SAS. All rights reserved.)