MANEJO QUIRURGICO DEL CANCER DE COLON CON CARCINOMATOSIS
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MANEJO QUIRURGICO DEL CANCER DE COLON CON CARCINOMATOSIS
- 1. 1 Cáncer de Colon Manejo Quirúrgico de Carcinomatosis Manejo Quirúrgico de Carcinomatosis Por: Humberto Juárez Rosario Médico Residente de Cirugía General CHMDr.AAM
- 2. 2 Objetivos Desglosar la epidemiología del cáncer de colon Exponer la fisiopatología de la carcinomatosis Exponer el abordaje quirúrgico de carcinomatosis y su manejo multidisciplinario Exponer la literatura actual Discutir los puntos en contra del abordaje quirúrgico
- 3. 3 Epidemiología Segunda causa de muerte por cáncer Panamá 6.5 por 100´000 habitantes Principales provincias Panamá, Chiriquí y Colon Base de Datos del Registro Nacional del Cáncer del Ministerio de Salud 2012
- 5. 5 Factores Pronóstico Cirugía Electiva vs Urgencia Sangrado 61% Obstrucción 52% Perforación 47% 58% 71% 39% 53% Stegeman I, Wijkerslooth T.Screening for colorectal cancer: What is the impact on the determinants of outcome? Cancer Epidemiology 8 March 2013
- 6. 6 Estadiaje NCCN Guidelines Version 3.2013
- 7. 7 Estadiaje NCCN Guidelines Version 3.2013
- 8. 8 Carcinomatosis Peritoneal 17% de los pacientes con Cáncer Colorrectal 10% debutan con carcinomatosis QT 20 meses 58% sin evidencia clínica o radiológica Elias D, Quenet F. Current Status and Future Directions in the Treatment of Peritoneal Dissemination from Colorectal Carcinoma Surg Oncol Clin N Am 21 (2012) 611–623
- 9. 9 Historia Natural 4 a 19% desarrollaran carcinomatosis en el seguimiento 30% de las muertes son por carcinomatosis media de supervivencia de 6 meses (5 -13 meses) Elias D, Quenet F. Current Status and Future Directions in the Treatment of Peritoneal Dissemination from Colorectal Carcinoma Surg Oncol Clin N Am 21 (2012) 611–623
- 10. 10 Fisiopatología Trauma durante la resección Transcelómica Sangrado de la pieza Extensión tumoral directa Sugarkaber P, Early Intervention for Treatment and Prevention of Colorectal Carcinomatosis Surg Oncol Clin N Am 21 (2012) 689–703
- 11. 11 Manejo Actual NCCN Guidelines Version 3.2013
- 12. 12 Supervivencia Franko J, et al Treatment of Colorectal Peritoneal Carcinomatosis With Systemic Chemotherapy: A Pooled Analysis of North Central Cancer Treatment Group Phase III Trials N9741 and N9841 Journal of Clinical Oncology Volume 3 Number 3 Jan 20 2012
- 13. 13 Clasificación de Gilly Valle M; Federici O, Garofalo A. Patient Selection for Cytoreductive SurgerySurg Oncol Clin N Am 21 (2012) 515–531
- 14. 14 Indice de Carcinomatosis Peritoneal (ICP) Peritoneal (ICP)
- 15. 15 Imágenes Tomografiía 12 % para ICP , 11% para lesiones de 5mm Tomografía en lesión de intestino delgado 8 a 17% PET sensibilidad de 90% y Especificidad 77% Valle M; Federici O, Garofalo A. Patient Selection for Cytoreductive SurgerySurg Oncol Clin N Am 21 (2012) 515–531
- 16. 16 Alto riesgo de Carcinomatosis Elias D, Quenet F. Current Status and Future Directions in the Treatment of Peritoneal Dissemination from Colorectal Carcinoma Surg Oncol Clin N Am 21 (2012) 611–623
- 17. 17 Objetivos Cirugía Enfermedad visible QT intraoperatoria hipertérmica Enfermedad Microscópica Elias D, Quenet F. Current Status and Future Directions in the Treatment of Peritoneal Dissemination from Colorectal Carcinoma Surg Oncol Clin N Am 21 (2012) 611–623
- 18. 18 Quimioterapia Franko J, et al Treatment of Colorectal Peritoneal Carcinomatosis With Systemic Chemotherapy: A Pooled Analysis of North Central Cancer Treatment Group Phase III Trials N9741 and N9841 Journal of Clinical Oncology Volume 3 Number 3 Jan 20 2012
- 19. 19 Cirugía Resecciones R0 Carcinomatosis limitada R2 no ofrecen beneficios en supervivencia Elias D, Quenet F. Current Status and Future Directions in the Treatment of Peritoneal Dissemination from Colorectal Carcinoma Surg Oncol Clin N Am 21 (2012) 611–623 Sugarkaber P, Early Intervention for Treatment and Prevention of Colorectal Carcinomatosis Surg Oncol Clin N Am 21 (2012) 689–703
- 20. 20 Quimioterapia intra-operatoria hipertérmica ( HIPEC) Temperatura 43-44 grados centígrados Potencia citotóxico y daño directo Homogenizar HIPEC 1 mm - 3 mm Avital et al Randomized Clinical Trials for Colorectal Cancer Peritoneal Surface Malignancy Surg Oncol Clin N Am 21 (2012) 665–688
- 21. 21 Esquema del HIPEC ç S Gonzalez-Moreno; From Oruezabal Moreno, M (ed). Oncología Digestiva, Algoritmos Diagnosticos y Terapeuticos. Chapter 7, Fig 7-5, page 52; 2012; reproduced with permission from Editorial Medica Panamericana 21
- 22. 22 Comparación entre técnicas Gonzalez-Moreno et al HIPEC: Methodology and Safety Considerations Surg Oncol Clin N Am 21 (2012) 543–557 22
- 23. 23 Citoreducción
- 24. 24 Drogas Intraperitoneales Alto peso molecular Baja toxicidad sistemica
- 26. 26 Contraindicaciones Pobre estado general del paciente Enfermedad peritoneal gigante Metastasis extraperitonales Infitración a la raiz mesenterica
- 27. 27 Contraindicaciones relativas Obstruccion intestinal en mas de un punto Progresión de la carcinomatosis durante la quimioterapia Presencia de tres o mas metástasis Indice peritoneal Envoltura de la capsula pancreatica Resección de por lo menos un tercio del intestino
- 28. 28 Alto riesgo de CP Metástasis ováricas Escasos nódulos peritoneales resecados con el primario Perforación
- 29. 29 HIPEC
- 30. 30 Supervivencia Thomas Weber et al Current Status of Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy in Patients With Peritoneal Carcinomatosis From Colorectal Cancer Clinical Colorectal Cancer, Vol. 11, No. 3, 167-76 Sept 2012
- 31. 31 ICP como Factor Pronóstico Thomas Weber et al Current Status of Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy in Patients Wi Peritoneal Carcinomatosis From Colorectal Cancer Clinical Colorectal Cancer, Vol. 11, No. 3, 167-76 Sept 2012
- 32. 32 Complicaciones Inicialmente morbilidad 45 % 4 Litros de Sangre Fistula enteral 15% ISO 6% IRA 6% Pancreatitis 2% Reintervenciones 14% Morbilidad y mortalidad:23-35%; respectivamente, 0- 4% Avital et al Randomized Clinical Trials for Colorectal Cancer Peritoneal Surface Malignancy Surg Oncol Clin N Am 21 (2012) 665–688
- 33. 33 Curva de Aprendizaje 140 a 150 casos para radicalidad y seguridad adecuada A partir del caso 86 se inicia resultados oncologicos adecuados Estudio limitado Kusamura et alThe Importance of the Learning Curve and Surveillance of Surgical Performance in Peritoneal Surface Malignancy Programs Surg Oncol Clin N Am 21 (2012) 559–576
- 34. 34 CONCLUSIONES
- 35. 35 GRACIAS!
- 36. 36
Hinweis der Redaktion
- must be targeted at an impor- tant health issue; the screening procedure should be simple, safe, precise and validated; e
- Median survival for the whole group was 6.3 months, but was 9.3 months for the patients who received chemotherapy. Similar results were reported by the Erlangen group: median survival was 8 months (5-year survival: 3%) for the 94 patients who underwent an incomplete (R2) resection of PC, but 15 months (5-year survival: 6%) for the 17 who presented with PC alone.6
- estudio en cerdos y pequeños estudios
- mitomycin C, cisplatin, doxorubicin, and oxaliplatin
- . A second- look operation performed 1 year after the first surgical procedure and 6 months after the end of systemic adjuvant chemotherapy, in asymptomatic patients with a completely negative workup, was able to detect macroscopic PC in respectively 63%, 75%, and 33% of these subgroups. Patients with macroscopic PC were treated with cytoreductive surgery plus HIPEC.
- her centers not using HIPEC at the time. The second group received 2.3 lines of different types of systemic chemotherapy. After a minimal follow-up of 63 months, overall 5-year survival was 51% for patients who had received HIPEC and 13% for patients in the no-HIPEC group (P<.05) (F
- ata were extracted from a prospectively collected institutional database of the PSM program of the NCI in Milan. In total, 462 CRS and HIPEC procedures performed from August 1995 to February 2012 were included in the study.