manejo, quién?
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Carcinomatosis.coe@gmail.com
MANEJO….. ¿QUIEN?
20 Agosto 2010
COE ISSEMyM - Toluca
Dr. Juan Manuel Medina Castro
Carcinomatosis.coe@gmail.com
Carcinomatosis.coe@gmail.com
Clínica de Carcinomatosis Peritoneal
Factores Pronóstico
Carcinomatosis.coe@gmail.com
Clínica de Carcinomatosis Peritoneal
Invasión transmural
Carcinomatosis.coe@gmail.com
Clínica de Carcinomatosis Peritoneal
Ganglios
El número mínimo de ganglios resecados y evaluados por patología para poder afirmar o negar su involucro
12
Colon and rectum. In: American Joint Committee on Cancer.: AJCC Cancer Staging Manual. 6th ed.
New York, NY: Springer, 2002, pp 113-124
Compton CC, Greene FL: The staging of colorectal cancer: 2004 and beyond. CA Cancer
J Clin 54 (6): 295-308, 2004 Nov-Dec
Swanson RS, Compton CC, Stewart AK, et al.: The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10 (1): 65-71, 2003 Jan-Feb
Le Voyer TE, Sigurdson ER, Hanlon AL, et al.: Colon cancer survival is associated with
increasing number of lymph nodes analyzed: a secondary survey of intergroup trial INT-0089. J
Clin Oncol 21 (15): 2912-9, 2003
Prandi M, Lionetto R, Bini A, et al.: Prognostic evaluation of stage B colon
cancer patients is improved by an adequate lymphadenectomy: results of a secondary analysis of a large scale adjuvant trial. Ann
Surg 235 (4): 458-63, 2002
Tepper JE, O'Connell MJ, Niedzwiecki D, et al.: Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 19 (1):
157-63, 2001
Carcinomatosis.coe@gmail.com
Clínica de Carcinomatosis Peritoneal
Micro metástasis
¿Porqué 40% de los EC II recurren?
Hasta 30% de micromestástasis
El estudio completo es con inmuno-histoquímica
SV a 5 años 90% vs 70% (EC II)
SV a 5 años 75% vs 60% (EC III)
Prognostic impact of micrometastases in colon cancer: interim results of a
prospective multicenter trial. - Bilchik AJ - Ann Surg - 01-OCT-2007; 246(4): 568-75;
discussion 575-7
Prognostic value of the detection of lymph node micrometastases in
colon cancer. - Bosch Roig CE - Clin Transl Oncol - 01-SEP-2008; 10(9):
572-8
Yasuda K,AdachiY, ShiraishiN, et al. Pattern of lymphnode micrometastasis andprognosisof patients with colorectal cancer. Ann Surg
Oncol 2001;8:300–4.
Carcinomatosis.coe@gmail.com
Clínica de Carcinomatosis Peritoneal
Invasión linfovascular
Que % de patólogos lo reportan?
Que % de cirujanos saben que es un FP
Cual es la traducción clínica?
SV a 5 años de 16% vs 3%
Prognostic value of the detection of lymph node micrometastases in
colon cancer. - Bosch Roig CE - Clin Transl Oncol - 01-SEP-2008; 10(9):
572-8
Newland RC, Dent OF, Lyttle MN, et al. Pathologic determinants of survival associated with
colorectal cancer with lymph node metastases: a multivariate analysis of 579 patients.
Cancer 1994;73:2076–82.
Compton CC, Fielding LP, Burgart LJ, et al. Prognostic factors in colorectal cancer: Collegeof American Pathologists Consensus Statement
1999. Arch Pathol Lab Med 2000;124:979–94.
Carcinomatosis.coe@gmail.com
Clínica de Carcinomatosis Peritoneal
Enfermedad residual
Principal factor pronóstico en enfermedad avanzada.
Relación inversa entre volumen de enfermedad residual y sobrevida.
Compton CC, Fielding LP, Burgart LJ, et al. Prognostic factors in colorectal cancer: Collegeof American Pathologists Consensus Statement
1999. Arch Pathol Lab Med 2000;124:979–94.
Swanson RS, Compton CC, Stewart AK, et al.: The prognosis of T3N0 colon cancer is dependent on the number of lymph nodes examined. Ann Surg Oncol 10 (1): 65-71, 2003 Jan-Feb
Carcinomatosis.coe@gmail.com
Clínica de Carcinomatosis Peritoneal
Enfermedad residual
Cirujano general Cirujano-oncólogo
Citorreducción óptima = 25-55%
Citorreducción completa = 8-27%
Citorreducción completa = 86%
Por cada cm de citorreducción se aumenta
la SV 10%
Rober E Brostow, Beth Y Karlan.
Ed. Taylor and Francis 2006
Carcinomatosis.coe@gmail.com
Clínica de Carcinomatosis Peritoneal
Grado Histológico
Wiggers T, Arends JW, Volovics A. Regression analysis of clinical and pathological factors
in colorectal cancer after curative resections. Dis Colon Rectum 1988;31:33–41.
Carcinomatosis.coe@gmail.com
Clínica de Carcinomatosis Peritoneal
¿Quien?
Aquel que conozca al cáncer
Aquel que ofrezca el tratamiento completo
Aquel que trabaje multidisciplinariamente
Nelson H, Petrelli N, Carlin A, et al.: Guidelines 2000 for colon and rectal cancer surgery. J Natl
Cancer Inst 93 (8): 583-96, 2001
Carcinomatosis.coe@gmail.com
Clínica de Carcinomatosis Peritoneal
Carcinomatosis.coe@gmail.com
GRACIAS
Carcinomatosis.coe@gmail.com
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