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2011, Número 5

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Cir Cir 2011; 79 (5)


Cáncer de recto. Diagnóstico, estadificación y tratamiento

Decanini-Terán CÓ, González-Acosta J, Obregón-Méndez J, Vega-de Jesús M

Idioma: Español
Referencias bibliográficas: 42
Paginas: 481-487
Archivo PDF: 289.18 Kb.


RESUMEN

El cáncer de recto representa una de las principales neoplasias malignas en el grupo de edad productiva en México, desgraciadamente el cáncer de recto no cuenta aún con los grandes estudios aleatorizados que encontramos para el cáncer de colon, por lo que se debe individualizar desde su epidemiología, factores de riesgo, métodos diagnósticos, etapificación y tratamiento. La etapa histopatológica representa el principal factor pronóstico para los pacientes con cáncer rectal, el sistema TNM es el más comúnmente usado para etapificar el cáncer de recto. La etapificación se realiza por medio de ultrasonido transrectal, aunque en estadios avanzados tiene como limitantes la baja sensibilidad y especificidad para detectar involucro ganglionar. La resonancia magnética nuclear ofrece mayor visualización de estructuras, depende menos del operador y, a diferencia del ultrasonido transrectal, permite valorar tumores estenóticos. En el tratamiento del cáncer de recto, el tratamiento neoadyuvante ha demostrado ser mejor que el adyuvante. Afortunadamente, la resección abdominoperineal ha quedado en desuso y la cirugía conservadora de esfínter es el tratamiento preferido en la actualidad. El abordaje laparoscópico solo ha conferido las ventajas propias del abordaje y aunque ha demostrado ser una opción viable en manos expertas, aún faltan estudios aleatorizados para considerarlo como primera opción. Las consideraciones diagnósticas y terapéuticas del cáncer de recto son totalmente distintas al cáncer de colon, por lo que los pacientes deben ser etapificados de manera específica para su tratamiento adecuado y se requieren más estudios serios sobre los resultados a largo plazo de las diferentes opciones terapéuticas.


REFERENCIAS (EN ESTE ARTÍCULO)

  1. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin 2008;58:71-96.

  2. Wolpin BM, Meyerhardt JA, Mamon HJ, Mayer RJ. Adjuvant treatment of colorectal cancer. CA Cancer J Clin 2007;57:168-185.

  3. Ellenhorn D, Coia L, Alberts S, Cullinane C. Colorectal and anal cancers. En: Coia L, Hoskins W, eds. Cancer Management: A Multidisciplinary Approach. Melville, NY: PRR Inc.; 2002. pp. 273-300.

  4. Cohen SM, Neugut AI, Cohen SM. Adjuvant therapy for rectal cancer in the elderly. Drugs Aging 2004;21:437-451.

  5. Meredith K, Hoffe S, Shibata D. The multidisciplinary management of rectal cancer. Surg Clin North Am 2009;89:177-215, IX-X.

  6. Greene F, Page D, Fleming I. AJCC Cancer Staging Handbook. 6th ed. New York: Springer; 2002. pp. 113-124.

  7. Brown G, Davies S, Williams GT, Bourne MW, Newcombe RG, Radcliffe AG, et al. Effectiveness of preoperative staging in rectal cancer: digital rectal examination, endoluminal ultrasound or magnetic resonance imaging? Br J Cancer 2004;91:23-29.

  8. Bipat S, Glas AS, Slors FJ, Zwinderman AH, Bossuyt PM, Stoker J, et al. Rectal cancer: local staging and assessment of lymph node involvement with endoluminal US, CT, and MR imaging-a metaanalysis. Radiology 2004;232:773-783.

  9. Siddiqui A, Fayiga Y, Huerta S. The role of endoscopic ultrasound in the evaluation of rectal cancer. Int Semin Surg Oncol 2006;3:1-7.

  10. Hildebrandt U, Feifel G. Preoperative staging of rectal cancer by intrarectal ultrasound. Dis Colon Rectum 1985;28:42-46.

  11. Orrom W, Wong W, Rothenberger D, Jensen L, Goldberg S. Endorectal ultrasound in the preoperative staging of rectal tumors. A learning experience. Dis Colon Rectum 1990;33:654-659.

  12. Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS. Morphologic predictors of lymph node status in rectal cancer with use of high-spatial-resolution MR imaging with histopathologic comparison. Radiology 2003;227:371-377.

  13. Brown G, Kirkham A, Williams GT, Bourne M, Radcliffe AG, Sayman J, et al. High-resolution MRI of the anatomy important in total mesorectal excision of the rectum. AJR Am J Roentgenol 2004; 182:431-439.

  14. Chun HK, Choi D, Kim MJ, Lee J, Yun SH, Kim SH, et al. Preoperative staging of rectal cancer: comparison of 3-T high-field MRI and endorectal sonography. AJR Am J Roentgenol 2006;187:1557-1562.

  15. Glynne-Jones R, Mathur P, Elton C, Train ML. The multidisciplinary management of gastrointestinal cancer. Multimodal treatment of rectal cancer. Best Pract Res Clin Gastroenterol 2007;21:1049-1070.

  16. NCCN Clinical Practice Guidelines in Oncology. Rectal Cancer 2008;3:1-69.

  17. Quirke P, Durdey P, Dixon MF, Williams NS. Local recurrence of rectal adenocarcinoma due to inadequate surgical resection: histopathological study of lateral tumour spread and surgical excision. Lancet 1986;2(8514):996-999.

  18. Kapiteijn E, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, Wiggers T, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 2001;345:638-646.

  19. Hall NR, Finan PJ, Al-Jaberi T, Tsang CS, Brown SR, Dixon MF, et al. Circumferential margin involvement after mesorectal excision of rectal cancer with curative intent. Predictor of survival but not local recurrence? Dis Colon Rectum 1998;41:979-983.

  20. Branagan G, Chave H, Fuller C, Mc Gee S, Finnis D. Can magnetic resonance imaging predict circumferential margins and stage in rectal cancer? Dis Colon Rectum 2004;47:1317-1322.

  21. Nagtegaal ID, Van de Velde CJ, Marijnen CA, Van Krieken JH, Quirke P. Low rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol 2005;23:9257-9264.

  22. Nagtegaal ID, Marijnen CA, Kranenbarg EK, Van De Velde CJ, Van Krieken JH. Circumferential margin involvement is still an important predictor of local recurrence in rectal carcinoma: not one millimeter but two millimeters is the limit. Am J Surg Pathol 2002;26:350-357.

  23. Tepper JE, O’Conell MJ, Niedzwiecki D, Hollis D, Compton C, Benson AB 3rd. Impact of number of nodes retrieved on outcome in patients with rectal cancer. J Clin Oncol 2001;19:157-163.

  24. Merchant NB, Guillem JG, Paty PB, Enker WE, Minsky BD, Quan SH, et al. T3N0 rectal cancer: results following sharp mesorectal excision and no adjuvant therapy. J Gastrointest Surg 1999;3:642-647.

  25. Heald RJ, Husband EM, Ryal RD. The mesorectum in rectal cancer surgery-clue to pelvic recurrence? Br J Surg 1982;69:613-618.

  26. Bokey EL, Ojerskog B, Chapuis PH, Dent OF, Newland RC, Sinlcair G, et al. Local recurrence after curative excision of the rectum for cancer without adjuvant therapy: role of total anatomical dissection. Br J Surg 1999;86:1164-1170.

  27. Williams NS, Dixon MF, Johnson D. Reappraisal of the 5 cm rule of distal excision for carcinoma of the rectum; a study of distal intramural spread and of patients’ survival. Br J Surg 1983;70:150-154.

  28. Gamagami RA, Liagre A, Chiotasso P, Istvan G, Lazorthes F. Coloanal anastomosis for distal third rectal cancer: prospective study of oncologic results. Dis Colon Rectum 1999;42:1272-1275.

  29. Guillem JG. Ultra-low anterior resection and coloanal pouch reconstruction for carcinoma of the distal rectum. World J Surg 1997;21:721-727.

  30. Hassan I, Larson DW, Cima RR, Gaw JU, Chua HK, Hahnloser D, et al. Long-term functional and quality of life outcomes after coloanal anastomosis for distal rectal cancer. Dis Colon Rectum 2006;49:1266-1274.

  31. Shiozawa M, Akaike M, Yamada R, Godai T, Yamamoto N, Saito H, et al. Lateral lymph node dissection for low rectal cancer. Hepatogastroenterology 2007;54:1066-1070.

  32. Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. JM, MRC CLASICC Trial Group. Short-term endpoints of conventional versus laparoscopic assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomized controlled study. Lancet 2005;365(9472):1718-1729.

  33. Nelson H, Sargent DJ, Wieand S, Fleshman J, Anvari M, Stryker SJ, et al. Clinical Outcomes of Surgical Therapy Study Group. A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 2004;350:2050-2059.

  34. Veldkamp R, Kuhry E, Hop WC. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomized trial. Lancet Oncol 2005;6:477-484.

  35. Lacy AM, Garcia-Valdecasas JC, Delgado S, Castells A, Taurá P, Pique JM, et al. Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomized trial. Lancet 2002;359(9325):2224-2229.

  36. Leung KL, Kwok SP, Lau WY, Meng WC, Chung CC, Lai PB, et al. Laparoscopic-assisted abdominoperineal resection for low rectal adenocarcinoma. Surg Endosc 2000;14:67-70.

  37. Liang JT, Lai HS, Lee PH. Laparoscopic pelvic autonomic nervepreserving surgery for patients with lower rectal cancer after chemoradiation therapy. Ann Surg Oncol 2007;14:1285-1297.

  38. Reza MM, Blasco JA, Andradas E, Cantero R, Mayol J. Systematic review of laparoscopic versus open surgery for colorectal cancer. Br J Surg 2006;93:921-928.

  39. Laurent C, Le Blanc F, Gineste C, Saric J, Rullier E. Laparoscopic approach in surgical treatment of rectal cancer. Br J Surg 2007;94:1555-1561.

  40. Wagman LD. Laparoscopic and open surgery for colorectal cancer: reaching equipoise? J Clin Oncol 2007;25:2996-2998.

  41. Boller AM, Nelson H. Colon and rectal cancer: laparoscopic or open? Clin Cancer Res 2007;13:6894-6896.

  42. Wolf BG, Fleshman JW, Beck DE, Pemberton JH, Wexner SD. The ASCRS Textbook of Colon and Rectal Surgery. New York: Springer; 2007. pp. 437-445.




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