Estadificación y preparación preoperatoria en TEM del cáncer precoz de recto

1. Ricardo Belda Lozano
Servicio de Cirugía General, Torrecárdenas

3. Diagnóstico Preoperatorio
N(-)
N(+) Adenoma (G1,2,3)
T1 Bajo riesgo T2-3
Cir. Local
RxQx Preop.
(Pref. TEM)
+
EM
ETM Sólo Ensayos Clínicos
Cir. Local
AP: pT2
(Pref. TEM)
RxQx preop.
Cirugía RxQx post.
+
de
Cir. Local
Rescate

4. Diagnóstico Preoperatorio
N(-)
N(+) Adenoma (G1,2,3)
T1 Bajo riesgo T2-3
Cir. Local
RxQx Preop.
(Pref. TEM)
+
EM
ETM Sólo Ensayos Clínicos
Cir. Local
AP: pT2
(Pref. TEM)
RxQx preop.
Cirugía RxQx post.
+
de
Cir. Local
Rescate

21. Rectal Cancer: Local Stagingand Assessment of LymphNodeInvolvementwithEndoluminal US, CT, and MRImaging—A
Meta-Analysis Radiology 2004; 232:773–783

29.  <45
 Distal
 Atipias cribiformes
 Infiltración linfoide
 Tumores ulcerados
o planos
1 .

34. .

36. Personalmente , yo no habría firmado !

37. CONVERSIÓN SUPERBIOPSIA

42. staging rectal cancer
lymph node involvement
• statistics
• chance is increased with tumour depth and worsening
grade
• endoanal ultrasound accurately predicts depth; pre-
operative biopsy is less accurate for grade
• except in stalked polyps, the risk for a tumour confined
to the bowel wall ranges from 3-15%
• imaging
• small nodes may be involved, big nodes may be
reactive
• serial imaging showing change in nodal size helps
• ultimately, this is still a statistical issue