Simposium de Càncer de Colon V Jornadas de Aniversario Dr. Juan Manuel Medina Castro

1. Carcinomatosis.coe@gmail.com
MANEJO….. ¿QUIEN?
Dr. Juan Manuel
Medina Castro
20 Agosto 2010
COE ISSEMyM - Toluca Carcinomatosis.coe@gmail.com

2. Clínica de Carcinomatosis Peritoneal
Factores Pronóstico
Carcinomatosis.coe@gmail.com

3. Clínica de Carcinomatosis Peritoneal
Invasión transmural
Carcinomatosis.coe@gmail.com

4. Clínica de Carcinomatosis Peritoneal
Ganglios
 El número mínimo de ganglios resecados y evaluados por
patología para poder afirmar o negar su involucro
 12
Prandi M, Lionetto R, Bini A, et al.:
Le Voyer TE, Sigurdson ER, Hanlon AL, et al.: Prognostic evaluation of stage B colon Tepper JE, O'Connell MJ, Niedzwiecki D, et al.:
Colon cancer survival is associated with cancer patients is improved by an adequate Impact of number of nodes retrieved on outcome
increasing number of lymph nodes analyzed: a lymphadenectomy: results of a secondary in patients with rectal cancer. J Clin Oncol 19 (1):
secondary survey of intergroup trial INT-0089. J analysis of a large scale adjuvant trial. Ann 157-63, 2001
Clin Oncol 21 (15): 2912-9, 2003 Surg 235 (4): 458-63, 2002
Swanson RS, Compton CC, Stewart AK, et al.: The
Colon and rectum. In: American Joint Committee Compton CC, Greene FL: The staging of
prognosis of T3N0 colon cancer is dependent on
on Cancer.: AJCC Cancer Staging Manual. 6th ed. colorectal cancer: 2004 and beyond. CA Cancer
the number of lymph nodes examined. Ann Surg
New York, NY: Springer, 2002, pp 113-124 J Clin 54 (6): 295-308, 2004 Nov-Dec
Oncol 10 (1): 65-71, 2003 Jan-Feb
Carcinomatosis.coe@gmail.com

5. 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 Prognostic value of the detection of
Yasuda K,AdachiY, ShiraishiN, et al. Pattern of
colon cancer: interim results of a lymph node micrometastases in
lymphnode micrometastasis andprognosis
prospective multicenter trial. - Bilchik AJ - colon cancer. - Bosch Roig CE - Clin
of patients with colorectal cancer. Ann Surg
Ann Surg - 01-OCT-2007; 246(4): 568-75; Transl Oncol - 01-SEP-2008; 10(9):
Oncol 2001;8:300–4.
discussion 575-7 572-8
Carcinomatosis.coe@gmail.com

6. 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%
Newland RC, Dent OF, Lyttle MN, et al. Pathologic Prognostic value of the detection of Compton CC, Fielding LP, Burgart LJ, et al.
determinants of survival associated with lymph node micrometastases in Prognostic factors in colorectal cancer: College
colorectal cancer with lymph node metastases: a colon cancer. - Bosch Roig CE - Clin of American Pathologists Consensus Statement
multivariate analysis of 579 patients. Transl Oncol - 01-SEP-2008; 10(9): 1999. Arch Pathol Lab Med 2000;124:
Cancer 1994;73:2076–82. 572-8 979–94.
Carcinomatosis.coe@gmail.com

7. 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.
Swanson RS, Compton CC, Stewart AK, et al.: The
Prognostic factors in colorectal cancer: College
prognosis of T3N0 colon cancer is dependent on
of American Pathologists Consensus Statement
the number of lymph nodes examined. Ann Surg
1999. Arch Pathol Lab Med 2000;124:
Oncol 10 (1): 65-71, 2003 Jan-Feb
979–94.
Carcinomatosis.coe@gmail.com

8. Clínica de Carcinomatosis Peritoneal
Enfermedad residual
Cirujano general Cirujano-oncólogo
Citorreducción óptima = 25-55% Citorreducción completa = 86%
Citorreducción completa = 8-27%
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

9. 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

10. 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

11. Clínica de Carcinomatosis Peritoneal
Carcinomatosis.coe@gmail.com

12. GRACIAS
Carcinomatosis.coe@gmail.com Carcinomatosis.coe@gmail.com