Análisis del tratamiento quirúrgico en pacientes con adenocarcinoma de recto localmente avanzado sometidos a neoadyuvancia preoperatoria en el ION -SOLCA Guayaquil período 2013 - 2016
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2018
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Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
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Los tumores malignos de recto son muy frecuentes, la estirpe patológica de mayor frecuencia
es el adenocarcinoma y el tratamiento de los mismos ha variado en la última década debido a
la neoadyuvancia con radio quimioterapia preoperatoria. El objetivo del estudio es analizar el
tratamiento quirúrgico en pacientes con adenocarcinoma de recto localmente avanzado
sometido a neoadyuvancia preoperatoria. La investigación es analítica, descriptiva con diseño
transversal, de enero del 2013 a octubre de 2016 en Solca Guayaquil, de los pacientes con
cáncer de recto localmente avanzado 45 recibieron tratamiento con neoadyuvancia
(radioterapia – quimioterapia), y fueron operados de 4 a 12 semanas, predominó el sexo
femenino al masculino, el adenocarcinoma de recto representa el 71%, la radio-quimioterapia
tuvo mayor porcentaje, frente a la radioterapia o quimioterapia sola. El tipo de procedimiento
quirúrgico de mayor porcentaje fue la amputación abdomino-perineal directamente 64.44%,
seguido de resección anterior baja sola, resección anterior baja más ostomia de protección en
13.33% respectivamente, resección anterior baja y luego de recidiva se realiza amputación
abdomino-perineal en 6.66% y 2.22% luego de neoadyuvancia solo se le realizo colostomía,
con muy buena respuesta en cuanto a recurrencia local y respuesta patológica global del 91%.
Se concluye la importancia del tratamiento neo adyuvante con quimioterapia y radioterapia en
adenocarcinomas de recto localmente avanzado sobre el tipo de procedimiento quirúrgico.
Recomendando a la neoadyuvancia como eficaz para determinar el tipo de cirugía adecuada
evitando posteriores recurrencias, recidivas, e incrementando el control local de la enfermedad
además de las posibles complicaciones a largo plazo
Malignant tumors of the rectum are very frequent, the most frequent pathological lineage is adenocarcinoma and the treatment of these has varied in the last decade due to neoadjuvant chemotherapy with radio preoperative. The aim of the study is to analyze the surgical treatment in patients with locally advanced adenocarcinoma of the rectum subjected to preoperative neoadjuvant. The investigation is analytical, descriptive with transversal design, from January 2013 to October 2016 in Solca Guayaquil, of patients with locally advanced rectal cancer 45 received neoadjuvant treatment (radiotherapy - chemotherapy), and were operated for 4 to 12 weeks, female to male predominated, adenocarcinoma of the rectum represented 71%, radio chemotherapy had a higher percentage compared to radiotherapy or chemotherapy alone. The type of surgical procedure of greater percentage was the abdomino-perineal amputation directly 64.44%, followed by low anterior resection alone, low anterior resection plus protection ostomy in 13.33% respectively, low anterior resection and after recurrence, abdomino-perineal amputation was performed in 6.66% and 2.22% after neoadjuvant, only a colostomy was performed. With a very good response in terms of local recurrence and overall pathological response of 91%. The importance of neo adjuvant treatment with chemotherapy and radiotherapy in locally advanced adenocarcinomas of the rectum on the type of surgical procedure is concluded. Recommending neoadjuvant as effective to determine the type of adequate surgery avoiding subsequent recurrences, recurrences, and increasing local control of the disease as well as possible long-term complications
Malignant tumors of the rectum are very frequent, the most frequent pathological lineage is adenocarcinoma and the treatment of these has varied in the last decade due to neoadjuvant chemotherapy with radio preoperative. The aim of the study is to analyze the surgical treatment in patients with locally advanced adenocarcinoma of the rectum subjected to preoperative neoadjuvant. The investigation is analytical, descriptive with transversal design, from January 2013 to October 2016 in Solca Guayaquil, of patients with locally advanced rectal cancer 45 received neoadjuvant treatment (radiotherapy - chemotherapy), and were operated for 4 to 12 weeks, female to male predominated, adenocarcinoma of the rectum represented 71%, radio chemotherapy had a higher percentage compared to radiotherapy or chemotherapy alone. The type of surgical procedure of greater percentage was the abdomino-perineal amputation directly 64.44%, followed by low anterior resection alone, low anterior resection plus protection ostomy in 13.33% respectively, low anterior resection and after recurrence, abdomino-perineal amputation was performed in 6.66% and 2.22% after neoadjuvant, only a colostomy was performed. With a very good response in terms of local recurrence and overall pathological response of 91%. The importance of neo adjuvant treatment with chemotherapy and radiotherapy in locally advanced adenocarcinomas of the rectum on the type of surgical procedure is concluded. Recommending neoadjuvant as effective to determine the type of adequate surgery avoiding subsequent recurrences, recurrences, and increasing local control of the disease as well as possible long-term complications
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Tratamiento quirúrgico, Neoplasias del recto, Terapia neoadyuvante, Epidemilogía descriptiva, Epidemiología analítica, Hospital SOLCA de Guayaquil, Cantón Guayaquil, Ecuador