Recidiva pélvica de adenocarcinoma de reto: abordagem cirúrgica

Abstract

Descritores: Adenocarcinoma retal; recidiva local; cirurgia pélvica. Trabalho realizado pelo Grupo de Coloproctologia, Disciplina de Moléstias do Aparelho Digestório, (DMAD), Faculdade de Ciências Médicas, Universidade Estadual de Campinas (UNICAMP), Campinas INTRODUÇÃOA recidiva pélvica do câncer do reto constitui grande desafio no seu tratamento, podendo cursar com altas taxas de morbimortalidade, envolvendo elevado custo econômico. A ressecção cirúrgica do segmento acometido com adenocarcinoma retal aliada à excisão total do mesorreto (ETM), além da neoadjuvância, tem sido preconizada para o tratamento desta afecção, com redução das taxas de recidiva local. (1,2,3,4,5,6) No entanto, a recidiva pélvica após ressecção curativa do câncer retal, continua influenciando na sobrevida dos doentes, e constituindo importante causa de morbidade pós-operatória. Entre 3% a 35% dos doentes evoluirão com recidiva local. (3,5,6,7,8) Os fatores que estão implicados nas diferentes taxas de recidiva observadas na literatura, são aqueles relacionados à técnica operatória e à própria biologia do tumor. O estadiamento inicial da neoplasia é um dos fatores relacionados à biologia tumoral, sendo considerado o mais importante. (7) Outros, como margem cirúrgica, distân-

Recurrence pattern of rectal cancer after surgical treatment. Analysis of 122 patients in a tertiary care center

“…One of the most important criteria to establish excellence in rectal cancer treatment is the recurrence rate, being local recurrence or distant metastasis. 10,14,19 In this series, where 122 patients were treated of rectal cancer with curative intention, female were more prevalent (55.7%), and this data does not show the same as literature, where most series show more men than women diagnosed of rectal cancer. Average age on diagnosis was however coincident with other series.…”

“…Despite a late diagnosis is shown here, it concurs with literature, where T2 and T3 are the most prevalent stages at diagnosis. 14,29 In this series they respond for 70.5% of all patients.…”

“…In about 50% of all cases, recurrence is exclusively local, and when surgery is the treatment to this condition, up to 20-30% 5-years survival can be achieved, while palliative radiochemoradiation can give an average of 10-17 months of survival. 8,14,15,17,22 Initial T stage T3 was found in 70% of all recurrences, which is well justified, as deep tumors are more aggressive. N staging was not consonant with literature.…”

“…The best treatment that has also shown the best results in rectal cancer treatment includes neoadjuvant therapy when indicated, excision of rectum, together with mesorectum (TME), and adjuvant therapy, when needed. [14][15][16][17] Rectal cancer recurrence is local in more than 60% of recurrences, 4,18 independent of low anterior or abdominoperineal resection, and in about 50% of all recurrences, there is no tumor in any other organ. Local (or pelvic) recurrence after curative-intention surgery is an important cause of morbidity in these patients' follow-up.…”

“…Three to 35% of patients operated of rectal cancer will have local recurrence. 4,14,19 Which has been shown to follow mainly surgeries with inadequate pelvic dissection, incomplete TME removal and affected surgical margins, but advanced stage tumor, tumor perforation and surgeon's experience can also count for it. 14…”