Surgical salvage of pelvic recurrences from colorectal tumors

Abstract

13580 Background: The morbidity of pelvic recurrences from colorectal tumors (PRCT) represents a challenge for the oncology multidisciplinary team. Surgical treatment is the best option for palliation and in several series it offers long term local control in 30% of the cases. Objective: To perform a retrospective analysis of patients (pts) surgically resected for PRCT in terms of: time to progression after surgical salvage (TP) and specific suvival (SS). Correlatives studies were performed with clinic and pathologic factors, surgical procedures (SP), and postoperative complications in terms of TP and SS. Methods: 64 pts treated (June 1994 - February 2005) were identified (women: 30), median age 63 years, site of the primary: rectum 48, sigmoid 16; Median number of resected nodes: 8 (r: 2 - 20) in pts with negative nodes and 15 (r: 6 - 42) in pts with positive nodes; primary treatment: surgery (S): 22 pts, S + chemotherapy (CT): 18, S + radiotherapy (RT): 4, S + CT/RT: 17, CT + S: 2 pts, QT/RT + CX: 1; in 7/64 a Miles procedure was performed as primary therapy, median disease free interval: 15 months; site of initial recurrence: locoregional 58 (90%), locoregional + systemic 10%. Pain and bleeding were the most frecuent symptoms. Results: The strategy in PRCT was: S: 29 pts, S + RT: 15, S + CT/RT: 9, CT/RT + S: 7, S + CT: 2, CT + S: 1, RT + S:1; IORT: 18/64; external beam RT: 17/64, 6 pts required Miles; type of resection: R0: 50/64 (78%), R1: 8/64 (12%), R2: 3/64 (5%) and 3 (5%) unknown. Median duration of surgery: 4 hours, abscesses and fistulas were the complications most frequently observed. Median time to progression (TP): 12 months, site of recurrence (56/64 pts) post salvage surgery: pelvic: 22 pts, extrapelvic: 6 pts, combined: 10 and unknown 18. Eleven pts are free of disease. In 16 pts more than one surgical salvage was perfomed. The specific survival was 21 months (IC 95% 37 - 61 m). Conclusions: In this serie surgical salvage of PRCT showed one year of local control disease, even in pts with R2 and with moderate morbidity. The surgical decision must be individualized and in the context of a trained surgical team. No significant financial relationships to disclose.

Criados, jornaleros y esclavos al servicio de la familia: la servidumbre de los Muñoz de Otálora en el siglo XVII

“…los criados y sirvientes eran un elemento de ostentación, de honra del linaje y una garantía del buen funcionamiento de la casa y de eficiencia de la gestión de la hacienda familiar 18 . También servían como elemento publicitario del poderío de la familia y del linaje: no resulta extraño, por tanto, que todos aquellos que contaban con los recursos económicos suficientes trataran de adoptar los signos externos del caballero y rodearse del mayor número de criados posible 19 . El deseo de emulación de la corte de los Austrias convirtió la servidumbre en una característica intrínseca del modo de vida nobiliario: las grandes casas aristocráticas, a pesar del sempiterno endeudamiento, imitaron los usos y costumbres de los monarcas y constituyeron grandes cortes señoriales de boato personal 20 .…”