Abstract
Cancers of the distal rectum (<7.5 cm from the anal verge) that are freely mobile, moderately well or well differentiated, <4 cm in size, limited to the bowel wall, and without evidence of metastasis should be considered candidates for treatment with electrocoagulation for cure. Tumor cell ploidy and evaluation with intrarectal ultrasound may in the future add additional useful information with regard to patient selection. Electrocoagulation and laser ablation of tumors may also be useful modalities for palliation of patients with metastatic disease or who are not candidates for curative surgery.
Résumé
Les cancers du bas rectum (c'est à dire situés à moins de 7 cm de la marge anale) qui sont mobiles, bien ou assez bien différenciés, de moins de 4 cm de diamètre, limités à la paroi, et sans métastase évidente peuvent être traités par l'électrocoagulation seule. La ploīdie cellulaire et l'évaluation par l'échographie endorectale sont peut-être de futurs moyens pour sélectionner les patients pouvant être traités ainsi. L'ablation des tumeurs par l'électrocoagulation et le laser sont des méthodes palliatives utiles chez les patients ayant des métastases ou qui ne sont pas des candidats à la chirurgie.
Resumen
Casi 50% de los cánceres rectales se ubican a menos de 7.5 cm del borde anal. En general, la sobrevida de los pacientes con cáncer del recto distal ha demostrado ser peor que la de los pacientes con cáncer del colon. Los cánceres del recto distal representan un dilema terapéutico; el estándar de comparación para su tratamiento sigue siendo la resección abdominoperineal descrita por Miles hace más de 80 años. La sobrevida global a 5 años de los pacientes sometidos a resección abdominoperineal es aproximadamente de 50% y poco ha mejorado en los últimos 40 años. La resección abdominoperineal se asocia con mortalidad y morbilidad significativas, especialmente en pacientes mayores de 70 años. Todos los pacientes quedan con colostomía permanente y la mayoría de los hombres resultan impotentes. El advenimiento de nuevas tecnologías y técnicas quirúrgicas ha disminuido la incidencia de resección abdominoperineal para cáncer rectal y, en pacientes seleccionados, el tratamiento local sigue siendo una alternativa viable.
Los cánceres del recto distal (por debajo de 7.5 cm del borde anal) que sean móviles, moderadamente o bien diferenciados, con tamaño menor de 4 cm, que estén limitados a la pared y que no presentan evidencia de metástasis, deben ser considerados como candidatos para tratamiento por electrocoagulación con propósito de curación. El estudio de la ploidia tumoral y la evaluación con ultrasonografía intrarectal posiblemente habrán de añadir información útil relativa a la selección de los pacientes. La electrocoagulación y la resección con laser también pueden ser modalidades útiles para la paliación de pacientes con enfermedad metastásica o en aquellos que no son candidatos para cirugía curativa.
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Eisenstat, T.E., Oliver, G.C. Electrocoagulation for adenocarcinoma of the low rectum. World J. Surg. 16, 458–462 (1992). https://doi.org/10.1007/BF02104447
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DOI: https://doi.org/10.1007/BF02104447