RESUMEN
The workup and management of squamous cell anal carcinoma, which represents the most common histologic form of the disease, are addressed in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Anal Carcinoma. These NCCN Guidelines Insights provide a summary of major discussion points of the 2012 NCCN Anal Carcinoma Panel meeting. In summary, the panel made 4 significant changes to the 2012 NCCN Guidelines for Anal Carcinoma: 1) local radiation therapy was added as an option for the treatment of patients with metastatic disease; 2) multifield technique is now preferred over anteroposterior-posteroanterior (AP-PA) technique for radiation delivery and the AP-PA technique is no longer recommended as the standard of care; 3) PET/CT should now be considered for radiation therapy planning; and 4) a section on risk reduction was added to the discussion section. In addition, the panel discussed the use of PET/CT for the workup of anal canal cancer and decided to maintain the recommendation that it can be considered in this setting. They also discussed the use of PET/CT for the workup of anal margin cancer and for the assessment of treatment response. They reaffirmed their recommendation that PET/CT is not appropriate in these settings.
Asunto(s)
Neoplasias del Ano/radioterapia , Carcinoma de Células Escamosas/radioterapia , Neoplasias del Ano/diagnóstico , Neoplasias del Ano/diagnóstico por imagen , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/diagnóstico por imagen , Humanos , Imagen Multimodal , Tomografía de Emisión de Positrones , Tomografía Computarizada por Rayos XAsunto(s)
Carcinoma/terapia , Neoplasias del Colon/terapia , Guías de Práctica Clínica como Asunto , Algoritmos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma/diagnóstico , Carcinoma/etiología , Carcinoma/patología , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/etiología , Neoplasias del Colon/patología , Terapia Combinada , Continuidad de la Atención al Paciente , Procedimientos Quirúrgicos del Sistema Digestivo/estadística & datos numéricos , Humanos , Quimioterapia de Mantención/métodos , Quimioterapia de Mantención/estadística & datos numéricos , Oncología Médica/legislación & jurisprudencia , Oncología Médica/normas , Terapia Neoadyuvante , Metástasis de la Neoplasia , Radioterapia/estadística & datos numéricos , RecurrenciaAsunto(s)
Carcinoma Medular , Neoplasias de la Tiroides , Calcitonina/biosíntesis , Calcitonina/sangre , Carcinoma Medular/diagnóstico , Carcinoma Medular/epidemiología , Carcinoma Medular/radioterapia , Carcinoma Medular/cirugía , Humanos , Cuidados Posoperatorios , Radioterapia Adyuvante , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/epidemiología , Neoplasias de la Tiroides/radioterapia , Neoplasias de la Tiroides/cirugía , Tiroidectomía , Estados Unidos/epidemiologíaAsunto(s)
Melanoma/diagnóstico , Melanoma/terapia , Neoplasias Cutáneas/diagnóstico , Neoplasias Cutáneas/terapia , Algoritmos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Biopsia , Quimioterapia Adyuvante , Ensayos Clínicos como Asunto , Humanos , Escisión del Ganglio Linfático/métodos , Metástasis de la Neoplasia/diagnóstico , Metástasis de la Neoplasia/terapia , RecurrenciaAsunto(s)
Biomarcadores de Tumor , Neoplasias de la Tiroides/terapia , Humanos , Neoplasia Endocrina Múltiple/diagnóstico , Neoplasia Endocrina Múltiple/genética , Neoplasia Endocrina Múltiple/terapia , Estadificación de Neoplasias , Neoplasias de la Tiroides/diagnóstico , Neoplasias de la Tiroides/genética , Neoplasias de la Tiroides/patologíaAsunto(s)
Neoplasias del Colon/diagnóstico , Neoplasias del Colon/terapia , Oncología Médica/normas , Protocolos de Quimioterapia Combinada Antineoplásica , Quimioterapia Adyuvante , Colectomía , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Pólipos del Colon/diagnóstico , Pólipos del Colon/terapia , Colostomía , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Neoplasias Pulmonares/secundario , Neoplasias Pulmonares/cirugía , Escisión del Ganglio Linfático , Metástasis Linfática , Invasividad Neoplásica , Estadificación de Neoplasias , Medición de Riesgo , Terapia RecuperativaAsunto(s)
Oncología Médica/normas , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/cirugía , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Camptotecina/análogos & derivados , Camptotecina/uso terapéutico , Fluorouracilo/uso terapéutico , Humanos , Leucovorina/uso terapéutico , Neoplasias Hepáticas/secundario , Neoplasias Pulmonares/secundario , Metástasis Linfática , Estadificación de Neoplasias , Compuestos Organoplatinos/uso terapéutico , Radioterapia Adyuvante , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/radioterapiaRESUMEN
Complications after pancreatic resection remain prevalent. Procedure-related morbidity has previously focused on prevention of pancreatic and biliary fistulas (PFs and BFs) with other complications receiving less attention. We examined morbidity and its impact on reoperation, length of stay (LOS), and mortality following pancreatic resection. We retrospectively reviewed patients having elective pancreatectomy at the University of Tennessee affiliated hospitals during a recent 5-year time period. Factors examined included morbidity, mortality, and the need for reoperation. Patient deaths were analyzed with a focus on antecedent complications. Comparisons were made using Student's t test and chi2 analysis where appropriated. From 1997 to 2003, 125 patients had pancreatic resections: 93 Whipple procedures, 27 distal, and 5 total pancreatectomies. Twenty-nine patients (23%) did not have intraperitoneal drainage (IPD). Resections were performed for cancer in 75 per cent. Seventy complications occurred in 55 patients (44%). Morbidity related to an intra-abdominal process resulted in 16 reoperations and 4/6 deaths in this series (overall mortality, 4.8%). There were no BFs. Of 10 patients with PFs (8%), none required reoperation, and there was no PF-related mortality. No patient without IPD developed a PF. The presence of a PF significantly increased LOS when compared to those without (30.9 +/- 13.1 vs 17.4 +/- 12.2 days, P < 0.01). Forty-four per cent of all complications were related to either intra-abdominal abscess (IAA), hemorrhage, or feeding tube placement (18, 8, and 5, respectively). Management of IAA included percutaneous drainage in 16 and reoperation in 2 with 1 associated death. Hemorrhage necessitated reoperation in 6, resulted in 1 patient death, and was followed by IAA in 2. Of 5 jejunostomy tube complications, 4 required reoperation and 2 patients died. LOS was significantly greater in these 28 patients when compared to all others (28.1 +/- 16.9 vs 15.8 +/- 9.9 days, P < 0.001). Following pancreatectomy, 1) BFs should be a rare event; 2) PFs remain important but are most often managed nonoperatively with few sequelae; 3) in this series, IAA and hemorrhage were more common than PF, frequently mandated reoperation, prolonged hospitalization, and were associated with procedure related mortality; 4) feeding tube complications, though rare, are often catastrophic; 5) future efforts should focus on factors that could reduce abscess formation and a reduction in overall complications--many of which are potentially preventable.