ABSTRACT
INTRODUCTION: Primary retroperitoneal parasitic leiomyoma (PRPL) with inguinal extension is a diagnostic-therapeutic challenge due to its uncertain etiopathogenesis and because it has been considered unresectable according to customary surgical techniques in some instances. The abdominoinguinal incision described by Karakousis in the 1980s allows a safe and radical approach for lower quadrants abdominopelvic tumors. OBJECTIVES: We present the case of a rare PRPL satisfactorily treated through Karakousis's approach. PRESENTATION OF CASE: A 35-year-old woman was referred from the Gynecology Service to our Unit. She suffered from a pelvic tumor with left inguinal extension. Initially, it was diagnosed as a retroperitoneal sarcomatous tumor as any digestive and/or gynecological origins of the pelvic tumor were excluded. A radical oncologic excision with permanent neuro-vascular control was undertaken using a left Karakousis's abdominoinguinal approach. The final anatomopathological report was PRPL. The patient was discharged after 8â¯days. She is disease-free 18 months later. DISCUSSION: PRPL variant could be related to remnant embryogenic cells of the ducts of Wolf and Müller. Karakousis's approach allowed an en-bloc ilioinguinal removal of the tumor in continuity, with permanent control of the aorto-ileo-femoral axis, the sparing of the neuro-vascular package, and ensured a total abdominal wall restoration. CONCLUSIONS: PRPL is a rare extrauterine entity probably derived from remnant embryogenic cells. The absence of clinical guidelines recommend an individualized treatment of these patients. Karakousis's abdominoinguinal approach should be present in any surgeon's armamentarium as the resectability-rate of tumors of the lower quadrant of the abdomen increases up to 95%.
Subject(s)
Asymptomatic Diseases , Pelvic Neoplasms , Retroperitoneal Neoplasms , Adult , Female , Humans , Diagnosis, Differential , Hospitals, University , Inguinal Canal , Pelvic Neoplasms/diagnostic imaging , Pelvic Neoplasms/pathology , Pelvic Neoplasms/surgery , Retroperitoneal Neoplasms/diagnostic imaging , Retroperitoneal Neoplasms/pathology , Retroperitoneal Neoplasms/surgery , Spain , Treatment Outcome , Tumor Burden , Systematic Reviews as TopicABSTRACT
El cáncer de origen colorrectal es el tumor digestivo más frecuente. La alta incidencia de su diseminación abdominal, el mal pronóstico de estos pacientes, con una media de supervivencia de 5-9 meses demostrada en todos los estudios sobre la historia natural de la carcinomatosis colorrectal, y el fracaso del tratamiento adyuvante sistémico, con supervivencias máximas de 18 meses, han obligado al estudio y desarrollo de otras estrategias de tratamiento. Se presenta una revisión de los principios que fundamentan el Protocolo de Tratamiento de Sugarbaker, que comprende la máxima cirugía (..) (AU)
Colorectal cancer is the most frequent digestive tumor. The incidence of abdominal dissemination is high and all studies of the natural history of colorectal carcinomatosis demonstrate that prognosis in these patients is poor, with a mean survival of between 5 and 9 months. Furthermore, the results of systemic adjuvant treatment are disappointing, with a maximum (..) (AU)
Subject(s)
Male , Female , Adult , Middle Aged , Humans , Carcinoma/diagnosis , Carcinoma/therapy , Clinical Protocols , Hepatectomy/methods , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/therapy , Injections, Intraperitoneal , Carcinoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols , Colorectal Neoplasms/historyABSTRACT
Colorectal cancer is the most frequent digestive tumor. The incidence of abdominal dissemination is high and all studies of the natural history of colorectal carcinomatosis demonstrate that prognosis in these patients is poor, with a mean survival of between 5 and 9 months. Furthermore, the results of systemic adjuvant treatment are disappointing, with a maximum survival of 18 months. Consequently, other treatment strategies need to be studied and developed. We present a review of the principles that underlie Sugarbakers treatment protocol, which includes maximal cytoreductive surgery for the treatment of macroscopic disease through peritonectomy together with perioperative intraperitoneal intensification chemotherapy for residual microscopic disease. We present all the phase II studies with more than 10 treated patients published in the medical literature by the main groups working in this line of treatment, together with the only phase III study published to date. With this new therapeutic alternative, the mean overall survival at 2 and 5 years is 40% and 20% respectively. Based on these results, this new therapeutic approach is recommended as the treatment of choice in these unfortunate patients. The limits of the treatment of advanced colorectal cancer are also discussed.
