Resultados clínico-oncológicos de la respuesta patológica completa en el cáncer de recto después de tratamiento neoadyuvante / Clinical and oncological results of the pathological complete response in rectal cancer after neoadjuvant treatment

Introduction Neoadjuvant chemo-radiotherapy is the treatment of choice for rectal cancer in order to reduce local recurrence. Patients with a pathological complete response (PCR) have a better prognosis. The aim of this study was to determine the influence of PCR on the oncological outcomes in our patients. Methods All patients with stage ii/iii rectal cancer treated with neoadjuvant chemo-radiotherapy and radical resection between 2007 and 2011were identified from a prospective database, and grouped based on whether they achieved PCR or not (non-PCR). Clinical, histological and oncological outcome data were compared. Results A total of 162 patients were included (62% men), with a mean age of 65 years. In terms of pre-operative TNM staging, 82 patients (50%) were T2, 75 (46%) were T3, and 5 (3%) were T4. Forty-two patients (25%) were N1, and 87 (53%) were N2. Low anterior resection and abdominoperineal resection were performed in 125 (77%) and 25 (15%) patients. Forty-three patients (26.5%) had postoperative morbidity. PCR was achieved in 19 patients (11.7%). After a median follow-up of 26 months, there are no recurrences in the PCR group, and in the non-PCR group, local recurrence was 1.4% (P = .78), and distant metastasis was 8.4% (P = .21). Overall survival (P = .39) and survival free of diseases (P = .23) were better in the PCR group, but the differences were not significant. Conclusion Patients with pathological complete response have better oncological outcome (AU)

Introducción La radioquimioterapia es el tratamiento de elección en el cáncer de recto para conseguir el control de la enfermedad. Los pacientes con respuesta patológica completa (RPC) presentan mejor pronóstico. El objetivo del trabajo es conocer nuestra incidencia de RPC y analizar los resultados oncológicos. Métodos Pacientes con neoplasia de recto estadios ii/iii , recogidos prospectivamente en el periodo comprendido entre 2007 y 2011. Los pacientes son sometidos a neoadyuvancia y a cirugía radical. Se dividen en 22 grupos según tengan o no RPC y se comparan las variables demográficas, clínicas e histológicas y su relación con la evolución oncológica. Resultados Se analizan 162 pacientes (62% varones) con una edad media de 65 a. La incidencia de RPC es del 11,7% (19 pacientes). El 50% de los pacientes son T2, el 46% son T3 y el 3% son T4, mientras que el 25% son N1 y el 53% son N2 antes de la neoadyuvancia. En 25 pacientes (15%)se ha practicado una amputación de recto y en 125 (77%) una resección anterior baja. La morbilidad global es del 26,5%(43 pacientes). Con una mediana de seguimiento de 26 meses, ningún paciente con RPC ha presentado recurrencia tumoral. En el grupo de NO-RPC la recidiva local es del 1,4% (p = 0,78) y las metástasis del 8,4% (p = 0,21), siendo la supervivencia global y la libre de enfermedad mayor en el grupo con RPC pero sin diferencias significativas (p = 0,39, p = 0,23). Conclusión La presencia de RPC después de tratamiento neoadyuvante se relaciona con mejores resultados oncológicos (AU)

[Clinical and oncological results of the pathological complete response in rectal cancer after neoadjuvant treatment]. / Resultados clínico-oncológicos de la respuesta patológica completa en el cáncer de recto después de tratamiento neoadyuvante.

INTRODUCTION: Neoadjuvant chemo-radiotherapy is the treatment of choice for rectal cancer in order to reduce local recurrence. Patients with a pathological complete response (PCR) have a better prognosis. The aim of this study was to determine the influence of PCR on the oncological outcomes in our patients. METHODS: All patients with stage ii/iii rectal cancer treated with neoadjuvant chemo-radiotherapy and radical resection between 2007 and 2011 were identified from a prospective database, and grouped based on whether they achieved PCR or not (non-PCR). Clinical, histological and oncological outcome data were compared. RESULTS: A total of 162 patients were included (62% men), with a mean age of 65 years. In terms of pre-operative TNM staging, 82 patients (50%) were T2, 75 (46%) were T3, and 5 (3%) were T4. Forty-two patients (25%) were N1, and 87 (53%) were N2. Low anterior resection and abdominoperineal resection were performed in 125 (77%) and 25 (15%) patients. Forty-three patients (26.5%) had postoperative morbidity. PCR was achieved in 19 patients (11.7%). After a median follow-up of 26 months, there are no recurrences in the PCR group, and in the non-PCR group, local recurrence was 1.4% (P=.78), and distant metastasis was 8.4% (P=.21). Overall survival (P=.39) and survival free of diseases (P=.23) were better in the PCR group, but the differences were not significant. CONCLUSION: Patients with pathological complete response have better oncological outcome.

[Current situation of colorectal trauma]. / Estado actual de los traumatismos colorrectoanales.

Mortality from colorectal trauma decreased from the end of the 19th Century, when death was the rule, to the 21st Century, when mortality is 5%. The greatest advances were produced during wars, mainly due to improved transport conditions, antisepsis, advances in operating and anesthetic techniques, the management of fluids, blood and blood products, the use of antibiotics, exteriorization of wounds, and the use of colostomy. Injuries to the anus, rectum and colon are infrequent. Their prevalence is difficult to establish because they can be caused by several factors. In Spain, the most frequent causes are traffic accidents and iatrogenic lesions, while in America the most common causes are stab or gunshot wounds. Although the etiology of these injuries is diverse, two major groups of colorectal trauma can be established: accidental injuries and iatrogenic trauma. Clinical symptoms vary, ranging from abdominal, pelvic, perianal or anal pain, sometimes associated with rectorrhagia, to peritonismus or shock. Diagnosis is based on physical and rectal examination and laboratory, radiological, and endoscopic investigations. Laparoscopy can also be used on occasions. Treatment should be individualized, depending on the patient's history, current status, the time elapsed since injury, the status of the injured intestine, the degree of fecal contamination, associated lesions, and the surgeon's experience.

Estado actual de los traumatismos colorrectoanales / Current situation of colorectal trauma

La mortalidad por heridas de colon y recto ha disminuido en el mundo, desde finales del siglo XIX, cuando la mortalidad era la regla, hasta el siglo XXI, al 5%. Durante los conflictos bélicos se produjeron los mayores avances. Esto se debe principalmente a la mejora en las condiciones de traslado, la antisepsia, los avances en las técnicas operatorias y anestésicas, el manejo de fluidos, sangre y hemoderivados, el uso de antibióticos, la exteriorización de las heridas y el empleo de la colostomía. Los traumatismos anales, rectales y colónicos son poco frecuentes. Su prevalencia es difícil de establecer debido a los diversos factores que intervienen en su origen. En España predominan los accidentes de tráfico y las lesiones iatrogénicas, frente a las lesiones por arma blanca o de fuego más frecuentes en América. La etiología es diversa, pero se pueden establecer 2 grandes grupos de traumatismos colorrectales: traumatismos accidentales y traumatismos iatrogénicos. Los síntomas clínicos son variados, con dolor abdominal, pelviano, perianal o anal, asociado o no a rectorragia, hasta peritonismo franco o cuadro de shock. El diagnóstico se basa en la exploración física, el tacto rectal y las pruebas complementarias analíticas, radiológicas, endoscópicas y en ocasiones laparoscópicas. El tratamiento se ha de individualizar en cada caso según los antecedentes patológicos del paciente, su estado actual, el tiempo de evolución, la situación del intestino lesionado, el grado de contaminación fecal, las lesiones asociadas y la experiencia del cirujano (AU)

Mortality from colorectal trauma decreased from the end of the 19th Century, when death was the rule, to the 21st Century, when mortality is 5%. The greatest advances were produced during wars, mainly due to improved transport conditions, antisepsis, advances in operating and anesthetic techniques, the management of fluids, blood and blood products, the use of antibiotics, exteriorization of wounds, and the use of colostomy. Injuries to the anus, rectum and colon are infrequent. Their prevalence is difficult to establish because they can be caused by several factors. In Spain, the most frequent causes are traffic accidents and iatrogenic lesions, while in America the most common causes are stab or gunshot wounds. Although the etiology of these injuries is diverse, two major groups of colorectal trauma can be established: accidental injuries and iatrogenic trauma. Clinical symptoms vary, ranging from abdominal, pelvic, perianal or anal pain, sometimes associated with rectorrhagia, to peritonismus or shock. Diagnosis is based on physical and rectal examination and laboratory, radiological, and endoscopic investigations. Laparoscopy can also be used on occasions. Treatment should be individualized, depending on the patient's history, current status, the time elapsed since injury, the status of the injured intestine, the degree of fecal contamination, associated lesions, and the surgeon's experience (AU)