Usefulness of Computed Tomography Angiography in the Preoperative Workup of Patients With Colorectal Cancer.

OBJECTIVES: The objective of this study is to analyze the main patterns of branching of the inferior mesenteric artery (IMA) and to determine if your knowledge changes the surgical strategy in the colorectal cancer. METHODS: This retrospective study included 63 patients with cancer of the sigmoid or rectum. We assessed the patterns of IMA in 3 subtypes: type A (independent left colic artery [LCA]), type B (LCA and sigmoid artery arising in a common trunk) and type C (LCA, sigmoid artery, and superior rectal artery with a common origin). Colorectal surgeons evaluated how the vascular map changed the type of IMA ligation. RESULTS: Inferior mesenteric artery branching was classified as type A in 55.6% patients, type B in 23.8%, and type C in 20.6%. Knowledge of the vascular map changed the type of ligation from high to low in 20 of the 50 patients who were candidates for surgery. The change was possible in tumors located in the sigmoid colon and the rectosigmoid junction with the type A or B branching. CONCLUSIONS: Preoperative Multidetector Computed Tomography angiography can define the pattern of IMA branching. Based on this information, a low ligation can be performed in tumors located in sigmoid colon and rectosigmoid junction with IMA branching types A and B.

Estimulación preoperatoria del asa eferente de la ileostomía con ácidos grasos de cadena corta / Stimulation the efferent limb before loop ileostomy closure with short chain fatty acids

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Resección de GIST rectal mediante cirugía transanal mínimamente invasiva (TAMIS) tras neoadyuvancia con imatinib / Resection of a rectal gastrointestinal stromal tumour by transanal minimally invasive surgery (TAMIS) after neoadjuvant treatment with Imatinib

Resumen El tratamiento primario de elección para los pacientes con una tumoración GIST localizada es la extirpación quirúrgica completa con márgenes microscópicos negativos. Sin embargo, en un espacio tan reducido como el de la pelvis, la resección completa de una tumo-ración rectal grande es difícil y necesita en ocasiones una amputación abdomino-perienal. En nuestro caso, con la finalidad de reducir el tamaño del tumor y la morbilidad asociada a procedimientos quirúrgicos más agresivos se introdujo el tratamiento con imatinib, con intención neoadyuvante monitorizando la respuesta mediante ecoendoscopia. La respuesta obtenida, rediciendo el volumen tumoral, modificó la estrategia quirúrgica inicial y fue posible conseguir una resección satisfactoria mediante cirugía transanal mínimamente invasiva (TAMIS), preservando los esfínteres anales y soslayando la morbilidad genitourinaria asociada a la excisión mesorectal.

Abstract The primary treatment of choice for patients with a localised gastro-intestinal stromal tumour (GIST) is complete surgical excision with negative microscopic margins. However, in a space as small as that of the pelvis, complete resection of a large rectal tumour is difficult, and sometimes requires an abdominoperineal amputation. In order to reduce the size of the tumour, as well as the morbidity associated with more aggressive surgical procedures, neoadjuvant treatment with Imatinib was introduced in this case, with the response being monitored by of endoscopic ultrasound. The response obtained by reducing the tumour volume modified the strategy, making it possible to obtain a satisfactory resection using transanal minimally invasive surgery (TAMIS), preserving the anal sphincters and avoiding the genitourinary morbidity associated with the mesorectal excision.

Cáncer de recto localmente avanzado. La necesidad de la superespecialización / Locally advanced rectal cancer. The need for further specialization

Presentamos un caso que por sus connotaciones diagnósticas y terapéuticas resulta especialmente didáctico e ilustrativo, pues aborda el cómo, el quién y dónde debe realizarse la cirugía de cáncer de recto localmente avanzado. Ilustra el manejo diagnóstico y la estadificación del cáncer de recto en el momento actual. Este caso se aborda en el comité de forma multidisciplinar, y reúne los distintos avances en la cirugía de cáncer de recto de los últimos años (escisión total mesorrectal, abordaje laparoscópico, radioterapia intraoperatoria, resección perineal extendida, reparación del suelo pélvico con material protésico). Todo ello aunado a la opinión de que deben ser instituciones y grupos muy especializados y dedicados al tratamiento de esta patología los que deberían centralizar su atención médica.

We present a case, which due to its diagnostic and therapeutic connotations makes it especially educational, as it addresses the how, the who and where should the surgery be performed for locally advanced rectal cancer. It illustrates the diagnostic management and staging of rectal cancer at the present time. The case is approached in a multidisciplinary committee manner, and binds the various advances in surgery of rectal cancer in recent years (total meso-rectal excision, laparoscopy, intraoperative radiotherapy, extended perineal resection, pelvic floor repair with prosthetic material). This serves to underline the view that there must be highly specialized institutions and groups dedicated to the treatment of this condition in order to centralize its health care.

Cáncer colorrectal en pacientes mayores de 90 años: ¿cuál es el mejor tratamiento? / Colorectal cancer in a nonagenarian. What is the best treatment?

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Duplicación de vena cava inferior / Inferior vena cava duplication

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