Publication: Abordaje laparoscópico en el tratamiento quirúrgico del cáncer de recto localmente avanzado
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2019-02-18
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Universidad Complutense de Madrid
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Abstract
El cáncer de recto localmente avanzado (LARC) se define como aquel con afectación extensa de la pared del recto o con invasión de las adenopatías locorregionales, estadios II-III de la AJCC [25]. La administración de quimioradioterapia neoadyuvante seguida de cirugía y quimioterapia adyuvante es el esquema de tratamiento multimodal habitual. La curación depende en gran medida de la radicalidad de la resección quirúrgica. En los últimos años se han desarrollado nuevos abordajes quirúrgicos, como la cirugía laparoscópica. Sin embargo, su uso para el tratamiento del cáncer de recto localmente avanzado aún no está ampliamente aceptado. Justificación: Los resultados a corto y largo plazo de la cirugía laparoscópica para el tratamiento del cáncer de recto son contradictorios, sin poder descartar la no inferioridad de la laparoscopia frente a la cirugía abierta. La literatura sobre el abordaje laparoscópico del cáncer de recto localmente avanzado es escasa. Hipótesis: El tratamiento quirúrgico laparoscópico en el cáncer de recto localmente avanzado proporciona unos resultados oncológicos similares a los obtenidos con el tratamiento quirúrgico abierto. Objetivos: Nuestro objetivo principal es comparar dos grupos de estudio (abordaje laparoscópico versus abierto) en el tratamiento quirúrgico del cáncer de recto localmente avanzado en términos de supervivencia global y supervivencia libre de enfermedad a largo plazo. Otros objetivos del estudio: En primer lugar, realizar un análisis comparativo de la calidad de la pieza quirúrgica según grupo de estudio y evaluar el impacto del tratamiento mínimamente invasivo en la recuperación peri y postoperatoria. En segundo lugar, analizar la influencia del abordaje quirúrgico en la topografía de la recidiva tumoral, estudiar las complicaciones quirúrgicas y su influencia en la supervivencia a largo plazo y detectar otros factores pronósticos con influencia en los resultados a largo plazo...
Locally advanced rectal cancer (LARC) is defined as a tumour with extensive involvement of the rectal wall or with locoregional lymph nodes invasion, stage II-III of the AJCC [25]. Administration of neoadjuvant chemoradiotherapy treatment followed by surgery and adjuvant chemotherapy, is the usual multimodal treatment scheme. Curative results mostly depend on the radicality of surgical resection. In recent years, new surgical approaches have been developed such as laparoscopic surgery. However, its use for the treatment of locally advanced rectal cancer is not yet widely accepted. Justification: The short and long-term results of laparoscopic surgery for the treatment of rectal cancer are contradictory, without been able to rule out the non-inferiority of laparoscopy compared to open surgery. Literature on laparoscopic approach of locally advanced rectal cancer is scarce. Hypothesis: Laparoscopic surgical treatment of locally advanced rectal cancer provides oncological results similar to those obtained with open surgical treatment. Aims: Our main objective is to compare two study groups (laparoscopic versus open approach) in the surgical treatment of locally advanced rectal cancer in terms of long term overall survival and disease-free survival. Other aims of the study: First of all, to perform a comparative analyses of the quality of the surgical specimen according to the group of study and evaluate the impact of minimally invasive treatment on peri and postoperative recovery. Secondly, to analyze the influence of the surgical approach on the topography of tumoral recurrence, study postoperative complications and their influence in long term survival and to detect other prognostic factors with influence in long term outcomes...
Locally advanced rectal cancer (LARC) is defined as a tumour with extensive involvement of the rectal wall or with locoregional lymph nodes invasion, stage II-III of the AJCC [25]. Administration of neoadjuvant chemoradiotherapy treatment followed by surgery and adjuvant chemotherapy, is the usual multimodal treatment scheme. Curative results mostly depend on the radicality of surgical resection. In recent years, new surgical approaches have been developed such as laparoscopic surgery. However, its use for the treatment of locally advanced rectal cancer is not yet widely accepted. Justification: The short and long-term results of laparoscopic surgery for the treatment of rectal cancer are contradictory, without been able to rule out the non-inferiority of laparoscopy compared to open surgery. Literature on laparoscopic approach of locally advanced rectal cancer is scarce. Hypothesis: Laparoscopic surgical treatment of locally advanced rectal cancer provides oncological results similar to those obtained with open surgical treatment. Aims: Our main objective is to compare two study groups (laparoscopic versus open approach) in the surgical treatment of locally advanced rectal cancer in terms of long term overall survival and disease-free survival. Other aims of the study: First of all, to perform a comparative analyses of the quality of the surgical specimen according to the group of study and evaluate the impact of minimally invasive treatment on peri and postoperative recovery. Secondly, to analyze the influence of the surgical approach on the topography of tumoral recurrence, study postoperative complications and their influence in long term survival and to detect other prognostic factors with influence in long term outcomes...
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Tesis de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Radiología y Medicina Física, leída el 19/12/2018