RESUMEN
BACKGROUND: We aim to investigate the possibility of using 18F-positron emission tomography/computer tomography (PET-CT) to predict the histopathologic response in locally advanced rectal cancer (LARC) treated with preoperative chemoradiation (CRT). METHODS: The study included 50 patients with LARC treated with preoperative CRT. All patients were evaluated by PET-CT before and after CRT, and results were compared to histopathologic response quantified by tumour regression grade (patients with TRG 1-2 being defined as responders and patients with grade 3-5 as non-responders). Furthermore, the predictive value of metabolic imaging for pathologic complete response (ypCR) was investigated. RESULTS: Responders and non-responders showed statistically significant differences according to Mandard's criteria for maximum standardized uptake value (SUVmax) before and after CRT with a specificity of 76,6% and a positive predictive value of 66,7%. Furthermore, SUVmax values after CRT were able to differentiate patients with ypCR with a sensitivity of 63% and a specificity of 74,4% (positive predictive value 41,2% and negative predictive value 87,9%); This rather low sensitivity and specificity determined that PET-CT was only able to distinguish 7 cases of ypCR from a total of 11 patients. CONCLUSIONS: We conclude that 18-F PET-CT performed five to seven weeks after the end of CRT can visualise functional tumour response in LARC. In contrast, metabolic imaging with 18-F PET-CT is not able to predict patients with ypCR accurately.
Asunto(s)
Carcinoma/diagnóstico por imagen , Fluorodesoxiglucosa F18 , Tomografía de Emisión de Positrones/métodos , Neoplasias del Recto/diagnóstico por imagen , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma/tratamiento farmacológico , Carcinoma/metabolismo , Carcinoma/radioterapia , Quimioterapia Adyuvante , Terapia Combinada , Femenino , Fluorodesoxiglucosa F18/farmacocinética , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Pronóstico , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/metabolismo , Neoplasias del Recto/radioterapia , Sensibilidad y EspecificidadAsunto(s)
Trasplante de Hígado/efectos adversos , Mielinólisis Pontino Central/etiología , Complicaciones Posoperatorias , Electroencefalografía , Femenino , Humanos , Trasplante de Hígado/mortalidad , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Mielinólisis Pontino Central/diagnóstico , Mielinólisis Pontino Central/mortalidad , Complicaciones Posoperatorias/diagnósticoRESUMEN
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Asunto(s)
Masculino , Femenino , Persona de Mediana Edad , Humanos , Mielinólisis Pontino Central/etiología , Trasplante de Hígado/efectos adversos , Cirrosis Hepática/cirugíaRESUMEN
PURPOSE: We evaluated the clinical results of different techniques of resection for malignant left-sided colonic obstruction. METHODS: The subjects of this prospective nonrandomized study were 63 consecutive patients who underwent surgery between 1995 and 2000 at a single institution. Patients with nonprimary colonic tumors, lesions located proximally to splenic flexure, peritonitis, perforation, or cecal necrosis were excluded. RESULTS: Segmental colectomy with primary anastomosis (CPA) was performed in 35 patients; with intraoperative colonic irrigation (ICI) in 19, and without ICI in 16. Total or subtotal colectomy (TSC) was performed in 8, and Hartmann's procedure (HP) was performed in 20. There were no differences in age, sex, comorbidity, time of symptoms, preoperative hospital stay, or tumor staging among the groups of patients defined by the different surgical techniques. The overall incidence of postoperative complications was 43%; postoperative mortality, 5%; anastomotic dehiscence, 12%; urgent reoperations, 12%; and readmissions, 5%, without significant differences among the treatment groups. However, the postoperative and total hospital stay were significantly shorter after ICI (P = 0.016 and P = 0.012, respectively). The overall 5-year survival was 42.7%. CONCLUSIONS: We think that segmental colectomy with anastomosis after intraoperative colonic irrigation is the most effective operative treatment for neoplastic left-sided colonic obstructions, considering its safety and cost-effectiveness.