RESUMO
BACKGROUND: Nonoperative management after neoadjuvant treatment in low rectal cancer enables organ preservation and avoids surgical morbidity. Our aim is to compare oncological outcomes in patients with clinical complete response in watch and wait strategy with those who received neoadjuvant therapy followed by surgery with a pathological complete response. METHODS: Patients with non-metastatic rectal cancer after neoadjuvant treatment with clinical complete response in watch and wait approach (group 1, n = 26) and complete pathological responders (ypT0N0) after chemoradiotherapy and surgery (group 2, n = 22), between January 2011 and October 2018, were included retrospectively, and all of them evaluated and followed in a multidisciplinary team. A comparative analysis of local and distant recurrence rates and disease-free and overall survival between both groups was carried out. Statistical analysis was performed using log-rank test, Cox proportional hazards regression model, and Kaplan-Meier curves. RESULTS: No differences were found between patient's demographic characteristics in both groups. Group 1: distance from the anal verge mean 5 cm (r = 1-12), 10 (38%) stage III, and 7 (27%) circumferential resection margin involved. The median follow-up of 47 months (r = 6, a 108). Group 2: distance from the anal verge mean 7 cm (r = 2-12), 16 (72%) stage III, and 13 (59%) circumferential resection margin involved. The median follow-up 49.5 months (r = 3, a 112). Local recurrence: 2 patients in group 1 (8.3%) and 1 in group 2 (4.8%) (p = 0.6235). Distant recurrence: 1 patient in group 1 (3.8%) and 3 in group 2 (19.2%) (p = 0.2237). Disease-free survival: 87.9% in group 1, 80% in group 2 (p = 0.7546). Overall survival: 86% in group 1 and 85% in group 2 (p = 0.5367). CONCLUSION: Oncological results in operated patients with pathological complete response were similar to those in patients under a watch and wait strategy mediating a systematic and personalized evaluation. Surgery can safely be deferred in clinical complete responders.
Assuntos
Terapia Neoadjuvante , Neoplasias Retais , Quimiorradioterapia , Humanos , Recidiva Local de Neoplasia/terapia , Prognóstico , Neoplasias Retais/terapia , Estudos Retrospectivos , Resultado do Tratamento , Conduta ExpectanteRESUMO
Menos de 100 casos de Satelitismo Plaquetario se han descrito desde que en 1963, Field y MacLeod describieron por primera vez este fenómeno. Estos son los dos primeros casos del fenómeno descritos en la literatura Costarricense. El satelitismo plaquetario se observo en muestras sanguíneas con EDTA como anticoaguante y alrededor de los polimorfonucleares. A diferencia de otros casos descritos en la literatura la fagocitosis plaquetaria era evidente y no se observó pseudotrombocitopenia.
Field and MacLeod first reported the platelet satellitosis or satellitism in 1963 and to date is has been observed in no more than 100 cases. These are the first two cases reported in Costa Rica. This phenomenon occurred only in blood anticoagulated by EDTA and around polymorphonuclears. Pseudotrombocytopenia was not observed but platelet phagocytosis was evident.