Discusión de Carcinomatosis Peritoneal originada en el Colon
En estudios de asignación aleatoria, cuando se compara la cirugía de citorreduccion más quimioterapia hipertér- mica intraperitoneal con la quimioterapia convencional, se ha encontrado una supervivencia de 22,3 meses, en comparación con 12,6 meses, respectivamente 5,18, con una razón de riesgo (HR) de 0,55. En otro estudio se encontró una supervivencia de 81 % (IC95%: 68-90 %) a favor de la quimioterapia hipertérmica intraperitoneal, comparada con la quimioterapia convencional paliativa (65 %) (IC95%: 55-74 %) 14.
Existen muy pocos datos sobre el uso de la escala de gravedad (PSDSS) en estos pacientes. Esta revisión y el flujograma son una primera propuesta de enfoque diagnóstico y terapéutico de los pacientes con carci- nomatosis peritoneal de origen en el colon, teniendo en cuenta que el tratamiento multidisciplinario es el estándar de tratamiento del cáncer y que el compromiso peritoneal a causa del cáncer colorrectal era considera- do en épocas anteriores como una señal inevitable de fracaso terapéutico.
La actual propuesta constituye un planteamiento interesante desde el punto de vista del pronóstico de los pacientes. Sin embargo, es pertinente la realización de futuros estudios que proporcionen información clínica y que permitan validar el flujograma planteado.
Este flujograma propuesto utiliza la información recolectada en otros artículos sobre el pronóstico de los pacientes con carcinomatosis peritoneal, partiendo de la idea y la evidencia clínica diaria de que no todos los casos de carcinomatosis peritoneal tienen similares características y que factores como el estado funcional, el comportamiento biológico (grado, compromiso ganglionar) y el compromiso peritoneal evaluados en el índice de PSDSS, orientan a manejar de una forma individualizada a los que padecen esta compleja enfermedad para optimizar el tratamiento con citorreducción y quimioterapia hipertérmica intraperitoneal, de tal manera que se logre disminuir el riesgo de complicaciones en quienes no se beneficiarían de esta propuesta terapéutica.
A diagnostic and therapeutic proposal in peritoneal carcinomatosis originating in the large bowel
Abstract
Abstract Introduction. Colorectal cancer is the fourth leading cause of cancer worldwide, with an incidence of 17.2 per 100,000 population, and in Colombia the incidence is 10.6 per 100,000, associated with high mortality. Metastatic cancer to the peritoneum is considered a systemic condition, for which only palliative chemotherapy is offered due to the poor prognosis. Cytoreductive surgery plus intraperitoneal hyperthermic chemotherapy is great option for these patients, optimizing their condition and overall survival.
Objective. The aim of this article is to propose a flowchart for the selection of patients with colorectal carcinomatosis using the severity score scale of surface peritioneal disease for the proper administration of intraperitoneal hyperthermic chemotherapy.
Material and methods. We completed a systematic search for articles in the PubMed, EMBASE and COCHRANE data bases with the MESH terms “colorectal cancer”, “peritoneal metastases” and “peritoneal carcinomatosis”, encountering four articles based on the use of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy that assessed the patients characteristics, the treatment received, and the follow-up.
Results and discussion. We propose a flow diagram based on the clinical, imaging and histological characteristics, that allows classifying the severity of the disease, and therefore define those that can benefit from systemic chemotherapy versus hyperthermic intraperitoneal chemotherapy, and thus reduce complications rates and optimize management.
Key words: colonic neoplasms; neoplasm metastasis; peritoneal neoplasms; hyperthermia, induced; mortality.
Bibliografía
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Correspondencia: Mauricio García, MD
Correo electrónico: maurogmora@hotmail.com
Bogotá, D.C., Colombia
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