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)
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REV ARGENT COLOPROCT | 2024 | VOL. 35, N° 2: 41-42
DOI: https://doi.org/10.46768/racp.v35i2.261
VIDEO
Cáncer de colon localmente avanzado. Resección
en bloque laparoscópica
https://youtu.be/SEJuc7YUp2c
Diego J. Valli, Brian Gelblung, Carina Chwat, Flavia Alexandre, Mauro Ramírez Duarte, Guido Díaz Duarte,
Guillermo Rosato, Gustavo Lemme
Hospital Universitario Austral, Pilar, Buenos Aires.
Palabras clave: Cáncer colorrectal, T4b, Resección multivisceral,
Localmente avanzado.
Keywords: colorectal cancer, T4b, multivisceral resection, locally
advanced
INTRODUCCIÓN
El cáncer colorrectal localmente avanzado es un desafío mul-
tidisciplinario. Este tipo de tumores constituye entre el 10 y
20% de los cánceres colorrectales. Se los clasica como T4a
cuando invaden el peritoneo visceral y T4b cuando invaden
otras estructuras vecinas.
1
La cirugía resectiva en bloque con
adyuvancia postoperatoria es la mejor opción terapéutica con
nes curativos.
2
El predictor más importante en la evolución
de estos pacientes es la cirugía R0.
3
DESCRIPCIÓN
Paciente de sexo femenino de 44 años que concurre a la con-
sulta por cuadro de anemia, dolor abdominal, masa palpable
móvil en hipogastrio y síntomas suboclusivos.
En el laboratorio se observa Hb 7gr/dl, hematocrito de 23,4,
CEA de 100 ng/ml y Ca 19-9 de 1923 U/ml. La videocolonos-
copía muestra una lesión a 18 cm de margen anal, ulcerada,
friable, de crecimiento endofítico infranqueable. Se completa
estudio con una colonoscopia virtual en la que se observa en-
grosamiento parietal circunferencial de colon sigmoides con
Los autores declaran ausencia de conictos de interés. Diego Julián Valli: diegojvalli@hotmail.com
Recibido: 8/5/2023. Aceptado: 3/5/2024.
Diego J. Valli: https://orcid.org/0000-0001-5207-2610, Brian Gelblung: https://orcid.org/0000-0002-5947-8266, Carina Chwat: https://orcid.org/0000-0002-2123-0388,
Flavia Alexandre: https://orcid.org/0000-0002-3236-4381, Mauro Ramírez Duarte: https://orcid.org/0009-0009-8983-0118, Guido Díaz Duarte: https://orcid.org/0000-0001-9220-4091,
Guillermo Rosato: https://orcid.org/0000-0002-9920-9335, Gustavo Lemme: https://orcid.org/0000-0001-5633-2707
compromiso de asa de intestino delgado. En la tomografía
computada (TC) de abdomen se observa engrosamiento del
tercio distal de colon sigmoides, con adenopatías regionales
y compromiso de ovario izquierdo y trompa homolateral. TC
de tórax sin evidencia de secundarismo.
Se decide internación para optimización clínica prequirúrgi-
ca. Se presenta en ateneo multidisciplinario y se decide reso-
lución quirúrgica.
Se realiza un abordaje laparoscópico. Se comienza con el
descenso del ángulo esplénico del colon, seguido de abordaje
medial de la pelvis y del pedículo en el origen del tronco de
las sigmoideas. Sección del íleon terminal y movilización del
colon derecho. Sección a nivel de colon transverso y sección
del recto superior con suturas lineales de 60 mm.
Dado el compromiso de los anexos izquierdos, éstos se rese-
can en bloque con el tumor. La pieza quirúrgica en bloque
incluye íleon distal, ciego, colon ascendente, colon sigmoi-
des, trompa y ovario izquierdo. Se realiza reconstrucción del
tránsito intestinal mediante anastomosis ileocólica laterola-
teral isoperistáltica intracorpórea y anastomosis colorrectal
con sutura mecánica circular.