Tratamiento del cáncer de recto
DOI:
https://doi.org/10.31837/relatos/7Palabras clave:
cirugía rectal, recto, neoplasmas, anatomía, tratamiento quirúrgico, imagenología, cáncer de rectoResumen
La mortalidad por cáncer de recto sigue siendo un tema de preocupación e impacto sanitario. A nivel mundial el cáncer colorrectal se encuentra en el 3er lugar en cuanto a incidencia. En Estados Unidos se calculan para el año 2015, 93.090 casos nuevos de cáncer de colon y 36.610 de recto. En Francia, la incidencia de cáncer de recto, oscila actualmente en los 15.000 casos nuevos por
año.1 En el Uruguay, el Registro Nacional de Cáncer de la Comisión Honoraria de la Lucha contra el
Cáncer de 2014, publica los resultados de incidencia del cáncer en el Uruguay en el período 2007-2011.2
La incidencia del cáncer colorrectal en el hombre mostró cifras de incidencia de 38,07 con una mortalidad de 19,23 (3er lugar detrás de próstata y pulmón) y en la mujer una incidencia de 27,28 con una mortalidad de 12,73 (2º lugar, detrás de mama) por 100.00 habitantes respectivamente. La estimación realizada para el año 2030 marca un aumento en la incidencia próximo al 25%
para ambos sexos (según cifras de Globocan OMS). Esto marca una realidad sanitaria preocupante y demanda un esfuerzo conjunto y políticas activas con vistas a mejorar los resultados. El tratamiento del cáncer de recto ha sufrido importantes cambios en los últimos 30 años. La introducción de la escisión total mesorrectal (TME) en 1982 por R. Heald, asociado a los
importantes avances en el campo de la oncología y la radioterapia han modificado la evolución de estos pacientes. La introducción de la cirugía laparoscópica, nuevas técnicas quirúrgicas que permiten llevar el límite de la preservación esfinteriana cada vez más distal, y las expectativas que plantea la cirugía robótica, hacen del cáncer de recto distal, un tema de actualidad. Los
avances en las disciplinas asociadas como la imagenología han permitido una selección precisa y la optimización de los tratamientos.
Descargas
Citas
Gérard J.P et al. Cáncer du rectum. Thésaurus National de Cancérologie Digestive, Juillet 2013
IV Atlas de incidencia del cáncer en el Uruguay. Periodo 2007-2011 Barrios E; Garau M; Alonso R, y Musetti C. Comisión honoraria de lucha contra el cáncer - Registro Nacional de Cáncer.
Minetti AM, Manoni JD. Relato anual 2013. Capítulo III Historia de la cirugía del cancer colorrectal. Rev Arg Coloproct (2013) Vol 24, No 3:107-110.
Galler AS, Petrelli NJ, Shakamuri SP. Rectal cancer surgery: A brief history. Review. Oncology 20 (2011) 223–230
Graney MJ, Graney CM. Colorectal surgery from antiquity to the modern era. Dis Colon Rectum 1980;23:432–41.
Corman ML. Contributions of eighteenth and nineteenth century French medicine to colon and rectal surgery. Dis Colon Rectum 2000;43 (Suppl.1):S1–29.
Ravitch MM, Steichen FM. A stappling instrument for end to end inverting anastomosis in the gastrointestinal tract”. Ann. Surg. 1979; 189:791.
Heald RJ,Husband EM,Ryall RDH.The mesorectum in rectal cancer surgery. The clue to pelvic recurrence? Br J Surg 1982;69:613-16
Balfour DC. A method of anastomosis between sigmoid and rectum. Dis Colon Rectum 1984;27:559–62
Improved survival with preoperative radiotherapy in resectable rectal cancer. Swedish Rectal Cancer Trial. N Engl J Med. 1997;336:980-987.
Kapiteijn E, Corre AM, Marijnen CA, Nagtegaal ID, Putter H, Steup WH, et al. Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. NEJM 2001;9:638–46.
Marijnen CA, Kapeteijn E, van de Velde CJ. Acute side effects and complications after short-term preoperative radiotherapy combined with total mesorectal excision in primary rectal cancer: report of a multicenter randomized trial. J Clin Oncol 2002;20:817–25.
Sauer R, Becker H, Hohenberger W, Rodel C, Wittekind C, Fietjau R, Martus P, et al. Preoperative versus postoperative chemoradiotherapy for rectal cancer. NEJM 2004;17:1731–40.
Bujko K, Nowacki MP, Nasierowska-Guttmejer A, Michalski W, Bebenek M, Kryj M. Long-term results of a randomized trial comparing preoperative short- course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer. Br J Surg. 2006; 93: 1215-1223.
Moore HG, Riedel E, Minsky BD, Saltz L, Paty P, Wong D, et al. Adequacy of 1 cm margin after restorative rectal cancer resection with sharp mesorectal excision and preoperative combined modality therapy. Ann Surg Oncol 2003;1:80–5.
Lacy AM, Garcia-Valdecasas JC, Delgado S, et al. (2002) Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial. Lancet 359: 2224-9
Leung KL, Kwok SPY, Lam SCW, et al. (2004) Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet 363:1187-92 121
The COLOR group (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6:477-84
The COST Group (2004) A comparison of laparoscopically-assisted and open colectomy for cancer. New Engl J Med 350: 2050-9
Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, Heath RM, Brown JM; MRC CLASICC trial group. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005 May
-20;365(9472):1718-26.
Bonjer J, Deijen C, Abis G, Cuesta MA, van der Pas M, de Lange-de Klerk E, Lacy AM, Bemelman W,
Andersson J, Angenete E, Rosenberg J, Fuerst A, Haglind E, for the COLOR II Study Group. A
Randomized Trial of Laparoscopic versus Open Surgery for Rectal Cancer N Engl J Med 2015;
:1324-1332
Habr-Gama A, de Souza PMSB, Ribeiro U Jr, Nadalin W, Gansl R, e Sousa AHSJr, Campos FG, GamaRodriguesJ. Low rectal cancer: impact of radiation and chemotherapy on surgical treatment. Dis Colon
Rectum 1998;41:1087-1096.
Szereszwski J; Anatomía del recto, conducto anal y aparato esfinteriano. Cirugía Digestiva, F. Galindo.
www.sacd.org.ar, 2009; iii-360, pág. 1-7.
Van Cutsem E, Dicato M, Haustermans K, Arber N, Bosset JF, Cunningham D, et al. The diagnosis and
management of rectal cancer: Expert discussion and recommendations derived from the 9th World
Congress on Gastrointestinal Cancer, Barcelona, 2007. Ann Oncol. 2008;19 (Suppl 6):vi1–8.
Ayuso Colella J, Pagés Llinás JM y Ayuso Colella C. Estadificación del cáncer de recto. Radiología.
;52(1):18–29.
Lindsey I, Guy RJ, Mortensen MC: Anatomy of Denonvilliers' fascia and pelvic nerves, impotence, and
implications for colorectal surgeon. Br J Surg 2000; 87: 1288-1299.
Santángelo h, Fazzini R. Mesorrecto. reflexiones sobre su confusa interpretación y cuestionada validez.
Rev. Arg. Cirug, 2006;91 (1-2):40-46.
Heald RJ, Moran BJ: Embryology and anatomy of the rectum. Seminars in Surgical Oncology 1998; 15:
-71.
Nano M, Prenoto M, Ferronato M, Solej M, Galloni M. The mesorectum: hypothesis on its evolution. Tech.
Coloproctol (2006) 10:323-328.
Zhi-ming Jin, Jia-Yuan Peng, Qing-Chao Zhu. Waldeyer´s fascia: anatomical location and relationship to
neighboring fasciae in retrorectal space. Surg Radiol Anat (2011) 33:851-854.
Church JM, Raudkivi PJ, Hill GL. The surgical anatomy of the rectum. A review with particular relevance to
the hazards of rectal mobilization. Int J Colorectal Dis 1987;3: 158–166.
Mollen RM, Kuijpers JH, van Hoek F. Effects of rectal mobilization and lateral ligaments division on colonic
and anorectal function. Dis Colon Rectum 2000;43:1283–1287.
Muntean V. The surgical anatomy of the fasciae and the spaces related to the rectum. Surg Radiol Anat
;21: 319–324.
Nano M, Dal Corso HM, Lanfranco G, Ferronato M, Hornung JP. Contribution to the surgical anatomy of
the ligaments of the rectum. Dis Colon Rectum 2000;43: 1592–1598.
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Nano M, Levi AC, Borghi F, Bellora P, Bogliatto F, Garbossa D, et al. Observations on surgical anatomy for
rectal cancer surgery. Hepatogastroenterology 1998;45:717–726.
Yamakoshi H, Ike H, Oki S, Hara M, Shimada H. Metastasis of rectal cancer to lymph nodes and tissues
around the autonomic nerves spared for urinary and sexual function. Dis Colon Rectum
;40:1079-1084
Charbit L, Peschaud F, Penna Ch. J Chir 2005, 142, Nº2. Masson, Paris, 2005
International Anatomical Nomenclature Committee. Nomina Anatomica. 6th ed. Singapour: Churchill
Livingstone; 1989
Sobin, L.H., Gospodarowicz, M. K., & Wittekind, C. (2009). TNM classification of malignant tumours.
Clinical Oncology (Vol. 10).
Canessa CE, Badia F, Fierro S, Fiol V, Hayek G. Anatomic study of the lymph nodes of the mesorectum.
Dis Colon Rectum 2001;44:1333-1336.
Pirro N, Sielezneff I, Ouaissi M, Sastre B. What do we know about the lymphatic drainage of the rectum?
Gastroentérologie Clinique et Biologique (2009) 33, 138—146
Malassagne B, Valleur P, Serra J, Sarnacki S, Galian A, Hoang C, et al. Relationship of apical lymph node
involvement to survival in resected colon carcinoma. Dis Colon Rectum 1993;36:645—53.
Kanemitsu Y, Hirai T, Komori K, Kato T. Survival benefit of high ligation of the inferior mesenteric artery in
sigmoid colon or rectal cancer surgery. Br J Surg 2006;93: 609-15.
Pezim ME, Nicholls R. Survival after high or low ligation of the inferior mesenteric artery during curative
surgery for rectal cancer. Ann Surg 1981;200:729-733.
Steup WH, Moriya Y, van de Velde CJ. Patterns of lymphatic spread in rectal cancer. A topographical
analysis on lymph node metastases. Eur J Cancer 2002;38:911-8.
Banderola S, Leo E, Belli F, Bufalino R, Tomasic G, Lavarino C et al. Manual dissection of adenocarcinoma
of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm.
Cancer 1996;77:607-612
Kotanagi H, Fufuoka T, Shibata Y, Yoshioka T, Aizawa O, Saito Y et al. The size of regional lymph nodes
does not correlate with the presence or absence of metastasis in lymph nodes in rectal cancer. J Surg
Oncol 1993;54:252-254
Herrera L, Villarreal JR. Incidence of metastases from rectal adenocarcinoma in small lymph nodes
detected by a clearing technique. Dis Colon Rectum 1992;35:783—8.
Hida J, Yasutomi M, Tokoro T, Kubo R. Examination of nodal metastases by a clearing method supports
pelvic plexus preservation in rectal cancer surgery. Dis Colon Rectum 1999;42:510-4.
Thorn CC, Woodcock NP, Scott N, Verbeke C, Scott SB, Ambrose NS. What factors affect lymph node
yield in surgery for rectal cancer ? Colorectal Dis 2004;6:356—61
Tekkis PP, Smith JJ, Heriot AG, Darzi AW, Thompson MR, Stamatakis JD. A national study on lymph node
retrieval in resectional surgery for colorectal cancer. Dis Colon Rectum 2006;49:1673—83.
Sarashina H, Inoue I, Saitoh N, Nunomura M, Nakayama H, Okui K. Preoperative radiotherapy in rectal
carcinoma. The effect of irradiation on lymph node involvement. Strahlenther Onkol 1991;167:361-5.
Lindsey I, Guy RJ, Warren BF, Mortensen NJ. Anatomy of Denonvilliers’ fascia and pelvic nerves,
impotence, and implications for the colorectal surgeon. Br J Surg 2000;87: 1288–1299.
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Rotholtz N. Tratamiento multimodal del cancer de recto. Relato Oficial, 84 Congreso Argentino de Cirugía.
Zappa M, Bertin C, Attar A. What morphological exams to perform for a rectal cancer?. Colon Rectum
(2012) 6:67-73)
Lasser P. Cancer du Rectum. EMC, Appareil digestif 9-084-A-10, 2000:21 p.
Garcia-Aguilar J, Pollack J, Lee SH, Hernandez de Anda E, Mellgren A, Wong WD, et al. Accuracy of
endorrectal ultrasonography in preoperative staging of rectal tumors. Dis Colon Rectum. 2002; 45: 1015.
Bianchi, P, Ceriani Ch, Rottoli, M. Endoscopic Ultrasonography and Magnetic Resonance in Preoperative
Staging of Rectal Cancer: Comparison With Histologic Findings. Journal of Gastrointestinal Surgery. Vol.
, Nº 9 2005.
Gleeson FC, Clain JE, Rajan E, Topazian MD, Wang KK, Levy MJ. EUS-FNA assessment of
extramesenteric lymph node status in primary rectal cancer. Gastrointest Endosc. 201;74: 897-905.
Marone P, de Bellis M, Avallone A, Delrio P, di Nardo G, D’Angelo V, et al. Accuracy of endoscopic ultrasound in staging and restaging patients with locally advanced rectal cancer undergoing neoadyuvant
chemoradiation. Clin Res Hepatol Gastroenterol. 2011; 35: 666670.
Murad-Regadas S, Regadas FS, Rodrigues L, Barreto R, Coracy F, Monteiro C, et al. Role of threedimensional anorectal ultrasonography in the assessment of rectal cancer after neoadjuvant
radiochemotherapy: preliminary results. Surg En dosc. 2009; 23:12861291.
García Figueiras R, Caro Dominguez P, García Dorrego R, Vázquez Martín A, Gómez Caamaño A.
Factores pronósticos e imagen funcional del cáncer de recto. Radiología 2012;54(1):45-58.
Butch RJ, Stark DD, Wittenberg J. Staging rectal cancer by MR and CT. Am J Roentgenol. 1986;
:11551160.
Taylor F, Mangat N, Swift IR, Brown G. Proforma-based reporting in rectal cancer. Cancer Imaging.
;Spec. A: S142-50.
Protin-Catteau L, Amara-Slimani N, Rousset P, Fornès P, Amzallag-Bellenger E, Deguelte-Lardière S,
Veron S, Hoeffel C. Imagerie par résonance magnétique dans le bilan préthérapeutique des cancers du
rectum. EMC 33-480-A-20.
Merkel S, Mansmann U, Siassi M, Papadopoulos T, Hohenberger W, Hermanek P. The prognostic
inhomogeneity in pT3 rectal carcinomas. Int J Colorectal Dis. 2001;16:298-304).
Wibe A, Moller B, Norstein J, Carlsen E,Wiig JN, Heald RJ, et al. A National Strategic Change in treatment
policy for rectal cancer. Implementation of Total Mesorectal Excision as routine treatment in Norway. A
national audit. Dis Colon Rectum. 2002;45:857–66.
Brown G, Radcliffe AG, Newcombe RG, Dallimore NS, Bourne MW, Williams GT. Preoperative
assessment of prognostic factors in rectal carcinoma using high-resolution MR imaging. Br J Surg.
;90:355-64.
MERCURY Study Group. Diagnostic accuracy of preoperative magnetic resonance imaging in predicting
curative resection of rectal cancer: prospective observational study. BMJ. 2006;333:779.
Diéguez A. Resonancia magnética de alta resolución en el cáncer de recto. Rev. Arg. Radiol. Vol 74, Nº 3,
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Bernstein TE, Endreseth BH, Romundstad P, Wibe A; Norwegian Colorectal Cancer Group.
Circumferential resection margin as a prognostic factor in rectal cancer. Br J Surg 2009;96(11):1348-57.
MERCURY Study Group. Extramural depth of tumor invasion at thin-section MR in patients with rectal
cancer: Results of the MERCURY Study. Radiology 2007;243(1):132-9.
Courtney ED, West NJ, Kaur C, Ho J, Kalber B, Hagger R, et al. Extramural vascular invasion is an
adverse prognostic indicator of survival in patients with colorectal cancer. Colorectal Disease.
;11:150-6.
Brown G, Richards CJ, Bourne MW, Newcombe RG, Radcliffe AG, Dallimore NS, et al. Morphologic
predictors of lymph node status in rectal cancer with use of high spatial-resolution MRI with
histopathologic comparison. Radiology. 2003;227:371-7.
Koh DM, Brown G, Temple L, et al. Rectal cancer: mesorectal lymph nodes at MR imaging with uspio
versus histopathologic findings-initial observations. Radiology 2004;231(1):91-9.
Lahaye MJ, Beets GL, Engelen SM, et al. Locally advanced rectal cancer: MR Imaging for restaging after
neoadjuvant radiation therapy with concomitant chemotherapy Part II. What are the criteria to predict
involved lymph nodes? Radiology 2009;252(1):81-91.
Taylor FG, Swift RI, Blomqvist L, Brown G. A systematic approach to the interpretation of preoperative
staging MRI for rectal cancer. AJR Am J Roentgenol 2008;191(6):1827-35.
Dresen RC, Beets GL, Rutten HJ, et al. Locally advanced rectal cancer: MR Imaging for restaging after
neoadjuvant radiation therapy with concomitant chemotherapy Part I. Are we able to predict tumor
confined to the rectal wall? Radiology 2009;252(1):71-80.
DeVries A, Griebel J, Judmaier W, et al (2000). Perfusion-index values evaluated by dynamic magnetic
resonance imaging in advanced rectal carcinoma. A new predictor of response to pre-operative
radiochemotherapy?. Strahlenther Onkol 176:567–72
Gunderson L, Jessup J, Sargent D, Greene F, Stewart A. Revised Tumor and Node Categorization for
Rectal Cancer based on surveillance, Epidemiology and End Results and Rectal Pooled Analysis
Outcomes. J Clin Oncol (2010) Jan 2010;28(2):256-63.
Hermanek P. TNM Supplement 1993: a Commentary on Uniform Use. Berlin: Springer-Verlag; 1993.
Shin R, Jeong SY, Yoo Hy et al. Depth of Mesorectal Extension Has Prognostic Significance in Patients
With T3 Rectal Cancer. Dis Colon Rectum, (2012) Vol 55:1220-1228
Rullier A, Laurent C, Vendrely V et al (2005). Impact of colloid response on survival after preoperative
radiotherapy in locally advanced rectal carcinoma. Am J Surg Pathol 29:602–6.
Shia J, Tickoo SK, Guillem JG et al (2002) Increased endocrine cells in treated rectal adenocarcinomas: a
possible reflection of endocrine differentiation in tumor cells induced by chemotherapy and radiotherapy.
Am J Surg Pathol 26:863–72.
Washington MK, Berlin J, Branton P et al (2009) Protocol for the examination of specimens from patients
with primary carcinoma of the colon and rectum. Arch Pathol Lab Med 133:1539–51.
Shia J, McManus M, Guillem JG et al (2011) Significance of acellular mucin pools in rectal carcinoma after
neoadjuvant che- moradiotherapy. Am J Surg Pathol 35:127–34.
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Maas M, Nelemans PJ, Valentini V et al (2010) Long-term outcome in patients with a pathological
complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data.
Lancet Oncol 11:835–44.
Habr-Gama A, Perez RO, Wynn G et al (2010) Complete clinical response after neoadjuvant
chemoradiation therapy for distal rectal cancer: characterization of clinical and endoscopic findings for
standardization. Colon Rectum 53:1692–8.
Habr-Gama A, Perez RO (2009) Non-operative management of rectal cancer after neoadjuvant
chemoradiation. Br J Surg 96:125–7.
Quirke P, Morris E (2007) Reporting colorectal cancer. Histopathology 50:103–12.
Parfitt JR, Driman DK (2007) The total mesorectal excision specimen for rectal cancer: a review of its
pathological assessment. J Clin Pathol 60:849–55.
Dworak O, Keilholz L, Hoffmann A (1997) Pathological features of rectal cancer after preoperative
radiochemotherapy. Int J Colorectal Dis 12:19–23.
Quirke P, Durdey P, Dixon MF et al (1986) Local recurrence of rectal adenocarcinoma due to inadequate
surgical resection. Histopathological study of lateral tumour spread and surgical excision. Lancet 2:996–9.
Nagtegaal ID, van Krieken JH (2002) The role of pathologists in the quality control of diagnosis and
treatment of rectal cancer-an overview. Eur J Cancer 38:964–72.
Mace A, Pai R, Stocchi L, Kalady M. American Joint Committee on Cancer and College of American
Pathologists Regression Grade: A new prognostic factor in rectal cancer. Dis Colon Rectum 2015; 58:
–44.Porter GA, Soskolne CL, Yakimets WW, Newman SC. Surgeon-related factors and outcome in
rectal cancer. Ann Surg. 1998;227:157-67.
Mc Ardle CS, Hole D. Influence of volume and specialization on survival following surgery for colorectal
cancer. Br J Surg. 2004;91: 610-7.
Heald RJ, Moran BJ, Ryan RD, et al. Rectal cancer: the Basingstoke experience of total mesorectal
excision, 1978-1997. Arch Surg. 1998;133:894-9.
Smedh K, Olsson L, Johansson H, Aberg C, Andersson M. Reduction of postoperative morbidity and
mortality in patients with rectal cancer following the introduction of a colorectal unit. Br J Surg.
;88:273-7.
García-Granero E, Martí-Obiol R, Gómez-Barbadillo J, García-Armengol J, Esclapez P, Espí A, et al.
Impact of surgeon organization and specialization in rectal cancer outcome. Colorectal Disease.
;3:179-84.
Lehander Martling A, Holm T, Rutqvist L-E, Moran BJ, Heald RJ, Cedermark B. Effect of a surgical
training programme on outcome of rectal cancer in the Country of Stockholm. Lancet. 2000;356:93-6.
Faucheron JL, Rullier E. (2009) Rapport de l’association française de chirurgie : cancer du rectum.
Monographies de l’association française de chirurgie.
Hodgson DC, Zhang W, Zalavsky AM et al. Surgery and survival in rectal cancer: Benefits of High-Volume
Hospitals. J Natl Cancer Inst 2003;95:708-16.
Van Gijn W, et al. Volume and outcome in colorectal cancer surgery. EJSO (2010), Sep;36 Suppl
:S55-63
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
García-Granero E. El factor cirujano y la calidad de la cirugía en el pronóstico del cáncer de recto.
Implicaciones en la especialización y organización. Cir Esp. 2006;79(2):75-7
Luján JA, Hernández Q, Valero G, De las Heras M, Gil J, Frutos MD, et al. Influencia del factor cirujano en
el tratamiento quirúrgico del cáncer de recto con radioquimioterapia preoperatoria. Estudio comparativo.
Cir Esp. 2006;79:89-94.
Hermanek P, Hohenberger W. The importance of volume in colorectal cancer surgery. Eur J Surg Oncol.
;22:213-5.
Mac Farlane JK, Ryall RD, Heald RJ (1993). Mesorectal excision for rectal cancer. Lancet 341:457–60
Kapiteijn E, Marijnen CA, Nagtegaal ID, et al (2001). Preoperative radiotherapy combined with total
mesorectal excision for resectable rectal cancer. N Engl J Med 345:638–46.
Gerard JP, Conroy T, Bonnetain F, et al (2006). Preoperative radiotherapy with or without concurrent
fluorouracil and leucovorin in T3-4 rectal cancers: results of FFCD 9203. J Clin Oncol 24:4620–5
Bosset JF, Collette L, Calais G, et al (2006). Chemotherapy with preoperative radiotherapy in rectal
cancer. N Engl J Med 355:1114–23.
Institut National du Cancer (2009). Indications de la radiothérapie: cancer du rectum http://www.ecancer.fr/soins/recommandations/cancers-digestifs.
Quah HM, Chou JF, Gonen M, Shia J, Schrag D, Saltz L, Goodman K, Minsky B, Wong D, Weiser M et al
(2008). Pathologic stage is most prognostic of disease-free survival in locally advanced rec- tal cancer
patients after preoperative chemoradiation. Cancer 113:57–64.
Garcia-Aguilar J, Shi Q, Thomas CR, Jr., et al (2012). A phase II trial of neoadjuvant chemoradiation and
local excision for T2N0 rectal cancer: preliminary results of the ACOSOG Z6041 trial. Ann Surg Oncol
:384–91.
Garcia-Aguilar J, Chen Z, Smith DD, et al (2011). Identification of a biomarker profile associated with
resistance to neoadjuvant chemoradiation therapy in rectal cancer. Ann Surg 254:486–92; discussion
-3
Wiltshire KL, Ward IG, Swallow C, et al (2006). Preoperative radiation with concurrent chemotherapy for
resectable rectal cancer: effect of dose escalation on pathologic complete response, local recurrence-free
survival, disease-free survival, and overall survival. Int J Radiat Oncol Biol Phys 64:709–16.
Mohiuddin M, Winter K, Mitchell E, et al (2006). Randomized phase II study of neoadjuvant combinedmodality chemoradiation for distal rectal cancer: Radiation Therapy Oncology Group Trial 0012. J Clin
Oncol 24:650–5.
Mohiuddin M, Mohiuddin MM, Marks J, et al (2009). Future directions in neoadjuvant therapy of rectal
cancer: maximizing pathological complete response rates. Cancer Treat Rev 35:547–52.
Mohiuddin M, Lingareddy V, Rakinic J, et al (1993). Reirradiation for rectal cancer and surgical resection
after ultra high doses. Int J Radiat Oncol Biol Phys 27:1159–63.
Wang Y, Cummings B, Catton P, et al (2005). Primary radical external beam radiotherapy of rectal
adenocarcinoma: long term outcome of 271 patients. Radiotherapy and oncology : journal of the
European Society for Therapeutic Radiology and Oncology 77:126-32.
Derdel J, Mohiuddin M, Kramer S, et al (1985). Is dose/time fractionation important in treating rectal
cancer? Int J Radiat Oncol Biol Phys 11:579–82.
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Gerard JP, Azria D, Gourgou-Bourgade S, et al (2010). Comparison of two neoadjuvant
chemoradiotherapy regimens for locally advanced rectal cancer: results of the phase III trial ACCORD
/0405-Prodige 2. Journal of clinical oncology : official journal of the American Society of Clinical
Oncology 28:1638-44.
Aschele C, Cionini L, Lonardi S, et al (2011). Primary tumor response to preoperative chemoradiation with
or without oxaliplatin in locally advanced rectal cancer: pathologic results of the STAR-01 randomized
phase III trial. Journal of clinical oncology : official journal of the American Society of Clinical Oncology
:2773-80.
Velenik V, Ocvirk J, Music M, et al (2011). Neoadjuvant capecitabine, radiotherapy, and bevacizumab
(CRAB) in locally advanced rectal cancer: results of an open-label phase II study. Radiat Oncol 6:105.
Francois Y, Nemoz CJ, Baulieux J, et al (1999). Influence of the interval between preoperative radiation
therapy and surgery on downstaging and on the rate of sphincter-sparing surgery for rectal cancer: the
Lyon R90-01 randomized trial. J Clin Oncol 17:2396.
Kalady MF, de Campos-Lobato LF, Stocchi L, et al (2009). Predictive factors of pathologic complete
response after neoadjuvant chemoradiation for rectal cancer. Ann Surg 250:582–9.
Chua YJ, Barbachano Y, Cunningham D, et al (2010). Neoadjuvant capecitabine and oxaliplatin before
chemoradiotherapy and total mesorectal excision in MRI-defined poor-risk rectal cancer: a phase 2 trial.
Lancet Oncol 11:241-8.
Garcia-Aguilar J, Smith DD, Avila K, et al (2011). Optimal timing of surgery after chemoradiation for
advanced rectal cancer: preliminary results of a multicenter, nonrandomized phase II prospective trial. Ann
Surg 254:97–102.
Habr-Gama A, Perez R, Lynn P, Sao Juliao G, Gama J. Selective non-operative management of distal
rectal cancer: The Watch and wait Protocol. R. Schissel et al. (eds) Low rectal tumors. Springer Verlag
Wien 2012; 43-53.
Nakagawa WT, Rossi BM, de OFF, et al: Chemoradiation instead of surgery to treat mid and low rectal
tumors: Is it safe? Ann Surg Oncol 9:568-573, 2002.
Sebag-Montefiore D, Stephens RJ, Steele R, et al (2009) Preoperative radiotherapy versus selective
postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a
multicenter, randomized trial. Lancet 373:811–20.
Peeters KC, van de Velde CJ, Leer JW, et al (2005). Late side effects of short-course preoperative
radiotherapy combined with total mesorectal exérèse for rectal cancer: increased bowel dysfunction in
irradiated patients--a Dutch colorectal cancer group study. J Clin Oncol 23:6199–206.
Hartley A, Ho KF, McConkey C, et al (2005) Pathological complete response following pre-operative
chemotherapy in rectal cancer: analysis of phase II/III trials. Br J Radiol 78:934–8.
Weiser M, Beets-Tan R, Beets G. Management of Complete Response After Chemoradiation in Rectal
Cancer. Surg Oncol Clin N Am 2014; 23(1): 113-25.
Guillem J, Chessin D, Shia J, Moore H, Mazumdar M, Bernard B, Paty P, Saltz L, Minsky B, Weiser M,
Temple L, Cohen A, Wong D. (2005) Clinical Examination Following Preoperative Chemoradiation for
Rectal Cancer Is Not a Reliable Surrogate End Point. J Clin Oncol 23:3475-3479.
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Hiotis S, Weber S, Cohen A, Minsky B, Paty P, Guillem J, Wagman R, Saltz L,Wong D. Assessing the
Predictive Value of Clinical Complete Response to Neoadjuvant Therapy for Rectal Cancer: An Analysis of
Patients. J Am Coll Surg 2002;194:131–136.
Gérard J-P et al. Clinical complete response (cCR) after neoadjuvant chemoradiotherapy and
conservative treatment in rectal cancer. Findings from the ACCORD 12/PRODIGE 2 randomized trial.
Radiother Oncol (2015).
Yang KL, Yang SH, Liang WY. Carcinoembryonic antigen (CEA) level, CEA ratio, and treatment outcome
of rectal cancer patients receiving pre-operative chemoradiation and surgery. Radiation Oncology 2013,
:43
Pérez R, Sao Juliao G, Habr-Gama A, Kiss D, Proscurshim I, Campos F, Gama-Rodrigues J, Cecconello
I. The role of carcinoembriogenic antigen in predicting response and survival to neoadjuvant
chemoradiotherapy for distal rectal cancer. Dis Colon Rectum 2009;52(6) 1137-43.
Kahn H, Alexander A, Rakinic J, et al (1997). Preoperative staging of irradiated rectal cancers using digital
rectal examination, computed tomography, endorectal ultrasound, and magnetic resonance imaging does
not accurately predict T0, N0 pathology. Dis Colon Rectum 40:140-4.
Perez R.O, Habr-Gama A, Pereira G, Lynn P, Alves P, Proscurshim I, Rawet V, Gama-Rodrigues J. Role of
biopsies in patients with residual rectal cancer following neoadjuvant chemoradiation after downsizing:
can they rule out persisting cancer?. Colorectal Disease, 2012, vol. 14, nº 6, p. 714-720.
De Nardi P, Carvello M. How reliable is current imaging in restaging rectal cancer after neoadjuvant
therapy? World J Gastroenterol 2013;19 (36) 5964-72.
Pomerri F, Pucciarelli S, Maretto I, Zandonà M, Del Bianco P, Amadio L, Rugge M, Nitti D, Muzzio PC.
Prospective assessment of imaging after preoperative chemoradiotherapy for rectal cancer. Surgery
; 149: 56-64.
Huh JW, Park YA, Jung EJ, Lee KY, Sohn SK. Accuracy of endorectal ultrasonography and computed
tomography for restaging rectal cancer after preoperative chemoradiation. J Am Coll Surg 2008; 207:
-12.
Murad Regadas S, Regadas F, Rodrigues L, Barreto R, Monteiro F, Landim B, Holanda E. Role of threedimensional anorectal ultrasonography in the assessment of rectal cancer after neoadjuvant
radiochemotherapy: preliminary results. Surg Endosc 2009;23:1286-91
Kang JH, Kim YC, Kim H, Kim YW, Hur H,Kim JS,Min BS, Kim H, Lim JS, Seong J, Keum KC, Kim NK
(2010) Tumor volume changes assessed by three-dimensional magnetic resonance volumetry in rectal
cancer patients after preoperative chemoradiation: the impact of the volume reduction ratio on the
prediction of pathologic complete response. Int J Radiat Oncol Biol Phys 76(4): 1018–1025.
Patel UB, Brown G, Rutten H, West N, Sebag-Montefiore D, Glynne-Jones R, et al. Comparison of
magnetic resonance imaging and histopathological response to chemoradiotherapy in locally advanced
rectal cancer. Ann Surg Oncol 2012;19:2842–52.
Weiser MR, Landmann RG, Wong WD, et al (2005). Surgical salvage of recurrent rectal cancer after
transanal exérèse. Dis Colon Rectum 48:1169–75.
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Lambregts DM, Vandecaveye V, Barbaro B, Bakers FC, Lambrecht M, Maas M, Haustermans K, Valentini
V, Beets GL, Beets-Tan RG (2011) Diffusion-weighted MRI for selection of complete responders after
chemoradiation for locally advanced rectal cancer: a multicenter study. Ann Surg Oncol 18(8):2224–2231.
Kim SH, Lee JM, Hong SH, Kim GH, Lee JY, Han JK, Choi BI. Locally advanced rectal cancer: added
value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo-and
radiation therapy. Radiology. 2009; 253:116–25.
Pérez R, Habr-Gama A, Gama-Rodrigues J, Procurshim I, Sao Juliao G, Lynn P. Accuracy of Positron
Emission Tomography/Computed Tomography and Clinical Assessment in the Detection of Complete
Rectal Tumor Regression After Neoadjuvant Chemoradiation. Cancer 2012;Jul. 3501-11.
Pérez R. O, Habr-Gama A, Sao Juliao G. P, Lynn P.B, Sabbath C, Proscurshim I, Campos F. G, GamaRodrigues J, Nahas S.C, Buchpiguel C.A. Predicting complete response to neoadjuvant CRT for distal
rectal cancer using sequential PET/CT imaging. Tech Coloproctol (2014) 18:699-708.
Guillem J, Ruby J, Leibold T, Akhurst T, Yeung H, Gollub M, Ginsberg M, Shia J, Suriawinata A, Riedel E,
Mazumdar M, Saltz L, Minsky B, Nash G, Paty P, Temple L, Weiser M, Larson S. Neither FDG-PET Nor
CT Can Distinguish Between a Pathological Complete Response and an Incomplete Response After
Neoadjuvant Chemoradiation in Locally Advanced Rectal Cancer A Prospective Study. Ann of Surg Vol
, Number 2, August 2013.
Read TE, Andujar JE, Caushaj PF, et al (2004). Neoadjuvant therapy for rectal cancer: histologic response
of the primary tumor predicts nodal status. Dis Colon Rectum 47:825–31.
Laurent C, Denost Q, Rullier E. Is it reasonnable to perform a local excision after neoadjuvant
chemoradiotherapy? Colon Rectum (2012) 6:84-88.
Sermier A, Gervaz P, Egger J, Dao M, Allal A, Bonet M, et al. Lymph node retrieval in abdominoperineal
surgical specimen is radiation time-dependent. World journal of surgical oncology. 2006; 4:29.
Pucciarelli S, Capirci C, Emanuele U, Toppan P, Friso M, Pennelli G, et al. Relationship between
pathologic T-stage and nodal metastasis after pre-operative chemoradiotherapy for locally advanced
rectal cancer. Annals of surgical oncology. 2005; 12:111-116.
Stipa F, Zernecke A, Moore HG, et al. Residual mesorectal lymph node involvement following neoadjuvant
combined- modality therapy: rationale for radical resection? Ann Surg Oncol. 2004;11:187–191.
Gérard JP. Improved sphincter preservation in low rectal cancer with high- dose preoperative
radiotherapy: the Lyon R96-02 randomized trial. J Clin Oncol 2004;22:2404–9.
Habr-Gama A, Perez RO, Nadalin W, et al (2004). Operative versus nonoperative treatment for stage 0
distal rectal cancer following chemoradiation therapy: long-term results. Ann Surg 240:711–7.
Habr-Gama A, Perez R, Sabbaga J, Nadalin W, Sao Juliao G, Gama-Rodrigues J. (2009) Increasing the
rates of complete response to neoadjuvant chemoradiotherapy for distal rectal cancer: results of a
prospective study using additional chemotherapy during the resting period. Dis Colon Rectum 52:
-1934.
Habr-Gama A, Sabbaga J, Gama Rodrigues J, Sao Juliao G, Proscurshim I, Bailao Aguilar P, Perez R.
Watch and wait approach following extended neoadjuvant chemoradiation for distal rectal cáncer: are we
getting closer to anal cancer management? Dis Colon Rectum 2013;56(10):1109-17.
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Habr-Gama A, Gama Rodrigues J, Sao Juliao G, Proscurshim I, Sabbagh C, Lynn P, Perez R. Local
recurrence after complete clinical response and watch and wait in rectal cáncer after neoadyuvant
chemoradiation: impact of salvage therapy on local disease control. Int J Radiat Oncol Biol Phys
;88(4):822-8.
Habr-Gama A, Perez RO, Proscurshim I, et al. Patterns of failure and survival for nonoperative treatment
of stage c0 distal rectal cancer following neoadjuvant chemoradiation therapy. J Gastrointest Surg
;10(10):1319–28.
Prajnan D, Minsky B. A Watch-and-Wait Approach to the Management of Rectal Cancer.Review Article.
Oncology 2013 Oct;27(10):962-8.
Sao Juliao G,Lynn P, Habr-Gama A, Perez R O,Proscurshim I, et al Complete Clinical Response after
Neoadjuvant Chemoradiotherapy Managed Nonoperatively Results in Better Anorectal Function When
Compared with Other Sphincter-Saving Alternatives for Distal Rectal Cancer. J Am Coll Surg 221, No.
S1, October 2015.
Maas, M. et al (2011) Wait-and-see policy for clinical complete responders after chemoradiation for rectal
cancer. J. Clin. Oncol. 29, 4633–4640.
Smith J, Ruby J, Goodman K, Saltz L, Guillem J, Weiser M et als. Nonoperative Management of Rectal
Cancer With Complete Clinical Response After Neoadjuvant Therapy. Ann Surg 2012;256(6):965-72.
Bujko K, Richter P, Kolodziejczyk M, et al (2009). Preoperative radiotherapy and local exérèse of rectal
cancer with immediate radical re-operation for poor responders. Radiother Oncol 92:195–201.
Borschitz T, Wachtlin D, Mohler M, et al (2008). Neoadjuvant chemoradiation and local exérèse for T2-3
rectal cancer. Ann Surg Oncol 15:712–20.
Garcia-Aguilar J, Shi Q, Thomas CR, Chan E, Cataldo P, Marcet J, et al. A phase II trial of neoadjuvant
chemoradiation and local excision for T2N0 rectal cancer: preliminary results of the ACOSOG Z6041trial.
Ann Surg Oncol 2011;19:384–91.
Bujko K, Richter P, Smith FM, Polkowski W, Szczepkowski M, Rutkowski A, et al. Preoperative
radiotherapy and local excision of rectal cancer with imme- diate radical re-operation for poor
responders: a prospective multicentre study. Radiother Oncol 2013;106:198–205.
Houard C, Rullier E, Rouanet P, Tuech J, Mosnier H, B. Lelong B, Rivoire M, Faucheron J, Jafari M,
Portier G. Résultats préliminaires de l’essai GRECCAR 2 : exérèse locale ou exérèse totale du
mésorectum après réponse à la chimioradiothérapie pour adénocarcinomes de stade T2–3 du bas
rectum. Cancer/Radiothérapie, Volume 18, Issues 5–6, October 2014, Page 588.
Arezzo A, Adolfo S, Allaix ME, Munoz F, Cassoni P, Monaghedu C, et al. Results of neoadjuvant shortcourse radiation therapy followed by transanal endoscopic microsurgery for T1-T2 N0 extraperitoneal
rectal cancer. Int J Radiat Oncol Biol Phys 2015;92:299–306.
V. Vendrely et al. Organ preserving strategies for rectal cancer treatment. Cancer/Radiothérapie 19 (2015)
–409.
Hur H, Kim N, Min B, Baik S, Lee K, Koom W, et als. Can a biomarker-based scoring system predict
pathologic complete response after preoperative chemoradiotherapy for rectal cancer? Dis Colon
Rectum 2014;57(5):592-601.
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Watanabe T, Kobunai T, Akiyoshi T, Matsuda K, Ishihara S, Nosawa K. Prediction of response to
preoperative chemoradiotherapy in rectal cancer by using reverse transcriptase polymerase chain
reaction analysis of four genes. Dis Colon Rectum 2014;57(1):23-31.
MacFarlane JK, Ryall RD, Heald RJ. (1993) Mesorectal excision for rectal cancer. Lancet 341:457–60.
Rullier A, Laurent C. Quels sont les critères de qualité de l´exérèse chirurgicale? Gastroenerol Clin Biol
, 31:1S34-1S51.
Hor T, Lefevre JH, Panis Y. Anastomosis techniques after total mesorectal excision for rectal cancer.
Colon Rectum (2013) 7:37-41.
Rullier E, Denost Q, Vendrely V. Low rectal cancer: Classification and standardization of surgery. Dis
Colon Rectum 2013; 56:560-67.
Valleur P. Cirugía del tracto digestivo inferior. Técnicas quirúrgicas. Elsevier-Masson 2007
Tiret E. Exérèse total du mésorectum et conservation de l’innervation autonome a destinée génito-urinaire
dans la chirurgie du cancer du rectum. Encycl Méd Chir (Elsevier, Paris) Techniques chirurgicales -
Appareil digestif, 40-610, 1998,8p.
Jacobs M, Verdeja JC, Goldstein HS. Minimally invasive colon resection (laparoscopic colectomy). Surg
Laparosc Endosc (1991) Sep;1(3):144-50.
Wexner, S. D., and S. M. Cohen. Port site metastases after laparoscopic colorectal surgery for cure of
malignancy. British journal of surgery 82.3 (1995): 295-298.
Wexner, S. D., et al. Laparoscopic colorectal surgery—are we being honest with our patients?. Diseases
of the colon & rectum 38.7 (1995): 723-727.
Zmora, O., P. Gervaz, and S. D. Wexner. Trocar site recurrence in laparoscopic surgery for colorectal
cancer. Surgical endoscopy 15.8 (2001): 788-793.
Laurent C, Leblanc F, Wütrick P, Scheffer M, Rullier E. Laparoscopic versus open surgery for rectal
cancer. Long-term oncologic results. Ann of Surg, vol 250, Nº1, July 2009.
Kang SB, Park JW, Jeong SY, Jeong SY, Nam BH, Choi HS, et al. Open versus laparoscopic surgery for
mid or low rectal cancer after neoadjuvantchemoradiotherapy (COREAN trial): short- term outcomes of an
open-label randomized controlled trial. Lancet Oncol. 2010;11:637-45.
Van der Pas MH, Haglind E, Cuesta MA, Fürst A, Lacy AM, Hop WC, et al; COlorectal cancer
Laparoscopic or Open Resection II (COLOR II) Study Group. Laparoscopic versus open surgery for rectal
cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol. 2013;14:210-8.
Maggiori L, Panis Y. Is it time for a paradigm shift: “laparoscopy is now the best approach for rectal
cancer”? Transl Gastrointest Cancer 2014;3(1):1-3.
Veldkamp R, Kuhry E, Hop WC, et al. Laparoscopic surgery versus open surgery for colon cancer: shortterm outcomes of a randomised trial. Lancet Oncol 2005;6:477-84.
Ohtani H, Tamamori Y, Arimoto Y, et al (2011) A meta-analysis of the short- and long-term results of
randomized controlled trials that compared laparoscopy-assisted and conventional open surgery for
colorectal cancer. J Cancer 2:425–34.
Trastulli S, Cirocchi R, Listorti C, et al (2012) Laparoscopic versus open resection for rectal cancer: a
meta-analysis of randomized clinical trials. Colorectal Dis [Epub ahead of print].
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Viola M, Laurini M. Zeballos J, Muniz N, Rodriguez Goñi P, Castelli F, Sanchez G, Canessa C, Viola H.
Cirugía colorrectal videoasistida en Uruguay. An Facultad Med (Univ Repúb Urug). 2015;2(1):43-52
Viola Malet M, Laurini Zanola M, Zeballos Jiménez de Aréchaga J, Rodríguez Goñi P, Sánchez García G,
Pereyra Cosco J, et al. Resección anterior de recto laparoscópica, nuestros resultados a corto y mediano
plazo. Rev Acircal [Internet]. 2014 Disponible en: http://www.acircal.net/revista/articulo. php?id=16
de Calan L, Gayet B, Bourlier P, Perniceni T. Chirurgie de cancer du rectum par laparotomie et par
laparoscopie. Encyclopedie Medico-Chirurgicale 40-630 (2004).
Parks AG. Transanal technique in low rectal anastomosis. Proc Royal Soc Med 1972; 65:975-976.
Pollett WG, Nicholls RJ (1983). The relationship between the extent of distal clearance and survival and
local recurrence rates after curative anterior resection for carcinoma of the rectum. Ann Surg 198:159–63.
Goldstein NS, Soman A, Sacksner J (1999). Disparate surgical margin lengths of colorectal resection
specimens between in vivo and in vitro measurements. The effects of surgical resection and formalin
fixation on organ shrinkage. Am J Clin Pathol 111:349–51.
Vernava AM, 3rd, Moran M, Rothenberger DA, et al (1992). A prospective evaluation of distal margins in
carcinoma of the rectum. Surg Gynecol Obstet 175:333–6).
Bernstein TE, Endreseth BH, Romundstad P, et al (2012). What is a safe distal resection margin in rectal
cancer patients treated by low anterior resection without preoperative radiotherapy? Colorectal Dis
:e48–55.
Rutkowski A, Nowacki MP, Chwalinski M, et al (2012). Acceptance of a 5-mm distal bowel resection
margin for rectal cancer: is it safe? Colorectal Dis 14:71–8.
Mezhir JJ, Smith KD, Fichera A, et al (2005). Presence of distal intramural spread after preoperative
combined-modality therapy for adenocarcinoma of the rectum: what is now the appropriate distal
resection margin? Surgery 138:658–63; discussion 63-4.
Schiessel R, Karner-Hanush J, Herbst F, Teleky B, Wunderlich M.: Intersphincteric resection for low rectal
tumours. Br J Surg 1994; 81: 1376-78.
Saito N, Sugito M, Ito M. Oncologic outcome of intersphincteric resection for very low rectal cancer. Word
J Surg 2009; 33: 1750-56.
Rullier E, Zerbib F, Laurent C: Intersphincteric resection with excision of the internal anal sphincter for
conservative treatment for very low rectal cancer. Dis Colon Rectum 1999; 44: 1168-75.
Bretagnol F, Rullier E, Laurent C. Comparison of functional results and quality of life between
intersphincteric resection and conventional coloanal anastomosis for low rectal cancer. Dis Colon Rectum
; 47: 832-38.
Pastore RLO: Resección interesfinteriana en cáncer de recto distal. Enciclopedia Cirugía Digestiva, F.
Galindo y colab. 2014;Tomo III-372: pág. 1-9
Saito N, Moriya Y, Shirouzu K. Intersphincteric resection in patients with very low rectal cancer: A review
of the Japanese experience. Dis Colon Rectum 2006; 49: S13–S22.
Mauvais F, Sabbagh C,Brehant O, Viart L, Benhaim T, Fuks D, Sinna R, Regimbeau JM. The current
abdominoperineal resection: Oncological problems and surgical modifications for low rectal cancer.
Journal of Visceral Surgery, Volume 148, Issue 2, Pages e85-e93
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Law WL, Chu KW. Abdominoperineal resection is associated with poor oncological outcome. Br J Surg
;91:1493-9
Marr R, Birbeck K, Garvican J, Macklin C. The modern abdominoperineal excision, the next challenge
after total mesorrectal excision. Annals of Surgery; Vol 242 Nº 1, July 2005.
Nagtegaal ID, van de Velde CJ, Marijnen CA, van Krieken JH, Quirke P. Pathology review committee low
rectal cancer: a call for a change of approach in abdominoperineal resection. J Clin Oncol
;23:9257-64
Nagtegaal ID, Quirke P. What is the role for the circumferential margin in the modern treatment of rectal
cancer? J Clin Oncol 2008;26:303-12.
Holm T, Ljung A, Häggmark T, Jurell G, Lagergren J. Extended abdominoperineal resection with gluteus
maximus flap reconstruction of the pelvic floor for rectal cancer. Br J Surg 2007;94:232-8.
West NP, Finan PJ, Andrein C, Lindholm J, Holm T, Quirke P. Evidence of the oncologic superiority of
cilindrical abdominoperineal excision for low rectal cancer. J Clin Oncol 2008;26:3517-22.
Parks AG. A technique for excising extensive villous papillomatous changes in the lower rectum. Proc R
Soc Med. 1968;61:441–2.
Perez R O , Habr-Gama A, Sao Juliao G, et al.Transanal Endoscopic Microsurgery for Residual Rectal
Cancer After Neoadjuvant Chemoradiation Therapy Is Associated With Significant Immediate Pain and
Hospital Readmission Rates. Dis Colon Rectum 2011; 54: 545–551.
Moore JS et al. Transanal endoscopic microsurgery is more effective than traditional transanal excision for
resection of rectal masses. Dis Colon Rectum 2008 Jul;51(7):1026-30.
Lacy AM, Rattner DW, Adelsdorfer C et al. Transanal natural orifice transluminal endoscopic surgery
(NOTES) rectal resection: “downtoup” total mesorectal excision (TME) – shortterm outcomes in the first
cases. Surg endosc 2013;27:316572.
Buess G. Technique of transanal endoscopic microsurgery. Surg Endosc. 1988; 2:71-5.
Lezoche E, Guerrieri M, Paganini AM, Feliciotti F. Long-term results of patients with pT2 rectal cancer
treated with radiotherapy and transanalendoscopic microsurgical excision. World J Surg. 2002;
:1170-4.
Atallah S, Martinez-Perez B, Albert M, de Beche-Adams T, Nassif G, Hunter L, Larach S. Transanal
minimally invasive surgery for total mesorectal excision (TAMIS-TME): results and experience with the 20
patients undergoing curative-intent rectal cancer surgery at single institution. Tech Coloproctol (2014)
:473-480.
Albert MR, Atallah SB, de Beche-Adams TC, Izfar S, Larach SW. Transanal minimally invasive surgery
(TAMIS) for local excision of benign neoplasms and early-stage rectal cancer: efficacy and outcomes in
the first 50 patients. Dis Colon Rectum. 2013 Mar; 56(3):301-7.
Heras MA, Cantero R. Cirugía transanal a través de puerto único (TAMIS). Revisión frente a otras técnicas
de excisión endoscópica de lesiones rectales. Rev Arg Coloproct (2013) Vol 24, N”2:55-60
Liz A. Resección local de tumores de recto. Monografía de postgrado. Clínica quirúrgica “1”, Facultad de
Medicina-Udelar
Allaix M, Arezzo A, Caldart M, Festa F, Morino M. Transanal endoscopic microsurgery for rectal
neoplasms: experience of 300 consecutive cases. Dis Colon Rectum 2009; 52: 1831–1836.
Relato Oficial 66º Congreso Uruguayo de Cirugía. Tratamiento del Cáncer de Recto
Sylla P, Rattner D, Delgado S, Lacy A M. NOTES transanal rectal cancer resection using transanal
endoscopic microsurgery and laparoscopic assistance. Surg Endosc (2010) 24:1205–1210.
Heald R.J. A new solution to some old problems: transanal TME. Tech Coloproctol (2013) 17:257–258.
Rouanet P, Mourregot A, Azar C et al. Transanal Endoscopic Proctectomy: An Innovative Procedure for
Difficult Resection of Rectal Tumors in Men With Narrow Pelvis Dis Colon Rectum 2013; 56: 408–415 .
Velthuis S, Nieuwenhuis D, Ruijter T, Cuesta MA, Bonjer J, Sietses C. Transanal versus traditional
laparoscopic total mesorectal excision for rectal carcinoma. Surg Endosc (2014) 28:3494–3499.
Zhang H, et al Transanal single-port laparoscopic total mesorectal excision in the treatment of rectal
cancer. Tech Coloproctol (2013) 17:117-123.
Deijen C, Velthuis S, Tsai A, Mavroveli S, de Lange-de Klerk ESM, Sietses C, Tuynman J, Lacy AM,
Hanna G, Bonjer J. Surg Endosc. COLOR III: a multicentre randomised clinical trial comparing transanal
TME versus laparoscopic TME for mid and low rectal cancer DOI 10.1007/s00464-015-4615-x
Royal College of Pathologists. Dataset for Colorectal Cancer. 2nd ed. Available at: http://www.rcpath.org/
resources/ pdf/G049-ColorectalDataset-Sep07.pdf Accessed on September 30, 2008 .
Faus C, Roda D, Frasson M, Roselló S, García-Granero E, Flor-Lorente B, Navarro S. The role of the
pathologist in rectal cancer diagnosis and staging and surgical quality assessment. Clin Transl Oncol
(2010) 12:339-345.
Hamilton SR, Bosman FT, Boffetta P, Ilyas M, Morreau H, Nakamura SI et al. Carcinoma of the colon and
rectum. In: Bosman FT, Carniero F, Hruban RH, Theise ND, editors. WHO Classification of Tumours of the
Digestive System (4th ed). Lyon: IARC Press, 2010.
Bibeau F, Boissiere F, Laurent-Puig P. Formes familiales des cancers colorectaux : techniques
diagnostiques. Colon Rectum 2011 ;5 :179-184.
Compton CC, Fielding LP, Burgart LJ, et al. Prognostic factors in colorectal cancer. College of American
Pathologists Consensus Statement 1999. Arch Pathol Lab Med 2000; 124(7):979–994.
