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CASE PRESENTATION

CASE PRESENTATION. 53 YEAR-OLD FEMALE HISTORY OF PRESENT ILLNESS February 2010 : Obstructive colloid sigmoid neoplasm with ovarian involvement pT4 ( serosal perforation ) N1 (2/23) M1 ( ovary ). No peritoneal disease SIGMOID COLON RESECTION + LEFT SO

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CASE PRESENTATION

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  1. CASE PRESENTATION 53 YEAR-OLD FEMALE HISTORY OF PRESENT ILLNESS February 2010 : Obstructivecolloidsigmoidneoplasmwithovarianinvolvement pT4 ( serosalperforation) N1 (2/23) M1 ( ovary ). No peritoneal disease SIGMOID COLON RESECTION + LEFT SO ADYUVANT Rx FOLFIRI ( Feb - Aug 2010 ). Intoleranceto FOLFOX FOLLOW UP OCTOBER 2010 / JANUARY 2011 : NED

  2. PHYSICAL EXAM : Ventral hernia. No masses PET-CT May 2011 Peritoneal recurrence: Implants in anterior abdomen, leftflank, colorectal anastomosis, leftparauterine. SUV 10 Presentstoour center with CC: Unspecificpainleftlowerquadrant Tumor markers: CEA 8,2 / Ca 19.9 y Ca 125 normal

  3. CASO CLÍNICO 2 PET/TAC

  4. PET/TAC

  5. PET/TAC

  6. THERAPEUTIC PLAN SHORT COURSE INDUCTION CHEMPTHERAPY 4 cicles Folfox-Avastin ReevaluationJuly 2011 Complete Colonoscopy: normal , anastomosis at 15 cm PET-CT : Metabolic and lesionizepartialrepsonse Tumor markers: CEA 8’2  5’8 Giventhe favorable response 2 new cycles are prescribedbeforesurgery September 2011 CT : Omental implants >3cm. Leftureteraldilatation ASSESSMENT: Colorectal Peritoneal Carcinomatosisconwithadequate response toinduction CT PLAN : CRS + HIPEC

  7. SURGERY PCI inicial: 7 PCI final: 0 Citorreducción completa CC-0 PROCEDIMIENTOS: - Peritonectomía pélvica completa, en bloque con histerectomía, anexectomía derecha, resección de anastomosis colo-rectal previa - Resección segmentaria uréter distal - Resección de parche seromuscular de ileon - Omentectomía mayor QIOH bidirecional: Oxaliplatinoip a 43ºC + 5FU/LV iv RECONSTRUCCIÓN – ILEOSTOMÍA DERIVATIVA

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