CASE PRESENTATION 53 YEAR-OLD FEMALE HISTORY OF PRESENT ILLNESS February 2010 : Obstructive colloid sigmoid neoplasm with ovarian involvement pT4 ( serosal.

Presentación del tema: "CASE PRESENTATION 53 YEAR-OLD FEMALE HISTORY OF PRESENT ILLNESS February 2010 : Obstructive colloid sigmoid neoplasm with ovarian involvement pT4 ( serosal."— Transcripción de la presentación:

1 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 ). pT4 ( serosal perforation) N1 (2/23) M1 ( ovary ). No peritoneal disease SIGMOID COLON RESECTION + LEFT SO ADYUVANT Rx FOLFIRI ( Feb - Aug 2010 ). Intolerance to FOLFOX FOLLOW UP OCTOBER 2010 / JANUARY 2011 : NED

2 PET-CT May 2011 Peritoneal recurrence: Implants in anterior abdomen, left flank, colorectal anastomosis, left parauterine. SUV 10 PHYSICAL EXAM : Ventral hernia. No masses Tumor markers : CEA 8,2 / Ca 19.9 y Ca 125 normal Presents to our center with CC: Unspecific pain left lower quadrant

3 CASO CLÍNICO 2 PET/TAC

4 PET/TAC

5 PET/TAC

6 THERAPEUTIC PLAN SHORT COURSE INDUCTION CHEMPTHERAPY 4 cicles Folfox-Avastin Reevaluation July 2011 Complete Colonoscopy: normal, anastomosis at 15 cm PET-CT : Metabolic and lesion ize partial repsonse Tumor markers: CEA 8’2  5’8 Given the favorable response 2 new cycles are prescribed before surgery September 2011 CT : Omental implants >3cm. Left ureteral dilatation ASSESSMENT: Colorectal Peritoneal Carcinomatosiscon with adequate response to induction 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: Oxaliplatino ip a 43ºC + 5FU/LV iv RECONSTRUCCIÓN – ILEOSTOMÍA DERIVATIVA