CASE PRESENTATIONCASE PRESENTATION

53 YEAR-OLD FEMALE53 YEAR-OLD FEMALE

HISTORY OF PRESENT ILLNESSHISTORY OF PRESENT ILLNESS

February 2010 : Obstructive colloid sigmoid neoplasm with ovarian involvement February 2010 : Obstructive colloid sigmoid neoplasm with ovarian involvement pT4pT4 ( serosal perforation) ( serosal perforation) N1N1 (2/23) (2/23) M1M1 ( ovary ). ( ovary ). No peritoneal disease No peritoneal disease

SIGMOID COLON RESECTION + LEFT SOSIGMOID COLON RESECTION + LEFT SO

ADYUVANT Rx FOLFIRI ADYUVANT Rx FOLFIRI ( Feb - Aug 2010 ). Intolerance to FOLFOX( Feb - Aug 2010 ). Intolerance to FOLFOX

FOLLOW UP OCTOBER 2010 / JANUARY 2011 : NEDFOLLOW UP OCTOBER 2010 / JANUARY 2011 : NED

PET-CT PET-CT May 2011 May 2011

Peritoneal recurrence:Peritoneal recurrence:Implants in anterior abdomen, left flank, colorectal anastomosis, left parauterine. Implants in anterior abdomen, left flank, colorectal anastomosis, left parauterine. SUV 10 SUV 10

PHYSICAL EXAM : Ventral hernia. No massesPHYSICAL EXAM : Ventral hernia. No masses

Tumor markers Tumor markers : CEA 8,2 / Ca 19.9 y Ca 125 normal: CEA 8,2 / Ca 19.9 y Ca 125 normal

Presents to our center with CC: Unspecific pain left lower quadrantPresents to our center with CC: Unspecific pain left lower quadrant

CASO CLÍNICO 2 PET/TAC CASO CLÍNICO 2 PET/TAC

PET/TAC PET/TAC

PET/TAC PET/TAC

THERAPEUTIC PLANTHERAPEUTIC PLAN

SHORT COURSE INDUCTION CHEMPTHERAPY SHORT COURSE INDUCTION CHEMPTHERAPY 4 cicles Folfox-Avastin4 cicles Folfox-Avastin

Reevaluation July 2011Reevaluation July 2011Complete Colonoscopy: normal , anastomosis at 15 cmComplete Colonoscopy: normal , anastomosis at 15 cmPET-CT : Metabolic and lesion ize partial repsonsePET-CT : Metabolic and lesion ize partial repsonseTumor markers: CEA 8’2 Tumor markers: CEA 8’2 5’8 5’8

Given the favorable response 2 new cycles are prescribed before surgeryGiven the favorable response 2 new cycles are prescribed before surgery

September 2011 CT : Omental implants >3cm. September 2011 CT : Omental implants >3cm. Left ureteral dilatationLeft ureteral dilatation

ASSESSMENT: ASSESSMENT: Colorectal Peritoneal Carcinomatosiscon with adequate response to induction CTColorectal Peritoneal Carcinomatosiscon with adequate response to induction CT

PLAN : CRS + HIPECPLAN : CRS + HIPEC

SURGERYSURGERY

PCI inicial: PCI inicial: 77PCI final: PCI final: 00Citorreducción completa CC-0Citorreducción completa CC-0

PROCEDIMIENTOS:PROCEDIMIENTOS:- Peritonectomía pélvica completa, en bloque con histerectomía, - Peritonectomía pélvica completa, en bloque con histerectomía,

anexectomía derecha, resección de anastomosis colo-rectal previaanexectomía derecha, resección de anastomosis colo-rectal previa- Resección segmentaria uréter distal- Resección segmentaria uréter distal- Resección de parche seromuscular de ileon- Resección de parche seromuscular de ileon- Omentectomía mayor- Omentectomía mayor

QIOH bidirecional: Oxaliplatino ip a 43ºC + 5FU/LV ivQIOH bidirecional: Oxaliplatino ip a 43ºC + 5FU/LV iv

RECONSTRUCCIÓN – ILEOSTOMÍA DERIVATIVARECONSTRUCCIÓN – ILEOSTOMÍA DERIVATIVA