NMS. Casos Clínicos

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Part II ♦ Specific Disorders

Q: What other factors in this primary tumor are important in the prognosis of this patient, who has no positive lymph nodes? A: A poor prognosis is associated with poor histologic differentiation of the tumor, elevated CEA level, bowel perforation, and aneuploidy. Q: What is the appropriate management plan for this patient once he has recovered from the surgery? A: Management is similar to that for any patient with colon cancer. Figure 8-27: Extent of surgery in abdominoperineal resection. (From Fiser SM. The ABSITE Review , 6th ed. Wolters Kluwer Health; 2019, Fig. 36-6.) SAMPLE Case 8.26  Heme-Positive Stool in Patient with Rectal Cancer You are asked to evaluate a 62-year-old patient with rectal cancer. Q: How would the level of the lesion from the anal verge affect operative management? A: It is possible to remove most rectal cancers that lie more than 5 cm proximal to the anal verge safely using an anterior approach leaving the anus and sphincter in place. If the lesion is closer to the anal verge, abdominoperineal resection is necessary because lesions close to the anal verge have lateral margins of resection that include the anal sphincter mechanism. Removal or disabling of this mechanism results in incontinence, obviously not a desirable situation.