NMS. Casos Clínicos

266

Part II ♦ Specific Disorders

A

Figure 8-30: A: Sphincter-preserving proctectomy. B: Coloanal anastomosis. (From Delaney CP. Operative Techniques in Laparoscopic Colorectal Surgery , 2nd ed. Wolters Kluwer Health; 2013, Fig. 10-3.) Q: What evaluation and management are appropriate for pelvic pain? A: If this occurs in the early postoperative period, it may be secondary to operative nerve injury or infection . If it occurs later, it is necessary to rule out local recurrence of the tumor by physical examination and CT of the pelvis. SAMPLE Q: What evaluation and management is appropriate for a new 0.5-cm lesion in the perineum? A: Biopsy of the lesion is necessary. If the biopsy shows carcinoma, the patient should undergo a repeat CT scan, CEA level, and colonoscopy to determine the extent of the lesion and whether there are other lesions. Typically, a multidisciplinary approach using chemother- apy radiation and surgery is appropriate for treatment of a recurrence. In general, recurrent cancer has a poor prognosis.