Felipe Ramos Nogueira

Ultrassom anorretal tri-dimensional pode selecionar pacientes com tumor no reto após neoadjuvância para cirurgia de preservação esfincteriana?

ABSTRACT: Proposal:Evaluate the post-chemoradiotherapy response for treatment of rectal tumor using three-dimensionalanorectal ultrasound-3D-US to determine the best surgical approach Methods:32 patients with lower and middle rectal cancerwere prospectively staged using 3D-US to identify anal canal invasion and the distance(cm) between tumor and the internal analsphincter-IAS, Group l:with anal canal invasion; Group II-with distance =2cm; Group III-with distance >2. They were submittedto neoadjuvant chemoradiation-CR T and the 3-D US was r epeated 50-55 days later . The choice of the surgical appr oach was basedon the post-chemoradiation response identified by the 3D-US comparing with pathologic findings. Results:The post-chemoradiation/3D-US findings were concordant with pathologic results in 31/32(97%). It was identified residual tumors in 26/27(96% sensibility), 19(59%) with partial response and 7(22%) without response. Complete response was demonstrated in 5/5 by3D-US, with specificity and predictive valor in 100%. Negative predictive valor in 83% since one(3%) case was inconclusive.Sphincter-saving resection was performed in 16 patients, 5 with complete response, 10 with partial response and one inconclusive,with distal margin >2cm. The pathologic findings confirmed distal margins without tumor. It was demonstrated highconcordance(87.5%) concerning the lymph nodes evaluation(Kappa test). Conclusion: 3D-US can be useful to determine thepatients who should be submitted to sphincter-saving resections.Key words: Rectal Cancer; Endorectal Ultrasonography; Radiotherapy; Surgery Treatment.