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Resumen
El objetivo de este trabajo es hacer una puesta al día del tratamiento actual del cáncer oclusivo del colon, planteando sucesivamente: a) la situación del problema; b) las etapas diagnósticas para responder a las cuatro preguntas básicas: hay realmente una oclusión? ¿Es mecánica o dinámica? ¿Cuál es su localización? y por último ¿a qué se debe? c) objetivos del tratamiento quirúrgico y por último, a las opciones técnicas, según se trata de un tumor resecable o irresecable y en dependencia de su topografía, tiempo de evolución, estado del enfermo, medios y ambiente quirúrgico, y experiencia del cirujano.
A través de siete conclusiones finales, insistimos como aportaciones más novedosas, el lavado intraoperatorio con povidona iodada al 5%, la colocación de endoprótesis y la colectomía subtotal con anastomosis ileo-sihmoidorrectal, procedimiento tal vez demasiado radical, que si bien tiene sus ventajas no carece de graves inconvenientes y, por lo tanto, sus indicaciones deben ser seriamente ponderadas.
El tiempo, juez inexorable, dirá la última palabra, dado que en el mundo de la ciencia pocas veces se puede afirmar que algo es lo último y definitivo.
Palabras clave:
Colon
Cáncer oclusivo
Tratamiento
The aim of this study was to provide an update of current surgical treatment of malignant obstruction of the colon, focussing on the following: a) an overview of the problem; b) diagnostic stages corresponding to the four basic questions: is there really an occlusion? is it mechanical or dynamic? where is it localized? and, lastly, what is the cause?; c) aims of surgical treatment and, lastly, the therapeutic options according to whether the tumor is resectable or unresectable, which in turn depend on the site, time of evolution, status of the patient, the surgical resources and environment, and the experience of the surgeon.
We draw seven conclusions, the most important and novel of which concern intraoperative lavage with 5% povidone iodine, insertion of endoprosthesis and subtotal colectomy with ileo-sigmoid-rectal anastomosis. This latter procedure is perhaps too radical. Despite its advantages it has serious drawbacks and therefore its indications should be seriously considered.
Time, the most inexorable of judges, will have the final word, given that in the world of science, the definitive answer is rarely found.
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