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CIRURGIA RADICAL NO ADENOCARCINOMA GÁSTRICO

CIRURGIA RADICAL NO ADENOCARCINOMA GÁSTRICO

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Published by Renato Accetta
The gastric carcinoma is the second most common cause of cancer-related death in the world, losing only against the bronchogenic carcinoma. Despite the decline in the incidence and mortality registered in the latest decades, it continues to be a disease of high prevalence, especially in the oriental countries. In Brazil, it was the fourth most common in men and the fifth in women in the year of 2003. It attacks most men than women especially in the sixth and seventh decades of life. Its pathogenesis seems to be related to environmental factors and a series of diseases, associated with certain genetic characteristics.
The histopathologic analyses of these tumors are extremely complex and for that, various types of classification have been proposed. The early gastric cancer is considered as not cross over the submucous, independent of the lymph node commitment. When diagnosed in this stage the prognosis is better and, when treated adequately, the rate of survival in five years is high. To get the best surgery treatment it is fundamental an accurate preoperative staging through out complementary image exams and videolaparoscopy in some selected patients. Thus, only the histopathologic staging gives more accurate information about the prognosis and the truth final result of an intentional curative surgery.
The radical surgery of the stomach is the best way to offer a higher survival chance to the patients; still there is a great controversy about the extent of lymphadenectomy, even with a certain tendency of acceptance of a more extended lymph node resection by most surgeons. The goal of this actual bibliographic review is exactly to try to figure out this matter: What kind of surgery gives out better results? Nowadays, the radical gastrectomy with extended lymph node resection is considered the standard when the surgery has curative intention. To perform this procedure it is necessary a
wide knowledge of the lymphatic drainage of the stomach which is very complex and not well understood by a number of surgeons.
The gastric carcinoma is the second most common cause of cancer-related death in the world, losing only against the bronchogenic carcinoma. Despite the decline in the incidence and mortality registered in the latest decades, it continues to be a disease of high prevalence, especially in the oriental countries. In Brazil, it was the fourth most common in men and the fifth in women in the year of 2003. It attacks most men than women especially in the sixth and seventh decades of life. Its pathogenesis seems to be related to environmental factors and a series of diseases, associated with certain genetic characteristics.
The histopathologic analyses of these tumors are extremely complex and for that, various types of classification have been proposed. The early gastric cancer is considered as not cross over the submucous, independent of the lymph node commitment. When diagnosed in this stage the prognosis is better and, when treated adequately, the rate of survival in five years is high. To get the best surgery treatment it is fundamental an accurate preoperative staging through out complementary image exams and videolaparoscopy in some selected patients. Thus, only the histopathologic staging gives more accurate information about the prognosis and the truth final result of an intentional curative surgery.
The radical surgery of the stomach is the best way to offer a higher survival chance to the patients; still there is a great controversy about the extent of lymphadenectomy, even with a certain tendency of acceptance of a more extended lymph node resection by most surgeons. The goal of this actual bibliographic review is exactly to try to figure out this matter: What kind of surgery gives out better results? Nowadays, the radical gastrectomy with extended lymph node resection is considered the standard when the surgery has curative intention. To perform this procedure it is necessary a
wide knowledge of the lymphatic drainage of the stomach which is very complex and not well understood by a number of surgeons.

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Published by: Renato Accetta on Dec 19, 2010
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11/19/2013

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Renato Accetta
 
CIRURGIA RADICAL NO ADENOCARCINOMA GÁSTRICO
Trabalho de Revisão Bibliográfica
UNIVERSIDADE FEDERAL DO ESTADO DO RIO DE JANEIRO - UNIRIOCENTRO DE CIÊNCIAS BIOLÓGICAS E DA SAÚDEHOSPITAL UNIVERSITÁRIO GAFFRÉE E GUINLEESCOLA DE MEDICINA E CIRURGIARIO DE JANEIRO – RJ2004
 
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Renato Accetta
CIRURGIA RADICAL NOADENOCARCINOMA GÁSTRICO
TRABALHO DE REVISÃO BIBLIOGRÁFICA
Internato realizado em convênio com a Universidade Federal Fluminense noHospital Universitário Antônio Pedro, Niterói RJ.Trabalho Monográfico de Conclusão de Curso apresentado ao término docurso de graduação em medicina da Universidade Federal do Estado do Rio deJaneiro (UNIRIO), como parte dos requisitos necessários para obtenção dotítulo de Médico.Orientador: Prof. Pietro AccettaRIO DE JANEIRO – RJ2004
 
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SUMÁRIO
RESUMO...........................................................................................................3ABSTRACT.......................................................................................................4INTRODUÇÃO.................................................................................................5CONSIDERAÇÕES GERAIS...........................................................................8Incidência...................................................................................................8Patogênese e Fatores de Risco..................................................................10Diagnóstico Precoce e Rastreamento.......................................................14PATOLOGIA...................................................................................................16Macroscopia.............................................................................................17Microscopia..............................................................................................22Disseminação do Carcinoma Gástrico......................................................29ESTADIAMENTO..........................................................................................33Sistema TNM............................................................................................34Estadiamento Japonês...............................................................................39CIRURGIA RADICAL....................................................................................41Histórico...................................................................................................42Indicações Cirúrgicas Gerais....................................................................43Estadiamento Per-operatório....................................................................45Cirurgia Curativa......................................................................................48Tipos de Cirurgia......................................................................................50Linfadenectomia.......................................................................................54REFERÊNCIAS BIBLIOGRÁFICAS.............................................................64

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