Duodenopancreatectomia: análise histopatológica de tumores periampulares
DOI:
https://doi.org/10.11606/issn.1679-9836.v99i4p366-373Palavras-chave:
Pancreaticoduodenectomia, Neoplasias abdominais, AdenocarcinomaResumo
Introdução: A Gastroduodenopancreatectomia Cefálica (GDPC) é a cirurgia de escolha para o tratamento de tumores periampulares. Os pacientes portadores dessa doença possuem sobrevida de 5 anos estimada em 20% a 50%, estando relacionado com o status de ressecção, estágio da doença e a localização do tumor. Conhecer o comportamento biológicos dos tumores periampulares possibilita um melhor planejamento no tratamento e no seguimento desses doentes. Método: O estudo analisou 105 pacientes através do resultado histopatológico oriundo de peças cirúrgicas de GDPC. Dados sobre sítio de origem, tamanho do tumor, status linfonodal, invasão perineural, invasão angiolinfática, margens de ressecção cirúrgicas e grau de diferenciação do tumor foram coletados e comparados com a literatura vigente. Resultados: Os pacientes portadores de neoplasia maligna totalizaram 94 (89,5%) das GDPCs. Desses, 40% (42) eram tumores pancreáticos, 37% (39) eram tumores de papila duodenal (papila de Vater), 4% (4) eram de origem duodenal e 2% (2) eram de colédoco distal. O tamanho médio dos tumores foi de 3,43cm (p = 0,049), com 85% dos tumores maiores de 2 cm e 46 (52,9%) dos adenocarcinomas eram estágio T3. Os linfonodos foram positivos em 27,6% dos adenocarcinomas e a margem foi R0 em 87% dos pacientes. Conclusão: O comportamento biológico dos tumores periampulares é de grande importância para pacientes que foram submetidos a cirurgia de GDPC. Um melhor planejamento no tratamento e no seguimento dos doentes pode ser oferecido quando se conhece o tipo histológico desses tumores. A experiência dos centros na realização dessa cirurgia tem importante relevância nos resultados obtidos.
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Referências
Lu F, Soares KC, He J, Javed AA, Cameron JL, Rezaee N, Pawlik TM, Wolfgang CL, Weiss MJ. Neoadjuvant therapy prior to surgical resection for previously explored pancreatic cancer patients is associated with improved survival. Hepatobil Surg Nutr. 2017;6(3):144-153. doi: https://doi.org/10.21037/hbsn.2016.08.06.
Konstantinidis IT, Warshaw AL, Allen JN, Blaszkowsky LS, Castillo CF, Deshpande V, Hong TS, Kwak EL, Lauwers GY, Ryan DP, Wargo JA, Lillemoe KD, Ferrone CR. Pancreatic ductal adenocarcinoma: is there a survival difference for r1 resections versus locally advanced unresectable tumors? What is a “true” R0 Resection? Ann Surg. 2013;257(4):731-6. doi: https://doi.org/10.1097/SLA.0b013e318263da2f.
Gillen S, Schuster T, Meyer zum Büschenfelde C, Friess H, Kleeff J. Preoperative/neoadjuvant therapy in pancreatic cancer: a systematic review and meta-analysis of response and resection percentages. PLoS Med. 2010;7(4):e1000267. doi: https://doi.org/10.1371/journal.pmed.1000267.
He J, Ahuja N, Makary MA, Cameron JL, Eckhauser FE, Choti MA, Hruban RH, Pawlik TM, Wolfgang CL. 2564 resected periampullary adenocarcinomas at a single institution: trends over three decades. HPB (Oxford). 2014;16(1):83-90. doi: https://doi.org/10.1111/hpb.12078.
Pawlik TM, Gleisner AL, Cameron JL, Winter JM, Assumpcao L, Lillemoe KD, Wolfgang C, Hruban RH, Schulick RD, Yeo CJ, Choti MA. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery. 2007;141(5):610-8. doi: https://doi.org/10.1016/j.surg.2006.12.013.
Riediger H, Keck T, Wellner U, zur Hausen A, Adam U, Hopt UT, Makowiec F. The Lymph Node Ratio is the Strongest Prognostic Factor after Resection of Pancreatic Cancer. J Gastroint Surg. 2009;13(7):1337-44. doi: https://doi.org/10.1007/s11605-009-0919-2.
Zhan H, Xu J, Wang L, Zhang G, Hu S. Lymph node ratio is an independent prognostic factor for patients after resection of pancreatic cancer. World J Surg Oncol. 2015;13:105. doi: https://doi.org/10.1186/s12957-015-0510-0.
Baldwin S, Kukar M, Gabriel E, et al. Pancreatic cancer metastatic to a limited number of lymph nodes has no impact on outcome. HPB. 2016;18(6):523-528. doi: https://doi.org/10.1016/j.hpb.2016.02.004.
Washington K, Berlin J, Branton P, Burgart LJ, Carter DK, Compton CC, Fitzgibbons P, Frankel WL, Jessup J, Kakar S, Minsky B, Nakhleh R, Tang LH, Vauthey JN. Protocol for the Examination of Specimens From Patients With Carcinoma of the Ampulla of Vater. College of American Pathologists. Protocol web posting date: January, 2016. Based on AJCC/ UICC TNM. 7th ed. Available from: https://www.researchgate.net/profile/Bassel_El-Rayes/publication/273785608_Substaging_Nodal_Status_in_Ampullary_Carcinomas_has_Significant_Prognostic_Value_Proposed_Revised_Staging_Based_on_an_Analysis_of_313_Well-Characterized_Cases/links/5670324508ae0d8b0cc0dc98.pdf
Tempero MA, Malafa MP, Al-Hawary M, Asbun H, Bain A, Behrman SW, Benson AB, Binder E, Cardin DB, Cha C, Chiorean E, Chung V, Czito B, Dillhoff M, Dotan E, Ferrone CR, Hardacre J, Hawkins WG, Herman J, Ko AH, Komanduri S, Koong A, LoConte N, Lowy AM, Moravek C, Nakakura EK, O’Reilly EM, Obando J, Reddy S, Scaife C, Thayer S, Weekes CD, Wolff RA, Wolpin BM, Burns J, Darlow S. (2017). Pancreatic Adenocarcinoma, Version 2.2017, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2020;15(8):1028-61. Retrieved Jul 13, 2020. Available from: https://jnccn.org/view/journals/jnccn/15/8/article-p1028.xml.
Hyder O, Dodson RM, Nathan H, Schneider EB, Weiss MJ, Cameron JL, Choti MA, Makary MA, Hirose K, Wolfgang CL, Herman JM, Pawlik TM. Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United States. JAMA Surg. 2013;148(12):1095-102. doi: https://doi.org/10.1001/jamasurg.2013.2509.
American Joint Committee on Cancer (AJCC) TNM staging system, September 6, 2013. American Cancer Society; 2016 [cited January 4, 2017]. Available from: http://www.cancer.org/cancer/pancreaticcancer/detailedguide/pancreatic-cancer-staging.
Radojkovic M, Stojanovic M, Radojković D, Jeremic L, Mihailovic D, Ilic I. Histopathologic differentiation as a prognostic factor in patients with carcinoma of the hepatopancreatic ampulla of Vater. J Int Med Res. 2018:300060518786920. doi: https://doi.org/10.1177/0300060518786920.
Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, Sauter PK, Coleman J, Hruban RH, Lillemoe KD. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg. 2000;4(6):567-79. doi: https://doi.org/10.1016/s1091-255x(00)80105-5.
Yeo CJ, Cameron JL, Lillemoe KD, Sitzman JV, Hruban RH, Goodman SN, et al. Pancreaticoduodenectomy for cancer of the head of the pancreas. 201 patients. Ann Surg. 1995;221:721-33. doi: https://doi.org/10.1097/00000658-199506000-00011.
Elberm H, Ravikumar R, Sabin C, Abu Hilal M, Al-Hilliv A, Aroori S, Bond-Smith G, Bramhall S, Coldham C, Hammond J, Hutchins R, Imber C, Preziosi G, Saleh A, Silva M, Simpson J, Spoletini G, Stell D, Terrace J, White S, Wigmore S, Fusai G. Outcome after pancreaticoduodenectomy for T3 adenocarcinoma: A multivariable analysis from the UK Vascular Resection for Pancreatic Cancer Study Group. Eur J Surg Oncol. 2015;41(11):1500-7. doi: https://doi.org/10.1016/j.ejso.2015.08.158.
Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ. 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg. 2006;10(9):1199-210; discussion 1210-1. doi: https://doi.org/10.1016/j.gassur.2006.08.018.
Lim JE, Chien MW, Earle CC. Prognostic factors following curative resection for pancreatic adenocarcinoma: a population-based, linked database analysis of 396 patients. Ann Surg. 2003;237(1):74-85. doi: https://doi.org/10.1097/00000658-200301000-00011.
Verbeke CS, Leitch D, Menon KV, McMahon MJ, Guillou PJ, Anthoney A. Redefining the R1 resection in pancreatic cancer. Br J Surg. 2006;93(10):1232-7. doi: https://doi.org/10.1002/bjs.5397.
Menon KV, Gomez D, Smith AM, Anthoney A, Verbeke CS. Menon et al Impact of margin status on survival following pancreatoduodenectomy for cancer: the Leeds Pathology Protocol (LEEPP). HPB (Oxford). 2009;11(1):18-24. doi: https://doi.org/10.1111/j.1477-2574.2008.00013.x.
Hatzaras I, George N, Muscarella P, Melvin WS, Ellison EC, Bloomston M. Predictors of survival in periampullary cancers following pancreaticoduodenectomy. Ann Surg Oncol 2010;17(4):991-7. doi: https://doi.org/10.1245/s10434-009-0883-9.
Chandrasegaram MD, Chiam SC, Chen JW, Khalid A, Mittinty ML, Neo EL, Tan CP, Dolan PM, Brooke-Smith ME, Kanhere H, Worthley CS. Distribution and pathological features of pancreatic, ampullary, biliary and duodenal cancers resected with pancreaticoduodenectomy. World J Surg Oncol. 2015;13:85. doi: https://doi.org/10.1186/s12957-015-0498-5.
Hellan M, Sun CL, Artinyan A, Mojica-Manosa P, Bhatia S, Ellenhorn JDI, Kim J. The impact of lymph node number on survival in patients with lymph node-negative pancreatic cancer. Pancreas. 2008;37(1):19-24. doi: https://doi.org/10.1097/MPA.0b013e31816074c9.
