RESUMO
Desde inicios de 2010 han entrado en vigor la 7.a edición del TNM (UICC/AJCC) y una nueva revisión de la Japanese Classification for Gastric Cancer y de la Treatment Guidelines (Japanese Gastric Cancer Association). Unas de las modificaciones más importantes consisten en la redefinición y simplificación de los tipos de linfadenectomía D1/D2 en función del tipo de gastrectomía realizada (anteriormente en función de la localización del tumor primario) y en la adopción del criterio numérico de la 7.a edición del TNM para evaluar el grado de afectación ganglionar (antes según la localización anatómica de los grupos respecto al tumor primario). Estos cambios pretenden facilitar el manejo terapéutico y la comparación de los resultados de una forma más uniforme entre países. La relevancia de estas modificaciones en ambos sistemas justifica este análisis exhaustivo y la actualización de los nuevos conceptos para un manejo correcto del cáncer gástrico (AU)
The 7th edition of the UICC/AJCC TNM, and a new revision of the Japanese Classification for Gastric Cancer and Treatment Guidelines (Japanese Gastric Cancer Association) have been available since the beginning of 2010. One of the most important changes consists on the redefining and simplification of type D1/D2 lymphadenectomy depending on the type of gastrectomy performed (previously it depended on the location of the primary tumour), and the adoption of numeric criteria of TNM-7th Edition to evaluate the level of lymph node involvement (before, according to the anatomical location of the groups as regards the primary tumour).These changes attempt to make therapeutic management easier and a more uniform comparison of results between countries. The importance of these modifications in both systems justifies this exhaustive analysis and update of the new concepts for a correct management of gastric cancer (AU)
Assuntos
Humanos , Guias de Prática Clínica como Assunto , Neoplasias Gástricas/classificação , Neoplasias Gástricas/terapia , JapãoRESUMO
Objetivo: Describir los datos enviados al Registro Nacional de Cirugía Gástrica por laparoscopia y analizar el tipo de cirugía, la reconversión, las complicaciones postoperatorias y la mortalidad. Pacientes y método: Desde marzo de 2005 a julio de 2008 han sido remitidos al registro 302 pacientes a través de un cuestionario ubicado en la página web de la Asociación Española de Cirujanos, donde se registraron datos clinicopatológicos, características de la cirugía realizada, reconversión y morbimortalidad. Resultados: Se ha intervenido a 245 pacientes por adenocarcinoma gástrico, 35 por tumores estromales y 22 por otras afecciones. En los adenocarcinomas gástricos se realizó cirugía resectiva en 232 (95%) casos. La localización predominante fue el tercio distal y el tipo de tumor más frecuente, el intestinal. El 34% fueron tumores localmente avanzados. Se realizó una linfadenectomía D2 en 117 casos, D1 en 105 y D0 en 6. Se realizó reconversión en 21 (9%), y entre las causas destacan las dificultades técnicas. Se han descrito complicaciones postoperatorias en 72 (31%) casos, entre las que destacan por su gravedad las fístulas digestivas. Hubo una mortalidad postoperatoria del 6%, y las causas más frecuentes fueron la sepsis por fuga anastomótica y las complicaciones cardiorrespiratorias. La estancia media hospitalaria en los pacientes que no presentaron complicaciones fue de 9,2±3 días. Conclusiones: La gastrectomía laparoscópica en el cáncer gástrico es un procedimiento factible que no está exento de dificultades técnicas. Una considerable tasa de complicaciones postoperatorias pueden llegar a condicionar los beneficios de la cirugía mínimamente invasiva(AU)
Objective: To study the data from the Laparoscopic Gastric Surgery Spanish National Register of laparoscopic Gastric Surgery and to analyse the type of surgery, the conversion to laparotomy, postoperative complications and mortality. Patients and Method: From March 2005 to July 2008, details of 302 laparoscopic gastric surgical interventions were sent to the Association of Spanish Surgeons web-site. Details of surgical technique, reconversion, clinical and pathological data, morbidity and mortality were collected and analysed. Results: A total of 245 patients had gastric adenocarcinoma, 35 of them stromal tumours and 22 other gastric pathologies. In gastric adenocarcinoma patients, resection was performed in 232 cases (95%). The most frequent histology was intestinal, mainly located in the distal third of the stomach, with 34% of the tumours being locally advanced. D2 lymphadenectomy was performed in 117 cases, D1 in 105, and D0 in 6. Reconversion was needed in 21 cases (9%), with technical difficulty being the most frequent cause . Postoperative complications were reported in 72 patients (31%), with anastomotic leak being one of the most significant. Postoperative mortality was 6%, with sepsis due to anastomotic leak and cardiac or respiratory complications the most frequent causes. The mean hospital stay of patients without complications was 9.2±3 days.Conclusions: Laparoscopic gastrectomy for gastric cancer is a feasible but technically demanding procedure. Potential benefits of minimal invasive surgery can be reduced due to a high rate of postoperative complications(AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Laparoscopia/estatística & dados numéricos , Neoplasias Gástricas/epidemiologia , Controle de Formulários e Registros/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/mortalidade , Inquéritos e Questionários , Indicadores de Morbimortalidade , Excisão de Linfonodo/estatística & dados numéricos , Gastrectomia/estatística & dados numéricos , Procedimentos Cirúrgicos do Sistema Digestório/estatística & dados numéricos , Neoplasias Gástricas/cirurgia , Controle de Formulários e Registros/classificação , Prontuários Médicos/estatística & dados numéricos , Neoplasias Gástricas/complicações , Inquéritos e Questionários/classificação , Adenocarcinoma/complicações , Adenocarcinoma/epidemiologia , Tumores do Estroma Gastrointestinal/epidemiologiaRESUMO
OBJECTIVE: To study the data from the Laparoscopic Gastric Surgery Spanish National Register of laparoscopic Gastric Surgery and to analyse the type of surgery, the conversion to laparotomy, postoperative complications and mortality. PATIENTS AND METHOD: From March 2005 to July 2008, details of 302 laparoscopic gastric surgical interventions were sent to the Association of Spanish Surgeons web-site. Details of surgical technique, reconversion, clinical and pathological data, morbidity and mortality were collected and analysed. RESULTS: A total of 245 patients had gastric adenocarcinoma, 35 of them stromal tumours and 22 other gastric pathologies. In gastric adenocarcinoma patients, resection was performed in 232 cases (95%). The most frequent histology was intestinal, mainly located in the distal third of the stomach, with 34% of the tumours being locally advanced. D2 lymphadenectomy was performed in 117 cases, D1 in 105, and D0 in 6. Reconversion was needed in 21 cases (9%), with technical difficulty being the most frequent cause. Postoperative complications were reported in 72 patients (31%), with anastomotic leak being one of the most significant. Postoperative mortality was 6%, with sepsis due to anastomotic leak and cardiac or respiratory complications the most frequent causes. The mean hospital stay of patients without complications was 9.2 +/- 3 days. CONCLUSIONS: Laparoscopic gastrectomy for gastric cancer is a feasible but technically demanding procedure. Potential benefits of minimal invasive surgery can be reduced due to a high rate of postoperative complications.