Laparoscopia no estadiamento do Carcinoma do Pâncreas
Abstract
Apesar do avanço no estadiamento pré-operatório do adenocarcinoma do pâncreas, cerca de 10-48% dos doentes classificados como potencialmente curáveis pela tomografia computadorizada pré-operatória apresentam doença metastizada que apenas será identificada no momento da cirurgia. O presente trabalho tem como objetivo rever o papel da laparoscopia no estadiamento desta neoplasia. Foi realizada uma pesquisa bibliográfica na base de dados PubMed, com posterior seleção dos artigos mais relevantes. A laparoscopia de estadiamento aumenta a identificação de tumores incuráveis em 10-15% em doentes com tomografia computadorizada pré-operatória e deve continuar a ser utilizada neste processo. A sua acuidade pode ser melhorada com a utilização da ecografia laparoscópica, da citologiaperitoneal e, no futuro, da laparoscopia de fluorescência. A introdução seletiva da laparoscopia no estadiamento de doentes de alto-risco de doença incurável definido pelas variáveis pré-operatórias dimensão do tumor primário, localização no corpo ou na cauda do pâncreas e níveis de antigénio hidrocarbonado 19-9 (CA 19-9) acima de 150 U/ml, pode minimizar cirurgias desnecessárias, com melhor relação custo-benefício comparativamente à sua aplicação sistemática. O estadiamento combinando a tomografia computadorizada, a ecografia endoscópica e a laparoscopia seletiva permite atingir uma elevada taxa de intervenções potencialmente curativas e
selecionar a melhor opção terapêutica nos doentes com tumor irressecável.
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References
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7. Huggett MT, Pereira SP. Diagnosing and managing pancreatic cancer. The Practitioner. 2011;255(1742):21-5, 2-3. Epub 2011/09/22.
8. Slaar A, Eshuis WJ, van der Gaag NA, Nio CY, Busch OR, van Gulik TM, et al. Predicting distant metastasis in patients with suspected pancreatic and periampullary tumors for selective use of staging laparoscopy. World journal of surgery. 2011;35(11):2528-34. Epub 2011/09/02.
9. Stefanidis D, Grove KD, Schwesinger WH, Thomas CR, Jr. The current role of staging laparoscopy for adenocarcinoma of the pancreas: a review. Annals of oncology : official journal of the European Society for Medical oncology / ESMO. 2006;17(2):189-99. Epub 2005/10/21.
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2012;4(5):104-13. Epub 2012/06/02.
11. Santoro PM, Abdel-Misih RZ, Petrelli NJ, Bennett JJ. Is laparoscopy still needed for staging resectable pancreatic cancer? ASCO Meeting
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13. Simianu VV, Zyromski NJ, Nakeeb A, Lillemoe KD. Pancreatic cancer: progress made. Acta oncologica (Stockholm, Sweden). 2010;49(4):407--17. Epub 2010/01/12.
14. Cascinu S, Falconi M, Valentini V, Jelic S, Group EGW. Pancreatic cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Annals of oncology : official journal of the European Society for Medical Oncology / ESMO. 2010;21 Suppl 5:v55-8. Epub 2010/06/29.
15. Maithel SK, Maloney S, Winston C, Gonen M, D'Angelica MI, Dematteo RP, et al. Preoperative CA 19-9 and the yield of staging laparoscopy in patients with radiographically resectable pancreatic adenocarcinoma. Annals of surgical oncology. 2008;15(12):3512-20. Epub 2008/09/11.
16. Xu Q, Zhang T-P, Zhao Y-P. Advances in early diagnosis and therapy of pancreatic cancer. Hepatobiliary & Pancreatic Diseases International. 2011;10(2):128-35.
17. Callery MP, Chang KJ, Fishman EK, Talamonti MS, William Traverso L, Linehan DC. Pretreatment assessment of resectable and borderline resectable pancreatic cancer: expert consensus statement. Annals of surgical oncology. 2009;16(7):1727-33. Epub 2009/04/28.
18. Tempero MA, Arnoletti JP, Behrman SW, Ben-Josef E, Benson AB, 3rd, Casper ES, et al. Pancreatic Adenocarcinoma, version 2.2012: featured updates to the NCCN Guidelines. Journal of the National Comprehensive Cancer Network : JNCCN. 2012;10(6):703-13. Epub 2012/06/09.
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20. Schima W, Fugger R, Schober E, Oettl C, Wamser P, Grabenwoger F, et al. Diagnosis and staging of pancreatic cancer: comparison of mangafodipir trisodium-enhanced MR imaging and contrast-enhanced helical hydro-CT. AJR American journal of roentgenology. 2002;179(3):717-24. Epub 2002/08/20.
21. Pery C, Meurette G, Ansquer C, Frampas E, Regenet N. Role and limitations of 18F-FDG positron emission tomography (PET) in the management of patients with pancreatic lesions. Gastroenterologie clinique et biologique. 2010;34(8-9):465-74. Epub 2010/08/07.
22. Barabino M, Santambrogio R, Pisani Ceretti A, Scalzone R, Montorsi M, Opocher E. Is there still a role for laparoscopy combined with
laparoscopic ultrasonography in the staging of pancreatic cancer? Surgical endoscopy. 2011;25(1):160-5. Epub 2010/06/23.
23. White R, Winston C, Gonen M, D'Angelica M, Jarnagin W, Fong Y, et al. Current utility of staging laparoscopy for pancreatic and peripancreatic
neoplasms. Journal of the American College of Surgeons. 2008;206(3):445-50. Epub 2008/03/01.
24. Thomson BN, Parks RW, Redhead DN, Welsh FK, Madhavan KK, Wigmore SJ, et al. Refining the role of laparoscopy and laparoscopic
ultrasound in the staging of presumed pancreatic head and ampullary tumours. British journal of cancer. 2006;94(2):213-7. Epub
2006/01/26.
25. Shoup M, Winston C, Brennan MF, Bassman D, Conlon KC. Is there a role for staging laparoscopy in patients with locally advanced, unresectable
pancreatic adenocarcinoma? Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract.
2004;8(8):1068-71. Epub 2004/12/09.
26. Hariharan D, Constantinides VA, Froeling FE, Tekkis PP, Kocher HM. The role of laparoscopy and laparoscopic ultrasound in the preoperative
staging of pancreatico-biliary cancers--A meta-analysis. European journal of surgical oncology : the journal of the European Society of
Surgical Oncology and the British Association of Surgical Oncology. 2010;36(10):941-8. Epub 2010/06/16.
27. Chang L, Stefanidis D, Richardson WS, Earle DB, Fanelli RD. The role of staging laparoscopy for intraabdominal cancers: an evidence-
-based review. Surgical endoscopy. 2009;23(2):231-41. Epub 2008/09/25.
28. Pisters PW, Lee JE, Vauthey JN, Charnsangavej C, Evans DB. Laparoscopy in the staging of pancreatic cancer. The British journal of surgery.
2001;88(3):325-37. Epub 2001/03/22.
29. Gaujoux S, Allen PJ. Role of staging laparoscopy in peri-pancreatic and hepatobiliary malignancy. World journal of gastrointestinal surgery.
2010;2(9):283-90. Epub 2010/12/17.
30. Satoi S, Yanagimoto H, Toyokawa H, Inoue K, Wada K, Yamamoto T, et al. Selective use of staging laparoscopy based on carbohydrate
antigen 19-9 level and tumor size in patients with radiographically defined potentially or borderline resectable pancreatic cancer. Pancreas.
2011;40(3):426-32. Epub 2011/01/06.
31. Nieveen van Dijkum EJ, Romijn MG, Terwee CB, de Wit LT, van der Meulen JH, Lameris HS, et al. Laparoscopic staging and subsequent
palliation in patients with peripancreatic carcinoma. Annals of surgery. 2003;237(1):66-73. Epub 2002/12/24.
32. Contreras CM, Stanelle EJ, Mansour J, Hinshaw JL, Rikkers LF, Rettammel R, et al. Staging laparoscopy enhances the detection of occult
metastases in patients with pancreatic adenocarcinoma. Journal of surgical oncology. 2009;100(8):663-9. Epub 2009/09/26.
33. Schneider C, Jung A, Reymond MA, Tannapfel A, Balli J, Franklin ME, et al. Efficacy of surgical measures in preventing port-site recurrences
in a porcine model. Surgical endoscopy. 2001;15(2):121-5. Epub 2001/04/05.
34. Velanovich V. The effects of staging laparoscopy on trocar site and peritoneal recurrence of pancreatic cancer. Surgical endoscopy.
2004;18(2):310-3. Epub 2003/12/24.
35. Urbach DR, Swanstrom LL, Hansen PD. The effect of laparoscopy on survival in pancreatic cancer. Archives of surgery (Chicago, Ill : 1960).
2002;137(2):191-9. Epub 2002/03/05.
36. Jimenez RE, Warshaw AL, Fernandez-Del Castillo C. Laparoscopy and peritoneal cytology in the staging of pancreatic cancer. Journal of
hepato-biliary-pancreatic surgery. 2000;7(1):15-20. Epub 2000/09/12.
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Published
2014-06-01
How to Cite
SAPAGE, Ana Rita; TAVEIRA-GOMES, António.
Laparoscopia no estadiamento do Carcinoma do Pâncreas.
Revista Portuguesa de Cirurgia, [S.l.], n. 29, p. 29-39, june 2014.
ISSN 2183-1165.
Available at: <https://revista.spcir.com/index.php/spcir/article/view/386>. Date accessed: 23 apr. 2024.
Section
Review Article
