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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