Estudo prospectivo da mucosa do coto gástrico em pacientes submetidos a gastrectomia subtotal distral para Carcinoma gástrico

• Ano de defesa: 2010
• Autor(a) principal: Henrique Gomes de Barros
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Carcinoma gástrico; Carcinoma do coto gástrico; subtotal distal; Avaliação histopatológica; Gastrectomia; Mucosa gástrica remanescente; Avaliação endoscópica; Carcinoma; Diagnóstico; Mucosa gástrica/patologia; Coto Gástrico/patologia; Mucosa gástrica; Cirurgia; Endoscopia; Oftalmologia
• Link de acesso: http://hdl.handle.net/1843/BUOS-8CTEP5

Gastric carcinoma still remains one of the most common causes of death by tumors in Brazil. Some patients will undergo subtotal distal gastrectomy and thus are at risk of acquiring pre-cancerous conditions and carcinoma in the gastric stump. The aim of this study was to investigate prospectively by endoscopic and histopathologicexamination the remnant gastric mucosa and the clinic-histopathological features and outcome following curative surgery. The subjects were 60 patients with gastric carcinoma who previously underwent curative subtotal distal gastrectomy and Billroth I procedure at our surgery department (IAG, HC-UFMG). We evaluated preoperativeand operative features, gastrectomized stomach histopathological characteristics, postoperative findings and the results of the endoscopic and histopathological followup. The median interval between the subtotal distal gastrectomy and the latest endoscopic evaluation of the gastric stump mucosa was 52,9 (range 6-188) months. The most common endoscopical finding was gastritis (n=51; 85%). Other frequentendoscopical findings were: atrophic epithelium (n=7; 11,7%) and polyps (n=5; 8,3%). The most common histopathological finding also was gastritis (n=55; 91,7%). Other frequent histopathological findings were chronic atrophy (n=36; 60%), foveolar hyperplasia (n=20; 33,3%), metaplasia (n=15; 25%) and H. pylori infection (n=14; 23,3%). Chronic atrophy was revealed to be mild in 15 cases (41,7%), moderate in12 cases (33,3%) and severe in nine cases (25%). Among patients with metaplasia, it was considered to be type I intestinal metaplasia in ten patients (66,7%) and pseudoantrum metaplasia in five patients (33,3%). Adenoma and dysplasia were not identified in any of the specimens examined. Overall, four patients (6,7%) developed gastric stump carcinoma diagnosed on the 10o, 36o, 58o and 62o postoperativemonths. Two of them had positive family background for gastric carcinoma. Neither synchronous carcinoma nor duodenal invasion was detected on theirs gastrectomized stomachs. Histopathological examination of the remnant mucosa of those four patients revealed gastritis (n=1), type I intestinal metaplasia (n=2), H. pylori infection (n=2) and chronic atrophy (n=3). Gastric stump carcinomas wereclassified as: intestinal-type (n=2), diffuse-type (n=1) and Laurens non-classifiedtype (n=1). In addiction to the absence of type III intestinal metaplasia, gastric adenoma or epithelial dysplasia diagnosed, lower rates of severe chronic atrophy indicated that the remnant mucosa appears to be at low risk of acquiring metacronic carcinoma, although the prevalence and intensity of chronic atrophy showed tendency to increase. Despite severe conditions, H. pylori infection was detected in significant number of patients.