{"id":7596,"date":"2023-10-19T06:30:00","date_gmt":"2023-10-19T09:30:00","guid":{"rendered":"https:\/\/gastropedia.pub\/pt\/?p=7596"},"modified":"2023-09-29T11:48:40","modified_gmt":"2023-09-29T14:48:40","slug":"fluxograma-de-tratamento-do-cancer-gastrico","status":"publish","type":"post","link":"https:\/\/gastropedia.pub\/pt\/cirurgia\/fluxograma-de-tratamento-do-cancer-gastrico\/","title":{"rendered":"Fluxograma de tratamento do c\u00e2ncer g\u00e1strico"},"content":{"rendered":"
\"image_pdf\"<\/a>\"image_print\"<\/a><\/div>\n

A associa\u00e7\u00e3o japonesa de c\u00e2ncer g\u00e1strico (JGCA) publica periodicamente suas diretrizes para o tratamento do c\u00e2ncer g\u00e1strico (CG). A sexta e \u00faltima edi\u00e7\u00e3o foi publicada em ingl\u00eas no peri\u00f3dico Gastric C<\/em>ancer em 2022.(1) A figura abaixo demonstra essas diretrizes de forma adaptada incorporando algumas diretrizes ocidentais.<\/p>\n\n\n\n

\"\"<\/a><\/figure>\n\n\n\n

Alguns pontos merecem destaque:<\/strong><\/h2>\n\n\n\n

N\u00e3o houve mudan\u00e7a dos crit\u00e9rios de indica\u00e7\u00e3o para tratamento endosc\u00f3pico e os crit\u00e9rios de cura endosc\u00f3pica (eCURA) incorporados na 5\u00aa edi\u00e7\u00e3o continuam presentes. Maiores detalhes sobre os crit\u00e9rios eCURA podem ser consultados no post de nossa colega Renata Nobre – Crit\u00e9rios de indica\u00e7\u00e3o e cura do ESD g\u00e1strico (eCura)<\/strong><\/a> (2)<\/p>\n\n\n\n

Outro ponto interessante foi a possibilidade da quimioterapia de convers\u00e3o para doen\u00e7a oligometast\u00e1tica. A defini\u00e7\u00e3o de doen\u00e7a oligometast\u00e1tica ainda \u00e9 controversa. Na diretriz japonesa foi considerado a possibilidade de convers\u00e3o para acometimento dos linfonodos cadeias 16a2 e 16b1, met\u00e1stase hep\u00e1tica ressec\u00e1vel, citologia onc\u00f3tica peritoneal positiva e carcinomatose peritoneal restrita (p1). Recentemente um grupo de trabalho Europeu definiu o CG oligometast\u00e1tico quando restrito \u00e0 um \u00f3rg\u00e3o com \u2264 3 met\u00e1stases ou 1 s\u00edtio de met\u00e1stase linfonodal a dist\u00e2ncia.(3) O real benef\u00edcio da cirurgia de convers\u00e3o para esses pacientes provavelmente ser\u00e1 esclarecido pelo estudo alem\u00e3o prospectivo randomizado FLOT5 que ainda est\u00e1 em andamento. Esse estudo compara um grupo submetido a tratamento quimioter\u00e1pico exclusivo com um grupo submetido a quimioterapia de convers\u00e3o seguida por gastrectomia.(4) Saiba mais sobre terapia de convers\u00e3o no CG nesse outro artigo (clique aqui).<\/a> <\/p>\n\n\n\n

Por fim, vale destacar a quimioterapia neoadjuvante para tumores avan\u00e7ados e\/ou com met\u00e1stases linfonodais. Nas diretrizes japonesas a indica\u00e7\u00e3o de quimioterapia neoadjuvante ocorre apenas na presen\u00e7a de \u201cbulky<\/em>\u201d linfonodal. Entretanto, no ocidente \u00e9 cada vez mais comum e indica\u00e7\u00e3o de neoadjuvancia\/pr\u00e9-operat\u00f3ria mesmo nos casos sem bulky <\/em>linfonodal.<\/p>\n\n\n\n

Refer\u00eancias<\/h2>\n\n\n\n
    \n
  1. Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition). Gastric Cancer. 2023;26(1):1-25.<\/li>\n\n\n\n
  2. Moura RN. Voc\u00ea sabe quais os crit\u00e9rios de indica\u00e7\u00e3o e cura do ESD g\u00e1strico (eCura)? Endoscopia Terap\u00eautica; 2022.  Dispon\u00edvel em: endoscopiaterapeutica.com.br\/assuntosgerais\/criterios-esd-gastrico-ecura<\/li>\n\n\n\n
  3. Kroese TE, van Laarhoven HWM, Schoppman SF, Deseyne P, van Cutsem E, Haustermans K, et al. Definition, diagnosis and treatment of oligometastatic oesophagogastric cancer: A Delphi consensus study in Europe. Eur J Cancer. 2023;185:28-39.<\/li>\n\n\n\n
  4. Al-Batran SE, Goetze TO, Mueller DW, Vogel A, Winkler M, Lorenzen S, et al. The RENAISSANCE (AIO-FLOT5) trial: effect of chemotherapy alone vs. chemotherapy followed by surgical resection on survival and quality of life in patients with limited-metastatic adenocarcinoma of the stomach or esophagogastric junction – a phase III trial of the German AIO\/CAO-V\/CAOGI. BMC Cancer. 2017;17(1):893.<\/li>\n<\/ol>\n\n\n\n

    Como citar este artigo<\/h2>\n\n\n\n

    Ramos MFKP, Fluxograma de tratamento do c\u00e2ncer g\u00e1strico Gastropedia 2023 Vol 2. Dispon\u00edvel em:
    gastropedia.pub\/pt\/cirurgia\/fluxograma-de-tratamento-do-cancer-gastrico\/<\/p>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    A associa\u00e7\u00e3o japonesa de c\u00e2ncer g\u00e1strico (JGCA) publica periodicamente suas diretrizes para o tratamento do c\u00e2ncer g\u00e1strico (CG). A sexta e \u00faltima edi\u00e7\u00e3o foi publicada em ingl\u00eas no peri\u00f3dico Gastric…<\/p>\n","protected":false},"author":5595,"featured_media":7598,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[24,27],"tags":[],"ano":[137],"tipo":[121],"volume":[44],"class_list":["post-7596","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-cirurgia","category-esofago-estomago-duodeno","ano-137","tipo-assuntos-gerais","volume-volume-ii"],"yoast_head":"\nFluxograma de tratamento do c\u00e2ncer g\u00e1strico - Gastropedia<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/gastropedia.pub\/pt\/cirurgia\/fluxograma-de-tratamento-do-cancer-gastrico\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Fluxograma de tratamento do c\u00e2ncer g\u00e1strico\" \/>\n<meta property=\"og:description\" content=\"A associa\u00e7\u00e3o japonesa de c\u00e2ncer g\u00e1strico (JGCA) publica periodicamente suas diretrizes para o tratamento do c\u00e2ncer g\u00e1strico (CG). 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