Interposição jejunal após gastrectomia total radical por adenocarcinoma gástrico

Pimenta, Luiz Gonzaga; Silva, Alcino Lázaro da; Nunes, Tarcizo Afonso; Cintra, Cássio Andrade; Rausch, Marcelo; Carvalho, Mário Gissoni; Conceição, Sérgio Alexandre da

doi:10.1590/S0100-69911998000200002

Resumos

Realizamos um estudo retrospectivo do tratamento cirúrgico do adenocarcinoma gástrico por uma gastrectomia total radical, com reconstrução do trânsito esofagoduodenal pela interposição de uma alça jejunal pediculada. Revisão de trabalhos nacionais e estrangeiros relacionados ao tratamento do adenocarcinoma gástrico pela gastrectomia total radical. De acordo com a operabilidade relacionada ao paciente e à ressecabilidade, à lesão primária e sua evolução, 126 pacientes foram submetidos à interposição de um segmento de alça jejunal após gastrectomia total radical. Ressecção oncológica total do estômago e sistematizada reconstrução técnica do reservatório gástrico e do trânsito esofagoduodenal. Nossos casos evoluíram de maneira satisfatória, não fugindo daqueles estudados na literatura. Ênfase especial foi dada ao procedimento técnico, mais anatômico e muito mais funcional, restituindo ao operado um neoestômago e um trânsito esôfago-intestinal através do duodeno. A interposição de uma alça jejunal pediculada entre o esôfago terminal e a segunda porção do duodeno age como neo-reservatório gástrico. Evita o refluxo esofágico e direciona o bolo alimentar para o delgado através do duodeno, trânsito anatômico e funcional capaz de proporcionar melhor qualidade de vida ao gastrectomizado total.

Carcinoma gástrico; Gastrectomia total; Interposição jejunal

We performed a retrospective study of the surgical treatment of the gastric adenocarcinoma by a radical total gastrectomy, followed by the reconstruction of the esophagoduodenal path with the interposition of a jejunal pouch. Revision of national and foreign papers related to the treatment of the gastric adenocarcinoma by the radical total gastrectomy was done. According to the operability related to the patient and ressecability related to the primary lesion and its evolution. 126 patients were submitted to an interposition of a jejunal loop following radical total gastrectomy. Total oncological resection of the stomach and systematic technical fqllow-up of the new gastric reservoir and the esophagoduodenal path. Our cases evolued in a satisfactory way, similar to those ones seen in the literature. Special emphasis was taken on the technical procedure. more anatomical and much more functional, giving back to the patient a new stomach and gastrointestinal path through the duodenum. The interposition of a jejunal pouch between the terminal esophagus and the second portion of the duodenum acts like a new gastric reservoir. It avoids the esophageal reflux and transports food and fluids to the small intestine through the duodenum. An anatomic and functional path which may give to the patient submitted to a total gastrectomy a better quality of life.

Stomach neoplasms; Total gastrectomy; Jejunal interposition

ARTIGOS ORIGINAIS

Interposição jejunal após gastrectomia total radical por adenocarcinoma gástrico

Jejunal interposition after radical total gastrectomy for gastric adenocarcinoma

Luiz Gonzaga Pimenta^I; Alcino Lázaro da Silva, TCBC-MG^II; Tarcizo Afonso Nunes^III; Cássio Andrade Cintra^III; Marcelo Rausch, ACBC-MG^III; Mário Gissoni Carvalho, ACBC-MG^III; Sérgio Alexandre da Conceição, ACBC-MG^III

^IProfessor Adjunto, Mestre e Doutor

^IIProfessor Titular de Cirurgia do Aparelho Digestivo

^IIICirurgião Geral do Instituto Mineiro de Oncologia (IMO)

^{Endereço para correspondência} Endereço para correspondência: Dr. Alcino Lázaro da Silva Rua Guaratinga, 151 - Sion 30315-430 - Belo Horizonte - MG

RESUMO

Realizamos um estudo retrospectivo do tratamento cirúrgico do adenocarcinoma gástrico por uma gastrectomia total radical, com reconstrução do trânsito esofagoduodenal pela interposição de uma alça jejunal pediculada. Revisão de trabalhos nacionais e estrangeiros relacionados ao tratamento do adenocarcinoma gástrico pela gastrectomia total radical. De acordo com a operabilidade relacionada ao paciente e à ressecabilidade, à lesão primária e sua evolução, 126 pacientes foram submetidos à interposição de um segmento de alça jejunal após gastrectomia total radical. Ressecção oncológica total do estômago e sistematizada reconstrução técnica do reservatório gástrico e do trânsito esofagoduodenal. Nossos casos evoluíram de maneira satisfatória, não fugindo daqueles estudados na literatura. Ênfase especial foi dada ao procedimento técnico, mais anatômico e muito mais funcional, restituindo ao operado um neoestômago e um trânsito esôfago-intestinal através do duodeno. A interposição de uma alça jejunal pediculada entre o esôfago terminal e a segunda porção do duodeno age como neo-reservatório gástrico. Evita o refluxo esofágico e direciona o bolo alimentar para o delgado através do duodeno, trânsito anatômico e funcional capaz de proporcionar melhor qualidade de vida ao gastrectomizado total.

Unitermos: Carcinoma gástrico; Gastrectomia total; Interposição jejunal.

ABSTRACT

We performed a retrospective study of the surgical treatment of the gastric adenocarcinoma by a radical total gastrectomy, followed by the reconstruction of the esophagoduodenal path with the interposition of a jejunal pouch. Revision of national and foreign papers related to the treatment of the gastric adenocarcinoma by the radical total gastrectomy was done. According to the operability related to the patient and ressecability related to the primary lesion and its evolution. 126 patients were submitted to an interposition of a jejunal loop following radical total gastrectomy. Total oncological resection of the stomach and systematic technical fqllow-up of the new gastric reservoir and the esophagoduodenal path. Our cases evolued in a satisfactory way, similar to those ones seen in the literature. Special emphasis was taken on the technical procedure. more anatomical and much more functional, giving back to the patient a new stomach and gastrointestinal path through the duodenum. The interposition of a jejunal pouch between the terminal esophagus and the second portion of the duodenum acts like a new gastric reservoir. It avoids the esophageal reflux and transports food and fluids to the small intestine through the duodenum. An anatomic and functional path which may give to the patient submitted to a total gastrectomy a better quality of life.

Key words: Stomach neoplasms; Total gastrectomy; Jejunal interposition.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

REFERÊNCIAS

I. Allen AW. Total gastrectomy for carcinoma of the stomach. Am J Surg 1938;40:35-41.

2. Barber Jr KW, Remine WH, et al. A critical evaluation of total gastrectomy. Arch Surg 1963;87:23-50.

3. Bozzetti F. Total versus subtotal gastrectomy in cancer of the distal stomach: Facts and fantasy. Eur J Surg Oncol 1992;18:572-579.

4. Schrock TR, Way LW. Total gastrectomy. Am J Surg 1978;135:348- 355.

5. Shahon DB, Horowitz S, Kelly WD. Cancer of the stomach. An analysis of 1.152 cases. Surgery 1956;39:204-221.

6. Shiu MH, et al. Influence of the extent of ressection on survival after curative treatment of gastric carcinoma. Arch Surg 1987;22:1347- 1351.

7. Finney JMT, Rienhoff JR WF. Total gastrectomy. Arch Surg 1929; 18:140-162.

8. Lahey FH. Total gastrectomy for all patients with operable cancer of the stomach. Editorial Surg Gynecol Obstet 1950;90:246-248.

9. Bittner R, Schirrow H, et al. Total gastrectomy. A 15 year experience with particular reference to the patient over 70 years of age. Arch Surg 1985;120:1120-1125.

10. Buhl K, Lehnert T, et al. Reconstruction after gastrectomy and quality of life World J Surg 1995;19;558-564.

11. Furukawa H, Hiratsuka M, Iwanaga T. A rational technique for surgical operation on Bormann type 4 gastric carcinoma: left upper abdominal evisceration plus Appleby's method. Br J Surg 1988; 75: 116-119.

12. Harrison JD, Fielding JWL. Prognostic factors for gastric cancer influencing clinical practice. World J Surg 1995; 19:496-500.

13. Muto M, Marki T, et al. Improvement in the end-results of surgical treatment of gastric cancer. Surgery 1968;63:229-235.

14. Walters W. Carcinoma of the stomach in this country and in the orient. Am Surg 1963;29:454-456.

15. Gama-Rodrigues JJ, Bresciani CJC, et al. Surgical management of gastric carcinoma. Extent of gastric resection and lymphadenectomy - Current trends and results. ABCD Arq Bras Cir Dig 1986;1:84-89.

16. Gama-Rodrigues 11, Bresciani CLC, et al. Subtotal versus total gastrectomy in radical surgical management of gastric cancer - Still a controversy. ABCD Arq Bras Cir Dig 1986; I :37-38.

17. Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 1987; 11: 418-425.

18. Maruyama K, Sasako M, et al. Pancreas preserving total gastrectomy for proximal gastric cancer. World J Surg 1995;19:532-536.

19. Mello JB, Moreira AA, et al. Gastrectomia total: Análise de 50 casos. Rev Paul Med 1978;91 :10-16.

20. Novaes HM, Mello JB, et al. Análise de 500 casos de câncer gástrico. Rev Ass Med Brasil 1980;26:28-30.

21. Paulino F. Cirurgia do câncer gástrico. Considerações sobre 522 casos e 305 ressecções. JBM 1970;20:16-31.

22. Shiu MH, et al. Selection of operative procedure for adenocarcinoma of the mid stomach: Twenty years experience with implications for future treatment strategy. Ann Surg 1980;192:730-737.

23. Comell GN, Gilder H, et al. The use of jejunal interposition with total gastrectomy. Ann Surg 1960;152:430-444.

24. Henley FA. Gastrectomy with replacement: A preliminary communication. Br J Surg 1952;40: 118-128.

25. Longmire Jr WP, Beal JM. Construction of a substitute gastric reservoir following total gastrectomy. Ann Surg 1952;135:637-645.

26. Bastos ES. Gastrosplenectomia total e pancreatectomia parcial com transplante de alça de jejuno interesofagoduodenal. Rev Assoc Med Brasil 1954;1:294-308.

27. Fava L, Rasslan S, et al. Reconstrução do trânsito com bolsa jejunal horizontal esofagoduodenal após gastrectomia total. Rev Col Bra.f Cir 1990;17:31-37.

28. Galvão L. Câncer gástrico. Medicina de Hoje 1976, p. 58-65.

29. Gentil F, Lopes A, et al. Gastrectomia total radical Rev Col Bras Cir 1991;18:154-159.

30. Lázaro da Silva A, Conceição SA, et al. Gastrectomia e interposição de intestino delgado no tratamento do câncer gástrico. Resultados. Rev Ass Med Brasil 1986;32:65-69.

31. Raia A, Lex A. Gastrectomia total com interposição de alça jejunal no tratamento do câncer gástrico extenso. Rev Paul Med 1961;59: 397-410.

32. Ladoux JE, Finochietto R. Gastrectomia total. Técnica de Henley - Longmire. Prensa Med Argentina 1957;44:2398-2402.

33. Mouchet A, Camey M. Un nouveau procédé de retablissement de la continuité aprés gastrectomie par interposition d'un segment de grêle entre l'oesophage et le duodenum. Arch Mal App Digest 1953; 42: 621-631.

34. Zacho A, Fischermann K. Total gastrectomy in carcinoma of the stomach Acta Chir Scand 1959;117:278-294.

35. Lázaro da Silva A, Salles JMP, et al. Infiltração gástrica intramural por carcinoma gástrico. Rev Hosp Clin Fac Med São Paulo 1976;31: 474-477.

36. Lázaro da Silva A, Moreno Jr M. Avaliação clínica imediata na gastrectomia quase total mais anastomose de tubo de fórnix com o duodeno (Tubinho) no adenocarcinoma do antro. An Paul Med Cir 1979;106:65-80.

37. Lázaro da Silva A, Marchini I. Tratamento cirúrgico do adenocarcinoma gástrico. Considerações sobre 530 casos. Rev Goiana Med 1982; 28: 127-136. .

38. Kockerling F, Reck T, et al. Extend gastrectomy: Who benefits? World J Surg 1995;19:541-545.

39. Lumpkin WM, Crow JR, et al. Carcinoma of the stomach: Review of 1.035 cases. Ann Surg 1964;159:919-932.

40. Korenaga D, Okamura T, et al. Results of resection of gastric cancer extending to adjacent organs. Br J Surg 1988;75:12-15.

41. Drummond Filho I, Freitas RG, et al. Gastrectomia total: Avaliação retrospectiva das técnicas e indicações em 25 casos estudados. Rev Col Bras Cir 1989;16:221-226.

42. Boku T, Nakane Y, et al. Strategy for Iymphadenectomy of gastric cancer. Surgery 1989; I 05:585-592.

43.Boku T, Nakane Y, et al. Prognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer. Br J Surg 1990; 77:436-439.

44. Korenaga D, Moriguchi V, et al. Trends in survival rates in japonese patients with advanced carcinoma of the stomach. Surg Gynecol Obstet 1992;174:387-393.

45. Leonardi LS, Comodo H, et al. Infiltração duodenal por câncer gástrico. Rev Ass Med Brasil 1976;22:205-209.

46. Topart Ph, et al. Adénocarcinoma sur moignon gastrique. A propos d'une série de 25 patients. Lyon Chir 1993;89:339-342.

47. Lahey FH. Complete removel of the stomach for malignancy. Surg Gynecol Obstet 1938;67:213-223.

48. Longmire Jr WP. Total gastrectomy for carcinoma of the stomach. Surg Gynecol Obstet 1947;84:21-30.

49. Iwanaga T, Koyama H, et al. Mechanisms of late recurrence after radical surgery fort gastric carcinoma. Am J Surg 1978;135: 637-640.

50. Lee Jr WM. Transposition of a colon segment as a gastric reservoir after total gastrectomy. Surg Gynecol Obstet 1951;92:456-465.

Recebido em 4/7/97

Aceito para publicação em 6/11/97

Trabalho realizado no Departamento de Cirurgia da Faculdade de Medicina da Universidade Federal de Minas Gerais - UFMG

I. Allen AW. Total gastrectomy for carcinoma of the stomach. Am J Surg 1938;40:35-41.
2. Barber Jr KW, Remine WH, et al. A critical evaluation of total gastrectomy. Arch Surg 1963;87:23-50.
3. Bozzetti F. Total versus subtotal gastrectomy in cancer of the distal stomach: Facts and fantasy. Eur J Surg Oncol 1992;18:572-579.
4. Schrock TR, Way LW. Total gastrectomy. Am J Surg 1978;135:348- 355.
5. Shahon DB, Horowitz S, Kelly WD. Cancer of the stomach. An analysis of 1.152 cases. Surgery 1956;39:204-221.
6. Shiu MH, et al. Influence of the extent of ressection on survival after curative treatment of gastric carcinoma. Arch Surg 1987;22:1347- 1351.
7. Finney JMT, Rienhoff JR WF. Total gastrectomy. Arch Surg 1929; 18:140-162.
8. Lahey FH. Total gastrectomy for all patients with operable cancer of the stomach. Editorial Surg Gynecol Obstet 1950;90:246-248.
9. Bittner R, Schirrow H, et al. Total gastrectomy. A 15 year experience with particular reference to the patient over 70 years of age. Arch Surg 1985;120:1120-1125.
¹⁰
Buhl K, Lehnert T, et al. Reconstruction after gastrectomy and quality of life World J Surg 1995;19;558-564.
11. Furukawa H, Hiratsuka M, Iwanaga T. A rational technique for surgical operation on Bormann type 4 gastric carcinoma: left upper abdominal evisceration plus Appleby's method. Br J Surg 1988; 75: 116-119.
12. Harrison JD, Fielding JWL. Prognostic factors for gastric cancer influencing clinical practice. World J Surg 1995; 19:496-500.
13. Muto M, Marki T, et al. Improvement in the end-results of surgical treatment of gastric cancer. Surgery 1968;63:229-235.
14. Walters W. Carcinoma of the stomach in this country and in the orient. Am Surg 1963;29:454-456.
15. Gama-Rodrigues JJ, Bresciani CJC, et al. Surgical management of gastric carcinoma. Extent of gastric resection and lymphadenectomy - Current trends and results. ABCD Arq Bras Cir Dig 1986;1:84-89.
16. Gama-Rodrigues 11, Bresciani CLC, et al. Subtotal versus total gastrectomy in radical surgical management of gastric cancer - Still a controversy. ABCD Arq Bras Cir Dig 1986; I :37-38.
17. Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 1987; 11: 418-425.
18. Maruyama K, Sasako M, et al. Pancreas preserving total gastrectomy for proximal gastric cancer. World J Surg 1995;19:532-536.
19. Mello JB, Moreira AA, et al. Gastrectomia total: Análise de 50 casos. Rev Paul Med 1978;91 :10-16.
20. Novaes HM, Mello JB, et al. Análise de 500 casos de câncer gástrico. Rev Ass Med Brasil 1980;26:28-30.
21. Paulino F. Cirurgia do câncer gástrico. Consideraçőes sobre 522 casos e 305 ressecçőes. JBM 1970;20:16-31.
22. Shiu MH, et al. Selection of operative procedure for adenocarcinoma of the mid stomach: Twenty years experience with implications for future treatment strategy. Ann Surg 1980;192:730-737.
23. Comell GN, Gilder H, et al. The use of jejunal interposition with total gastrectomy. Ann Surg 1960;152:430-444.
24. Henley FA. Gastrectomy with replacement: A preliminary communication. Br J Surg 1952;40: 118-128.
25. Longmire Jr WP, Beal JM. Construction of a substitute gastric reservoir following total gastrectomy. Ann Surg 1952;135:637-645.
26. Bastos ES. Gastrosplenectomia total e pancreatectomia parcial com transplante de alça de jejuno interesofagoduodenal. Rev Assoc Med Brasil 1954;1:294-308.
27. Fava L, Rasslan S, et al. Reconstruçăo do trânsito com bolsa jejunal horizontal esofagoduodenal após gastrectomia total. Rev Col Bra.f Cir 1990;17:31-37.
²⁸
Galvão L. Câncer gástrico. Medicina de Hoje 1976, p. 58-65.
²⁹
Gentil F, Lopes A, et al. Gastrectomia total radical Rev Col Bras Cir 1991;18:154-159.
30. Lázaro da Silva A, Conceiçăo SA, et al. Gastrectomia e interposiçăo de intestino delgado no tratamento do câncer gástrico. Resultados. Rev Ass Med Brasil 1986;32:65-69.
31. Raia A, Lex A. Gastrectomia total com interposiçăo de alça jejunal no tratamento do câncer gástrico extenso. Rev Paul Med 1961;59: 397-410.
32. Ladoux JE, Finochietto R. Gastrectomia total. Técnica de Henley - Longmire. Prensa Med Argentina 1957;44:2398-2402.
33. Mouchet A, Camey M. Un nouveau procédé de retablissement de la continuité aprés gastrectomie par interposition d'un segment de gręle entre l'oesophage et le duodenum. Arch Mal App Digest 1953; 42: 621-631.
³⁴
Zacho A, Fischermann K. Total gastrectomy in carcinoma of the stomach Acta Chir Scand 1959;117:278-294.
35. Lázaro da Silva A, Salles JMP, et al. Infiltraçăo gástrica intramural por carcinoma gástrico. Rev Hosp Clin Fac Med Săo Paulo 1976;31: 474-477.
36. Lázaro da Silva A, Moreno Jr M. Avaliaçăo clínica imediata na gastrectomia quase total mais anastomose de tubo de fórnix com o duodeno (Tubinho) no adenocarcinoma do antro. An Paul Med Cir 1979;106:65-80.
37. Lázaro da Silva A, Marchini I. Tratamento cirúrgico do adenocarcinoma gástrico. Consideraçőes sobre 530 casos. Rev Goiana Med 1982; 28: 127-136.
³⁸
Kockerling F, Reck T, et al. Extend gastrectomy: Who benefits? World J Surg 1995;19:541-545.
39. Lumpkin WM, Crow JR, et al. Carcinoma of the stomach: Review of 1.035 cases. Ann Surg 1964;159:919-932.
40. Korenaga D, Okamura T, et al. Results of resection of gastric cancer extending to adjacent organs. Br J Surg 1988;75:12-15.
41. Drummond Filho I, Freitas RG, et al. Gastrectomia total: Avaliaçăo retrospectiva das técnicas e indicaçőes em 25 casos estudados. Rev Col Bras Cir 1989;16:221-226.
42. Boku T, Nakane Y, et al. Strategy for Iymphadenectomy of gastric cancer. Surgery 1989; I 05:585-592.
43.Boku T, Nakane Y, et al. Prognostic significance of serosal invasion and free intraperitoneal cancer cells in gastric cancer. Br J Surg 1990; 77:436-439.
44. Korenaga D, Moriguchi V, et al. Trends in survival rates in japonese patients with advanced carcinoma of the stomach. Surg Gynecol Obstet 1992;174:387-393.
45. Leonardi LS, Comodo H, et al. Infiltraçăo duodenal por câncer gástrico. Rev Ass Med Brasil 1976;22:205-209.
46. Topart Ph, et al. Adénocarcinoma sur moignon gastrique. A propos d'une série de 25 patients. Lyon Chir 1993;89:339-342.
47. Lahey FH. Complete removel of the stomach for malignancy. Surg Gynecol Obstet 1938;67:213-223.
48. Longmire Jr WP. Total gastrectomy for carcinoma of the stomach. Surg Gynecol Obstet 1947;84:21-30.
49. Iwanaga T, Koyama H, et al. Mechanisms of late recurrence after radical surgery fort gastric carcinoma. Am J Surg 1978;135: 637-640.
50. Lee Jr WM. Transposition of a colon segment as a gastric reservoir after total gastrectomy. Surg Gynecol Obstet 1951;92:456-465.

Endereço para correspondência:

Dr. Alcino Lázaro da Silva

Rua Guaratinga, 151 - Sion

30315-430 - Belo Horizonte - MG

Datas de Publicação

Publicação nesta coleção
05 Ago 2010
Data do Fascículo
Abr 1998

Histórico

Aceito
06 Nov 1997
Recebido
04 Jul 1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] I. Allen AW. Total gastrectomy for carcinoma of the stomach. Am J Surg 1938;40:35-41.

[2] 2. Barber Jr KW, Remine WH, et al. A critical evaluation of total gastrectomy. Arch Surg 1963;87:23-50.

[3] 3. Bozzetti F. Total versus subtotal gastrectomy in cancer of the distal stomach: Facts and fantasy. Eur J Surg Oncol 1992;18:572-579.

[4] 4. Schrock TR, Way LW. Total gastrectomy. Am J Surg 1978;135:348- 355.

[5] 5. Shahon DB, Horowitz S, Kelly WD. Cancer of the stomach. An analysis of 1.152 cases. Surgery 1956;39:204-221.

[6] 6. Shiu MH, et al. Influence of the extent of ressection on survival after curative treatment of gastric carcinoma. Arch Surg 1987;22:1347- 1351.

[7] 7. Finney JMT, Rienhoff JR WF. Total gastrectomy. Arch Surg 1929; 18:140-162.

[8] 8. Lahey FH. Total gastrectomy for all patients with operable cancer of the stomach. Editorial Surg Gynecol Obstet 1950;90:246-248.

[9] 9. Bittner R, Schirrow H, et al. Total gastrectomy. A 15 year experience with particular reference to the patient over 70 years of age. Arch Surg 1985;120:1120-1125.

[10] ¹⁰
Buhl K, Lehnert T, et al. Reconstruction after gastrectomy and quality of life World J Surg 1995;19;558-564.

[11] 11. Furukawa H, Hiratsuka M, Iwanaga T. A rational technique for surgical operation on Bormann type 4 gastric carcinoma: left upper abdominal evisceration plus Appleby's method. Br J Surg 1988; 75: 116-119.

[12] 12. Harrison JD, Fielding JWL. Prognostic factors for gastric cancer influencing clinical practice. World J Surg 1995; 19:496-500.

[13] 13. Muto M, Marki T, et al. Improvement in the end-results of surgical treatment of gastric cancer. Surgery 1968;63:229-235.

[14] 14. Walters W. Carcinoma of the stomach in this country and in the orient. Am Surg 1963;29:454-456.

[15] 15. Gama-Rodrigues JJ, Bresciani CJC, et al. Surgical management of gastric carcinoma. Extent of gastric resection and lymphadenectomy - Current trends and results. ABCD Arq Bras Cir Dig 1986;1:84-89.

[16] 16. Gama-Rodrigues 11, Bresciani CLC, et al. Subtotal versus total gastrectomy in radical surgical management of gastric cancer - Still a controversy. ABCD Arq Bras Cir Dig 1986; I :37-38.

[17] 17. Maruyama K, Okabayashi K, Kinoshita T. Progress in gastric cancer surgery in Japan and its limits of radicality. World J Surg 1987; 11: 418-425.

[18] 18. Maruyama K, Sasako M, et al. Pancreas preserving total gastrectomy for proximal gastric cancer. World J Surg 1995;19:532-536.

[19] 19. Mello JB, Moreira AA, et al. Gastrectomia total: Análise de 50 casos. Rev Paul Med 1978;91 :10-16.

[20] 20. Novaes HM, Mello JB, et al. Análise de 500 casos de câncer gástrico. Rev Ass Med Brasil 1980;26:28-30.

[21] 21. Paulino F. Cirurgia do câncer gástrico. Consideraçőes sobre 522 casos e 305 ressecçőes. JBM 1970;20:16-31.

[22] 22. Shiu MH, et al. Selection of operative procedure for adenocarcinoma of the mid stomach: Twenty years experience with implications for future treatment strategy. Ann Surg 1980;192:730-737.

[23] 23. Comell GN, Gilder H, et al. The use of jejunal interposition with total gastrectomy. Ann Surg 1960;152:430-444.

[24] 24. Henley FA. Gastrectomy with replacement: A preliminary communication. Br J Surg 1952;40: 118-128.

[25] 25. Longmire Jr WP, Beal JM. Construction of a substitute gastric reservoir following total gastrectomy. Ann Surg 1952;135:637-645.

[26] 26. Bastos ES. Gastrosplenectomia total e pancreatectomia parcial com transplante de alça de jejuno interesofagoduodenal. Rev Assoc Med Brasil 1954;1:294-308.

[27] 27. Fava L, Rasslan S, et al. Reconstruçăo do trânsito com bolsa jejunal horizontal esofagoduodenal após gastrectomia total. Rev Col Bra.f Cir 1990;17:31-37.

[28] ²⁸
Galvão L. Câncer gástrico. Medicina de Hoje 1976, p. 58-65.

[29] ²⁹
Gentil F, Lopes A, et al. Gastrectomia total radical Rev Col Bras Cir 1991;18:154-159.

[30] 30. Lázaro da Silva A, Conceiçăo SA, et al. Gastrectomia e interposiçăo de intestino delgado no tratamento do câncer gástrico. Resultados. Rev Ass Med Brasil 1986;32:65-69.

[31] 31. Raia A, Lex A. Gastrectomia total com interposiçăo de alça jejunal no tratamento do câncer gástrico extenso. Rev Paul Med 1961;59: 397-410.

[32] 32. Ladoux JE, Finochietto R. Gastrectomia total. Técnica de Henley - Longmire. Prensa Med Argentina 1957;44:2398-2402.

[33] 33. Mouchet A, Camey M. Un nouveau procédé de retablissement de la continuité aprés gastrectomie par interposition d'un segment de gręle entre l'oesophage et le duodenum. Arch Mal App Digest 1953; 42: 621-631.

[34] ³⁴
Zacho A, Fischermann K. Total gastrectomy in carcinoma of the stomach Acta Chir Scand 1959;117:278-294.

[35] 35. Lázaro da Silva A, Salles JMP, et al. Infiltraçăo gástrica intramural por carcinoma gástrico. Rev Hosp Clin Fac Med Săo Paulo 1976;31: 474-477.

[36] 36. Lázaro da Silva A, Moreno Jr M. Avaliaçăo clínica imediata na gastrectomia quase total mais anastomose de tubo de fórnix com o duodeno (Tubinho) no adenocarcinoma do antro. An Paul Med Cir 1979;106:65-80.

[37] 37. Lázaro da Silva A, Marchini I. Tratamento cirúrgico do adenocarcinoma gástrico. Consideraçőes sobre 530 casos. Rev Goiana Med 1982; 28: 127-136.

[38] ³⁸
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