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Revista do Colégio Brasileiro de Cirurgiões

Print version ISSN 0100-6991On-line version ISSN 1809-4546

Rev. Col. Bras. Cir. vol.26 no.5 Rio de Janeiro Sept./Oct. 1999

http://dx.doi.org/10.1590/S0100-69911999000500008 

ARTIGOS ORIGINAIS

 

Esofagectomia transiatal para o tratamento do adenocarcinoma do esôfago

 

Transhiatal esofagectomy for adenocarcinoma of the esophagus

 

 

Dino Antonio Oswaldo Altmann, TCBC-SPI; Fábio de Oliveira FerreiraII; Roberto Anania de Paula, TCBC-SPII; Eugênio Américo Bueno Ferreira, TCBC-SPIII

IDoutor pelo Departamento de Cirurgia da FMUSP
IIMédico do Departamento de Cirurgia Pélvica do Hospital A. C. Camargo - SP
IIIProfessor Associado do Departamento de Cirurgia da FMUSP. Professor Titular da Disciplina de Técnica Cirúrgica da Faculdade de Medicina de Jundiaí

Endereço para correspondência

 

 


RESUMO

A esofagite de refluxo associada ao epitélio de colunar do esôfago predispõe ao adenocarcinoma, cuja incidência vem aumentando nos últimos anos. Entre 1976 e 1993, os autores trataram 11 pacientes com adenocarcinoma primário do esôfago. Em dois casos, a neoplasia desenvolveu-se em epitélio colunar ectópico no esôfago cervical e torácico. Nos demais casos, ocorreu no terço distal do esôfago em epitélio colunar de Barrett, em pacientes com sintomas clínicos de esofagite de refluxo, dos quais sete eram portadores de hérnia de hiato e refluxo gastroesofágico previamente documentados. Nove pacientes foram submetidos a esofagectomia transiatal com esofagogastroplastia, um foi submetido a esofagectomia distal com interposição de jejuno e o último a esofagogastroplastia retroestemal sem esofagectomia. A exceção de três pacientes, os demais tiveram operações consideradas curativas. Cinco doentes encontravam-se em estádios mais iniciais, ainda sem comprometimento linfonodal. Não houve mortalidade operatória, sendo que as principais complicações foram a fístula da anastomose esofagogástrica e a abertura da cavidade pleural, ambas ocorrendo em dois pacientes. A sobrevida média dos pacientes foi de 40,5 meses. Três pacientes permanecem vivos e sem evidência de doença (estádio 0, I e IIA) com 64, 94 e 117 meses de seguimento. Concluiu-se que a esofagectomia neste tipo de tumor é um procedimento seguro e que a sobrevida a longo prazo é possível quando os tumores em estadio inicial são tratados adequadamente.

Unitermos: Câncer do esôfago; Tumor do esôfago; Neoplasia do esôfago; Adenocarcinoma do esôfago; Esôfago de Barrett.


ABSTRACT

Esophagitis associated with Barretts esophagus is a recognized predisponent factor for the development of adenocarcinoma. its incidence has been raising through the last years. Between 1976 and 1993, eleven patients with primary adenocarcinoma of the esophagus were treated. In two cases, the neoplasia occurred in an aberrant gastric mucosa in the cervical and thoracic esophagus. in the remaining cases, the tumor occurred in the distal third of the organ. in columnar-lined (Barretts) esophagus, in patients with hiatal hernia and gastroesophageal refluxo Nine patients were submitted to transhiatal esophagectomy. one to distal esophagectomy with interposition of jejunum. and one to retrosternal esophagogastroplasty without esophagectomy. All but three patients had curative operations. Five patients had early stage disease, without limphonode involvement. There was no operative mortality and the main complications were anastomotic leackage and openning of pleural cavity, both of them occurring, in two patients. The average survival of these patients was 40.5 months. Three patients remain alive and with no evidence of recurrence (Stage 0, I and IIA), with a follow-up of 64, 94 and 117 months. Patients with gastroesophagic reflux and Barretts esophagus must be properly treated and they need endoscopic surveillance for the evaluation of progressive dysplasia or adenocarcinoma. The authors conclude that esophagectomy is a safe procedure and long term survival is possible when these esophageal tumors are treated in the early stages.

Key words: Cancer of the esophagus; Tumor of the esophagus; Neoplasia of the esophagus; Adenocarcinoma of the esophagus; Barretts esophagus.


 

 

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

 

 

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Endereço para correspondência:
Dr. Dino Antonio Oswaldo Altmann
Rua Jesuíno Arruda, 676 cj. 131
04532-082 - São Paulo - SP
E-mail: altmand@ibm.net

Recebido em 4/12/97
Aceito para publicação em 13/9/99

 

 

Trabalho realizado no Hospital Sírio-Libanês - SP.

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