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Impacto na qualidade de vida da gastrectomia total e distal em doentes com cancro gástrico
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No mundo ocidental, o tratamento do cancro gástrico em estadios precoces passa principalmente pela gastrectomia com intenção curativa. A gastrectomia distal, quando comparada à total, apresenta uma menor taxa de mortalidade e morbilidade decorrentes da cirurgia e mantém uma taxa de recidivas semelhante mas, o impacto destes procedimentos na qualidade de vida ainda não está bem esclarecido, principalmente a longo prazo. Esta revisão procura explorar o impacto na qualidade de vida destes dois tipos de cirurgia no cancro gástrico.
Para este fim, foi realizada uma pesquisa bibliográfica na plataforma PubMed/Medscape de estudos até Março de 2019 que tinham como objectivo a avaliação da qualidade de vida após gastrectomia total e distal com intenção curativa no contexto de cancro gástrico. Estudos que se focavam noutros tipos de resseções ou que comparavam procedimentos laparoscópicos com cirurgia aberta foram excluídos. Ao todo foram identificados 24 artigos que cumpriam estes critérios. Segundo a evidência científica disponível a gastrectomia total e distal apresentam uma evolução semelhante da qualidade de vida após a cirurgia, com uma queda inicial mas com retorno da maior parte dos parâmetros aos valores pré-cirurgia por volta do primeiro ano. Aos 5 anos, os doentes parecem ter uma qualidade de vida global semelhante à da população geral apesar de ainda apresentarem alterações sintomáticas, principalmente a nível da restrição alimentar. Quando os dois tipos de ressecções são comparadas entre si a gastrectomia distal parece permitir atingir uma melhor qualidade de vida nos primeiros meses. A longo termo as duas técnicas não parecem apresentar diferenças na qualidade de vida global apesar de a nível sintomático a gastrectomia distal estar associada a menor sintomatologia. Com base nestas observações, sempre que possível, a gastrectomia distal é o procedimento recomendado entre os dois tipos de ressecções.
In the western world, the key treatment for early gastric cancer consists in a gastrectomy with curative intent. Distal gastrectomy, compared to total, presents a lower mortality and morbidity rate related to surgery and also has a similar relapse rate, but the impact of these procedures on the quality of life is still not yet fully understood, especially in the long term. This review aims to explore the impact on the quality of both these types of surgery in gastric cancer patients. To this end, a literature research was conducted using the PubMed/Medscape platform focused on studies published until March 2019 that evaluated the quality of life after total or distal gastrectomy with curative intent in gastric cancer. Studies that focused on other types of resections or that compared laparoscopic procedures with open surgery were excluded. In total, 24 articles that met these criteria were identified. According to the scientific evidence available both distal and total gastrectomy have a similar progress of the quality of life after surgery, with an initial drop but with the return of most parameters to the pre-surgery values by the end of the first year. At 5 years the global quality of life appears to be similar to the general population although some symptoms still persist, especially related to food restrictions. When both types of resection are compared between them, distal gastrectomy appears to show a better quality of life during the first months. At long term, the two procedures have no difference in the global quality of life despite distal gastrectomy being associated with fewer symptoms.
In the western world, the key treatment for early gastric cancer consists in a gastrectomy with curative intent. Distal gastrectomy, compared to total, presents a lower mortality and morbidity rate related to surgery and also has a similar relapse rate, but the impact of these procedures on the quality of life is still not yet fully understood, especially in the long term. This review aims to explore the impact on the quality of both these types of surgery in gastric cancer patients. To this end, a literature research was conducted using the PubMed/Medscape platform focused on studies published until March 2019 that evaluated the quality of life after total or distal gastrectomy with curative intent in gastric cancer. Studies that focused on other types of resections or that compared laparoscopic procedures with open surgery were excluded. In total, 24 articles that met these criteria were identified. According to the scientific evidence available both distal and total gastrectomy have a similar progress of the quality of life after surgery, with an initial drop but with the return of most parameters to the pre-surgery values by the end of the first year. At 5 years the global quality of life appears to be similar to the general population although some symptoms still persist, especially related to food restrictions. When both types of resection are compared between them, distal gastrectomy appears to show a better quality of life during the first months. At long term, the two procedures have no difference in the global quality of life despite distal gastrectomy being associated with fewer symptoms.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2019
Palavras-chave
Cancro gástrico Gastrectomia total Gastrectomia distal Qualidade de vida Oncologia