Invasão do duodeno por carcinoma do terço distal do estômago: estudo histopatológico e revisão da literatura / Distal gastric carcinoma with duodenal invasion: histopathologic study and literature review

RESUMO

Gastric carcinoma with duodenal invasion is reported in 11 per cent to 33.3 per cent of surgical specimens. In spite of this high frequency, it is not easily recognised during the surgical proceeding or at gross examination. The study of risk factors like histological type, tumor stage and extension of duodenal invasion can be useful in establishing the best surgical approach in order to diminish the risk of local recurrence. We report 50 cases of distal gastric carcinoma in which we analysed the tumor extension in the different layers of the duodenal wall; duodenal invasion was correlated with histological type, level of infiltration in the gastric wall and presence of vascular invasion. Duodenal invasion was observed in 27 cases (54 per cent), 17/32 of intestinal type (53 per cent), 9/10 of diffuse type (90 per cent) e 1/8 of non-classifiable tumours (12.5 per cent). Diffuse type carcinoma was the most important risk factor for invasion (OR = 11; CI 95 per cent 1.20 to 254.16; P < 0.01). Most of the cases (21/27, 77 per cent) were stage III or IV. The submucosal layer was the most frequent (22/27 cases, 81per cent) and also most extensively (8.21 +/- 9.75 mm) invaded. We conclude that the risk of duodenal invasion is higher in diffuse type tumours and in stage III or IV. Distal surgical resection should be wider in these cases and determined by frozen section biopsy specimen at the point of transection