Recent Developments in the Treatment of Pancreatic Cancer

Jorge Paulino; Hélder Mansinho

doi:10.20344/amp.19957

Autores

Jorge Paulino General Surgery Department. Hospital da Luz. Lisboa. https://orcid.org/0000-0002-8491-2802
Hélder Mansinho Oncology Department. Hospital Garcia de Orta. Almada.

DOI:

https://doi.org/10.20344/amp.19957

Palavras-chave:

Carcinoma Ductal Pancreático/cirurgia, Carcinoma Ductal Pancreático /tratamento, Carcinoma Ductal Pancreático/tratamento farmacológico, Neoplasias Pancreáticas/cirurgia, Neoplasias Pancreáticas/tratamento, Neoplasias Pancreáticas/tratamento farmacológico

Resumo

O adenocarcinoma ductal é atualmente a sexta causa de morte oncológica a nível mundial, e a quarta na Europa, com um aumento contínuo da letalidade anual em Portugal nas duas últimas décadas. A ressecção cirúrgica em bloco do tumor com margens microscopicamente negativas e com uma linfadenectomia adequada é a única possibilidade de sobrevida a longo prazo. Como o adenocarcinoma ductal é uma doença sistémica tem uma alta taxa de recidiva, mesmo depois de uma ressecção curativa, tornando a terapêutica sistémica o centro da sua abordagem, baseada sobretudo em quimioterapia. As estratégias neoadjuvantes para a doença não metastizada demonstraram uma melhoria significativa na sobrevida global em comparação com a cirurgia direta, nomeadamente em doença tangencialmente ressecável. Além disso, estas estratégias possibilitaram um re-estadiamento inferior em várias situações, permitindo ressecções R0. Sob essas novas estratégias oncológicas, foram introduzidas várias modalidades cirúrgicas recentes, nomeadamente ressecções vasculares mais agressivas e mesmo ressecções tumorais na doença oligometastática. Esta revisão aborda o estado da arte das intervenções cirúrgicas e oncológicas no adenocarcinoma ductal pancreático e destaca os avanços recentes na área visando alcançar maiores taxas de sobrevida.

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