MANUAL UNIFICADO PARA MANEJO DO PACIENTE COM CÂNCER GÁSTRICO RESSECÁVEL

VISÃO GERAL E OBJETIVO

Este documento tem por objetivo unificar recomendações das sociedades envolvidas na jornada do paciente com câncer gástrico ressecável, a fim de estruturar um manual de boas práticas com linguagem comum, pontos de concordância e caminhos de decisão claros. A jornada é organizada em: identificação de risco e rastreio; diagnóstico; estadiamento; decisão terapêutica multidisciplinar; tratamento (perioperatório e cirurgia); patologia; acompanhamento e vigilância; organização do cuidado que envolve equipe multidisciplinar (enfermagem e nutrição oncológica).

Segue abaixo as principiais recomendações nutricionais e o documento na integra ao final desta matéria.

MANUAL UNIFICADO PARA MANEJO DO PACIENTE COM CÂNCER GÁSTRICO RESSECÁVEL

 

Perioperatório
1. Protocolos de Pré-Habilitação Cirúrgica Nutricional (protocolo multimodal, ACERTO e ERAS): analgesia poupadora de opioides, restrição hídrica, mobilização precoce e profilaxias.43-46
2. Nutrição: iniciar nutrição enteral precoce preferencialmente por sonda até o jejuno e planejar suplementação conforme o risco nutricional.43

Nutrição clínica – prevenção, tratamento, reabilitação e monitoramento

  • Prevenção e diagnóstico da desnutrição o Muito prevalente em tumores do trato digestivo alto; iniciar triagem precoce e contínua, usando a Avaliação Subjetiva Global Produzida pelo Paciente (PG-SGA/ASGPPP) como ferramenta de referência.43,72-1200
  • Identificar sinais e sintomas que impactam a alimentação (anorexia, náusea, vômitos, diarreia, mucosite, disfagia, alteração do paladar) e intervir precocemente.43,72-120o
  • Iniciar protocolo de pré-habilitação cirúrgica (Protocolo Multimodal -ACERTO).43-46

• Terapia suplementar
o Terapia oral: iniciar imediatamente quando a ingestão estiver abaixo de 60% a 70% das necessidades para alcançar 100% (aconselhamento e suplementos).77
o Terapia enteral: indicada quando a via oral é insuficiente (abaixo de 60%), nos casos de síndromes de má-absorção, disfagia,dor ao engolir, mucosite e cirurgias altas; preferir fórmulas imunomoduladoras que contenham arginina, ácidos graxos ômega-3 e nucleotídeos na faixa de 500 a 1.000 ml por dia; quando exclusiva, associar a fórmula enteral hiperproteica para
cobrir metas.72,78-83
o Terapia parenteral: suplementar quando a nutrição enteral for insuficiente por intolerância, iniciando após 3–4 dias de insucesso; exclusiva quando o trato gastrointestinal não pode ser usado; melhor evidência no pré-operatório de desnutridos e continuidade no pós-operatório.43,72-120
o Jejum abreviado: em situações de cirurgias eletivas com esvaziamento gástrico preservado, oferecer 400 ml de solução com 12,5% de dextrose na noite anterior e 200 ml 2 horas antes da anestesia.72,82,88,93

o A fórmula hiperproteica e imunomoduladora deve ser ofertada, por via oral ou enteral, para o paciente em risco nutricional ou desnutrido, candidato a operação de médio e grande portes. A formulação imunomoduladora que contém arginina, ômega-3 e nucleotídeos deve ser ofertada por pelo menos cerca de 5 a 7 dias antes da operação e na quantidade mínima de 500 ml a 1.000 ml/dia.72,82,93
o A dieta por via oral deve ser modificada e adaptada às preferências e às necessidades individuais dos pacientes oncológicos clínicos e cirúrgicos. Essa conduta individualizada, aliada ao aconselhamento nutricional, visa garantir a ingestão adequada de todos os nutrientes e minimizar a perda de peso corporal e a piora clínica no pré- e no pós-tratamento oncológico clínico e cirúrgico.44,72-86
• Reabilitação
o Nutrição domiciliar: oferecer terapia oral, enteral ou parenteral em domicílio para pacientes desnutridos ou com alto risco de desnutrição com trato gastrointestinal funcional; entregar orientação escrita detalhada (fórmula, volumes, horários, contatos); realizar monitoramento presencial ou telefônico.76-85,96

• Acompanhamento e monitoramento
o Realizar avaliação nutricional sistemática do diagnóstico à alta e durante todo o tratamento; utilizar a PG-SGA/ASGPPP; planejar alta com educação tanto do paciente quanto dos cuidadores; monitorar peso, ingestão, sintomas e adesão; prevenir reinternações. 44,72-96
Suplementação após gastrectomia
o Suplementar ferro, ácido fólico, vitamina B12 (obrigatória após gastrectomia total), vitamina D e cálcio e fazer ajustes conforme exames e sintomas.72,82

• Integração com recuperação aprimorada após cirurgia: nutrição como pilar do protocolo perioperatório; início precoce da via enteral; coordenação com enfermagem para transição segura.44,72-96

Veja documento completo em:

Manual_Boas_Praticas_Tratamento_Câncer_Gástrico_BR-54025_Agosto 2026

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