[email protected]. Brasil Burfeind W,, Harpole D, DAmico TA et al. A cost-minimization...
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Brasil
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Burfeind W,, Harpole D, D’Amico TA et al. A cost-minimization analysis of lobectomy:thoracoscopic vs. posterolateral thoracotomy. Eur J Cardiothorac Surg 2010
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Câncer de pulmãoCâncer de pulmãoQual o estadiamento no Brasil ? Qual o estadiamento no Brasil ?
Cortesia : Dr Jose Rodrigues Pereira
I/II
IIIIV
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Estadio %
IA 25,3
IB 1,4
IIB 17,4
IIIA 16,1
IIIB 20,3
IV 11,5
Sobrevida 28%
18,9 meses
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1
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4 5
6
7
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4
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Drenagem linfática dos pulmões
Estação 7
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N
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44,8% Avulso excluindo #7 ( n=43)
22,9% Avulso # 7
34,8% Total N2 (n=64)
9,4% Totais vivos múltiplos (n=801)
Linfonodos envolvidos N2 no prognóstico de sobrevida
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Survival by number of zones
1 pN1 zoneSeveral pN1 zones
1 pN2 zoneSeveral pN2 zones
N
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Tamanho dos linfonodos x % Tamanho dos linfonodos x % comprometimentocomprometimento
GrupoGrupo NúmeroNúmero ComprometidosComprometidos %% SignificânciaSignificância
1 1 (até 1cm)(até 1cm) 329329 1010 3,033,03NSNS
2 2 (1,1 a 2cm)(1,1 a 2cm) 211211 1111 5,215,21
3 3 (2,1 a 3cm)(2,1 a 3cm) 5252 1212 23,0723,07
4 4 ( >3cm)( >3cm) 4646 1212 26,0826,08
S (p<0,0001)
Análise comparativa entre a tomografia axial computadorizada e amediastinoscopia no estadiamento linfático do câncer do pulmão
Angelo – Tese, 1992
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Comparação com outros autoresComparação com outros autores
Angelo – Tese, 1992
AutorAutor NNoo
% comprometimento% comprometimento
Grupo 1Grupo 1(até 1cm)(até 1cm)
Grupo Grupo 22
(1,1 a 2cm)(1,1 a 2cm)
Grupo Grupo 33
(2,1 a 3cm)(2,1 a 3cm)
Grupo Grupo 44
( >3cm)( >3cm)
WhittleseyWhittlesey 138138 2,72,7 31,831,8 69,669,6 NDND
McKennaMcKenna 102102 3,23,2 25,625,6 75,075,0 100100
WathenWathen 5656 2,12,1 40,040,0 82,082,0 NDND
FernandezFernandez 5050 3,03,0 5,25,2 23,023,0 26,026,0
ND – Não descrito
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Revisaram: 15 - Outras recomendações (guidelines) 9 - Metanálise 12 - Revisões sistemáticas 80 - Artigos sobre o tema
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Classificação - Estágio IIIa (N2)Classificação - Estágio IIIa (N2) • IIIa1 - Achado incidental no exame anátomo- IIIa1 - Achado incidental no exame anátomo-
patológico.patológico.
• IIIa2 - Linfonodo comprometido em uma estação IIIa2 - Linfonodo comprometido em uma estação identificado no Intra-operatório.identificado no Intra-operatório.
• IIIa3 - Linfonodo comprometido em uma ou mais IIIa3 - Linfonodo comprometido em uma ou mais estações identificado no pré-operatório (pet, estações identificado no pré-operatório (pet, mediastinoscopia, outra forma de biópsia).mediastinoscopia, outra forma de biópsia).
• IIIa4 - Múltiplas estações comprometidas com IIIa4 - Múltiplas estações comprometidas com Invasão ou Infiltração mediastinal. Invasão ou Infiltração mediastinal.
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713 pacientes2548 disparos de grampeador 1 falha mecânica
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5018,8%6424,1%6122,9%41,5%93,4%72,6%62,3%41,5%31,1%3412,8%103,8%114,1%10,4%20,8%20,8%266100,0%TOTAL
BroncoplastiaDiafragma (Eventração)Ligadura ducto toracicoRessecção de cisto
Lobectomia
Ressecção de tumor pleural
Toracotomia ExploradoraPneumonectomiaRessecção de tumor de MediastinoEsofagectomiaRessecção metastase bilateralRessecção metastase
PROCEDIMENTO REALIZADOSegmentectomiaNúmero de pacientes%
Decorticação
Ressecção em cunha
5018,8%6424,1%6122,9%41,5%93,4%72,6%62,3%41,5%31,1%3412,8%103,8%114,1%10,4%20,8%20,8%266100,0%TOTAL
BroncoplastiaDiafragma (Eventração)
Ligadura ducto toracicoRessecção de cisto
Lobectomia
Ressecção de tumor pleural
Toracotomia ExploradoraPneumonectomiaRessecção de tumor de MediastinoEsofagectomiaRessecção metastase bilateralRessecção metastase
PROCEDIMENTO REALIZADOSegmentectomiaNúmero de pacientes%
Decorticação
Ressecção em cunha
TORACOTOMIA VERTICAL – TORACOTOMIA VERTICAL – EXPERIÊNCIA COM 266 PACIENTES OPERADOS EXPERIÊNCIA COM 266 PACIENTES OPERADOS
TORACOTOMIA VERTICAL – TORACOTOMIA VERTICAL – EXPERIÊNCIA COM 266 PACIENTES OPERADOS EXPERIÊNCIA COM 266 PACIENTES OPERADOS
50 18,8%
64 24,1%
61 22,9%
4 1,5%
9 3,4%
7 2,6%
6 2,3%
4 1,5%
3 1,1%
34 12,8%
10 3,8%
11 4,1%
1 0,4%
2 0,8%
2 0,8%
266 100,0%TOTAL
Broncoplastia
Diafragma (Eventração)
Ligadura ducto toracico
Ressecção de cisto
Lobectomia
Ressecção de tumor pleural
Toracotomia Exploradora
Pneumonectomia
Ressecção de tumor de Mediastino
Esofagectomia
Ressecção metastase bilateral
Ressecção metastase
PROCEDIMENTO REALIZADO
Segmentectomia
Número de pacientes
%
Decorticação
Ressecção em cunha
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Toracotomia verticalToracotomia verticalLOBECTOMIA SUPERIOR ESQUERDALOBECTOMIA SUPERIOR ESQUERDA
Aspecto no 5o POAspecto no 5o PO
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A Escala visual de dor foi mensurada no A Escala visual de dor foi mensurada no 1ºPO – média de 4,5. 1ºPO – média de 4,5.
No 3º PO foi de 2,8 e na alta foi de 1,3. No 3º PO foi de 2,8 e na alta foi de 1,3.
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Tipo Descrição
IIIA0 T3N1 ou T4 N0-1 sem envolvimento N2
IIIA1 Achado incidental de N2 na patologia
IIIA2 1 estação metastática reconhecida no intraoperatório
IIIA3 Metástase linfonodal reconhecida por mediastinoscopia, EBUS, biópsia ou PET
IIIA4 Doença N2 múltipla
Divisão no estadio IIIADivisão no estadio IIIA
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““RE-Classificação” - Estágio IIIa (N2)RE-Classificação” - Estágio IIIa (N2)
• IIIa1 - Achado incidental no exame anátomo- IIIa1 - Achado incidental no exame anátomo- patológico OU Linfonodo comprometido em patológico OU Linfonodo comprometido em uma uma estação identificado no Intra ou pré-operatório.estação identificado no Intra ou pré-operatório.
• IIIa2 -Linfonodo comprometido em mais IIIa2 -Linfonodo comprometido em mais estações identificado no pré-operatório (pet, estações identificado no pré-operatório (pet, mediastinoscopia, outra forma de biópsia).mediastinoscopia, outra forma de biópsia).
• IIIa3 -Múltiplas estações comprometidas com IIIa3 -Múltiplas estações comprometidas com Invasão ou Infiltração mediastinal. Invasão ou Infiltração mediastinal.
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