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Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Hospital São Paulo Department of Thoracic SurgeryABC School of Medicine Department of Thoracic SurgeryUniversidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Department of Thoracic SurgeryFederal University of São Paulo School of Medicine Hospital São Paulo Department of Thoracic SurgeryUNIFESP, EPM, Hospital São Paulo Department of Thoracic SurgeryUNIFESP, EPM, Department of Thoracic SurgeryUNIFESP, EPM, Hospital São Paulo Department of Thoracic SurgerySciEL

Results of lung cancer surgical treatment in reference institutions from countries with different socioeconomic inequality indexes

INTRODUÇÃO: O tratamento cirúrgico para o câncer de pulmão representa a maior probabilidade para se alcançar a cura e sua viabilidade depende do diagnóstico precoce, de condições clínicas do paciente e do acesso aos serviços de saúde. Esse acesso provém do tipo de assistência à saúde e de condições socioeconômicas do paciente e do meio em que ele se insere. OBJETIVOS: Avaliar a influência de fatores socioeconômicos e das agências prestadoras de saúde sobre os resultados do tratamento cirúrgico para o câncer de pulmão, através da análise dos resultados de instituições de referência pertencentes a países com diferentes níveis de desigualdade social. MÉTODOS: Estudo retrospectivo que consistiu na coleta de bancos de dados. Foram comparados 4 grupos: SUS, pacientes brasileiros atendidos pelo Sistema Único de Saúde; pacientes brasileiros atendidos por convênios ou regime particular (grupo Privado); pacientes ingleses atendidos pelo National Health Service (NHS), o serviço de saúde público britânico; e os pacientes ingleses cobertos pela assistência privada (grupo Private). Foram obtidos dados clínicos e índices socioeconômicos de vulnerabilidade social. Foi realizada análise de dados e comparação entre os grupos quanto à morbimortalidade pós-operatória e sobrevida global. RESULTADOS: Foram incluídos 2594 pacientes, sendo 411 do grupo SUS, 215 do Privado, 1651 do NHS e 317 do grupo Private. As idades médias foram, respectivamente: 64,5 anos (±12,3); 63,6 anos (±12,3); 67,3 anos (±10,2); 64,9 anos (±11,5). O grupo com a maior frequência de complicações pós-operatórias foi o SUS (37,7%), seguido pelo grupo NHS (34,8%), Private (29,0%) e, por último, o grupo Privado (24,5%). O risco de complicações foi analisado em relação ao grupo Privado: SUS apresentou OR=1,870 (p=0,002); NHS OR=1,646 (p=0,005) e Private OR=1,263 (p=0,270). Em relação a complicações maiores, os riscos foram: SUS OR=2,373 (p=0,001); NHS OR=2,567 (p < 0,001) e Private OR 1,258 (p=0,424). A proporção de mortalidade intra-hospitalar no grupo SUS foi a maior (4,4%; Privado 0,5%; NHS 1,1%; Private 0,6%). Em comparação ao grupo Privado, os riscos foram: SUS - OR=9,802 (p=0,027); NHS - OR=2,359 (p=0,405) e Private - OR=1,359 (p=0,803). CONCLUSÕES: os grupos da saúde pública, SUS e NHS, apresentaram maiores taxas de complicações e mortes pós-operatórias em relação aos grupos privados. A diferença entre os resultados foi mais ampla entre os grupos brasileiros do que entre os inglesesINTRODUCTION: Surgical treatment for lung cancer represents the highest probability of cure and its viability relies on early diagnosis, patient\'s clinical condition and access to health services. This access depends on the type of health care provider and socioeconomic conditions of the patient and their environment. OBJECTIVES: To evaluate the influence of socioeconomic factors and health care agencies on the results of surgical treatment for lung cancer by analyzing the results of referral institutions from countries with different levels of social inequality. METHODS: Retrospective study that consisted of database collection. Four groups were compared: SUS, Brazilian patients treated by the Unified Health System; Brazilian patients attended by agreements or private regime (BRAra group); English patients served by the National Health Service (NHS), the British public health service; and English patients covered by private care (Private group). Clinical data and socioeconomic indices of social vulnerability were obtained. Data analysis and comparison between groups regarding postoperative morbidity and mortality and overall survival were performed. RESULTS: A total of 2594 patients were included: 411 in the SUS group, 215 in the BRA group, 1651 in the NHS and 317 in the Private group. The average ages were, respectively: 64.5 years (± 12.3); 63.6 years (± 12.3); 67.3 years (± 10.2); 64.9 years (± 11.5). The group with the highest frequency of postoperative complications was SUS (37.7%), followed by the NHS group (34.8%), Private (29.0%) and, lastly, the BRA group (24, 5%). The risk of complications was analyzed in comparison to the BRA group: SUS presented with an OR=1.870 (p=0.002); NHS OR=1.646 (p=0.005) and Private OR=1.263 (p=0.270). Regarding major complications, the risks were: SUS - OR=2.373 (p=0.001); NHS - OR=2.567 (p < 0.001) and Private - OR=1.258 (p=0.424). The proportion of in-hospital mortality in the SUS group was the highest (4.4%; Private 0.5%; NHS 1.1%; Private 0.6%). Compared to the BRA group, the risks were: SUS - OR=9.802 (p=0.027); NHS - OR=2.359 (p=0.405) and Private - OR=1.359 (p = 0.803). CONCLUSIONS: the public health groups, SUS and NHS, presented higher rates of postoperative complications and deaths than the private groups. The difference between the results was wider among the Brazilian groups than among the English one

Anatomic pulmonary resection by videoassisted thoracoscopy: the Brazilian experience (VATS Brazil study)

Objetivo: O objetivo deste estudo foi descrever os resultados de ressecções pulmonares anatômicas por videotoracoscopia no Brasil. Métodos: Cirurgiões torácicos (membros da Sociedade Brasileira de Cirurgia Torácica) foram convidados, por correio eletrônico, a participar do estudo. Dezoito cirurgiões participaram do projeto enviando seus bancos de dados retrospectivos referentes a ressecções anatômicas de pulmão por videotoracoscopia. Dados demográficos, cirúrgicos e pós-operatórios foram coletados em um instrumento padronizado e posteriormente compilados e analisados. Resultados: Dados referentes a 786 pacientes foram encaminhados (média de 43,6 ressecções por cirurgião), sendo 137 excluídos por informações incompletas. Logo, 649 pacientes constituíram nossa população estudada. A média de idade dos pacientes foi de 61,7 anos, 295 eram homens (45,5%), e a maioria — 521 (89,8%) — foi submetida à cirurgia por neoplasia, mais frequentemente classificada como estádio IA. A mediana do tempo de drenagem pleural foi de 3 dias, e a do tempo de internação, 4 dias. Dos 649 procedimentos realizados, 598 (91,2%) foram lobectomias. A taxa de conversão para toracotomia foi de 4,6% (30 casos). Complicações pós-operatórias ocorreram em 124 pacientes (19,1%), sendo pneumonia, escape aéreo prolongado e atelectasia as mais frequentes. A mortalidade em 30 dias foi de 2,0%, tendo como preditores idade avançada e diabetes. Conclusões: A casuística brasileira mostra que as ressecções pulmonares por cirurgia torácica videoassistida são factíveis e seguras, além de comparáveis àquelas de registros internacionais.Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority—521 (89.8%)—had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries

Anatomic pulmonary resection by videoassisted thoracoscopy: the Brazilian experience (VATS Brazil study)

Objetivo: O objetivo deste estudo foi descrever os resultados de ressecções pulmonares anatômicas por videotoracoscopia no Brasil. Métodos: Cirurgiões torácicos (membros da Sociedade Brasileira de Cirurgia Torácica) foram convidados, por correio eletrônico, a participar do estudo. Dezoito cirurgiões participaram do projeto enviando seus bancos de dados retrospectivos referentes a ressecções anatômicas de pulmão por videotoracoscopia. Dados demográficos, cirúrgicos e pós-operatórios foram coletados em um instrumento padronizado e posteriormente compilados e analisados. Resultados: Dados referentes a 786 pacientes foram encaminhados (média de 43,6 ressecções por cirurgião), sendo 137 excluídos por informações incompletas. Logo, 649 pacientes constituíram nossa população estudada. A média de idade dos pacientes foi de 61,7 anos, 295 eram homens (45,5%), e a maioria — 521 (89,8%) — foi submetida à cirurgia por neoplasia, mais frequentemente classificada como estádio IA. A mediana do tempo de drenagem pleural foi de 3 dias, e a do tempo de internação, 4 dias. Dos 649 procedimentos realizados, 598 (91,2%) foram lobectomias. A taxa de conversão para toracotomia foi de 4,6% (30 casos). Complicações pós-operatórias ocorreram em 124 pacientes (19,1%), sendo pneumonia, escape aéreo prolongado e atelectasia as mais frequentes. A mortalidade em 30 dias foi de 2,0%, tendo como preditores idade avançada e diabetes. Conclusões: A casuística brasileira mostra que as ressecções pulmonares por cirurgia torácica videoassistida são factíveis e seguras, além de comparáveis àquelas de registros internacionais.Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority—521 (89.8%)—had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries

Anatomic pulmonary resection by video-assisted thoracoscopy: the Brazilian experience (VATS Brazil study)

ABSTRACT Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries