Artigos e Materiais de Revistas Científicas - LIM/61

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https://observatorio.fm.usp.br/handle/OPI/3839

A coleção de Artigos e Materiais de Revistas Científicas engloba artigos originais, artigos de revisão, artigos de atualização, artigos técnicos, relatos de experiências, resenhas, ensaios, editoriais, cartas ao editor, debates, notas científicas e técnicas, depoimentos, entrevistas e pontos de vista. Consideram-se como artigos científicos originais os trabalhos redigidos para divulgação de informações e resultados sobre determinada pesquisa científica, publicados em periódico científico após avaliação por outros pesquisadores.

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Abruzzini procedure for the treatment of bronchopleural fistulas: surgical technique description using intraoperative recording
(2023) GREGóRIO, P. H. Peitl; CHIRICHELA, I. A.; ULLOA, P. J.; MARIANI, A. W.; PêGO-FERNANDES, P. M.
Despite all improvements in thoracic surgery over the last decades, chronic bronchopleural fistulas still pose a challenging disease to treat. The Abruzzini technique is often considered one of the last viable options to manage this undesirable complication. Unfortunately, surgical trainees are not regularly exposed to this procedure during their training since it is not routinely performed. Moreover, available educational resources are particularly restricted to text descriptions or illustrations. Those factors lead to insufficient training of this technique, which is fundamental to the thoracic surgery practice. In this article, we present a step-by-step description of the Abruzzini technique using an intraoperative video recorded with a rigid endoscope. This device allows improved teaching and guidance for every trainee in the operating room and grants further review for educational purposes after the surgery. The media used in the present description was collected from a surgery performed to treat a large right bronchopleural fistula, which was a result of a lung resection secondary to aspergilloma. In this case, an approach through the pleural cavity would not be feasible due to several previous surgeries, so a transsternal approach was planned. The bronchus was successfully closed and the patient did not present any signs of recurrence, with over 1 year of follow-up.
Robot-assisted thoracoscopic surgery resection of a ground-glass nodule in the right middle lobe
(2023) MINAMOTO, Fabio Eiti Nishibe; MENDES, Guilherme Falleiros; CAMPOS, Jose Ribas Milanez de; GARCIA, Rodrigo Gobbo; TERR, Ricardo Mingarini
Practice patterns and trends in surgical treatment for chronic lung infections: a survey from the Brazilian Society of Thoracic Surgery
(2023) MARIANI, Alessandro Wasum; D'AMBROSIO, Paula Duarte; ROCHA JUNIOR, Eserval; NETO, Antero Gomes; FORTUNATO, Sergio Tadeu Lima; TERRA, Ricardo Mingarini; PEGO-FERNANDES, Paulo Manuel
Background: Chronic lung infections represent a diversity of clinical entities that combined respond to significant public health, particularly in developing countries. However, there is no data regarding the practice patterns, surgeons' preferences, and technological usage, especially among Brazilian surgeons, in the setting of the surgical treatment of chronic lung infections. We, therefore, surveyed Brazilian thoracic surgeons from the Brazilian Society of Thoracic Surgery (SBCT) about practice patterns and trends in surgical treatment for chronic lung infections. Methods: A cross-sectional anonymous survey of all thoracic surgeons from the Brazilian Society was conducted in 2019. As the study was purely descriptive no further statistical evaluation was performed. Results: The responsive rate was 34% (259/766) from 23 of the 26 states in Brazil. A total of 141 (54.4%) participants reported their institution as a surgical reference for chronic infection lung disease, only 13.1% of surgeons have a high-volume service (more than 11 cases operated annually). The majority (76.2%) of respondents performed 1-5 surgical resection to treat tuberculosis (TB) sequelae, but only 62 (30.1%) had performed more than one resection to treat active TB. Chronic lung infection (76%) and hemoptysis (66%) were the most common symptoms as surgical indications. A proportion of 42.2% of the respondents do not have and/or perform routine drug sensitivity tests. In addition, 19.3% of respondents were not familiar with the recommendations of surgery in the treatment of pulmonary TB. Video-assisted thoracoscopic surgery (VATS) is available for 80% of respondents, while robotic surgery is for only 10%. Most (86%) surgeons have access to surgical staplers. Among the structural resources, respiratory isolation beds in the intensive care unit (ICU) (80%) and ward (79%) are frequently available resources. However, less than 12% of surgeons have in their institution a specific operating room for sputum-positive patients. Conclusions: Lung resection for chronic infectious disease is an essential area of activity for thoracic surgeons in Brazil, which occurs mainly in the public sphere, with no concentration of cases per surgeon or institution. The lack of adequate resources in many centers justifies the creation of reference centers for improving care for these patients.
A semi-automated microscopic image analysis method for scoring Ki-67 nuclear immunostaining
(2023) FERNEZLIAN, S. M.; BALDAVIRA, C. M.; SOUZA, M. L. F. de; FARHAT, C.; VILHENA, A. F. de; PEREIRA, J. C. N.; CAMPOS, J. R. M. de; TAKAGAKI, T.; BALANCIN, M. L.; AB'SABER, A. M.; CAPELOZZI, V. L.
Nuclear proliferation marker MIB-1 (Ki-67) immunohistochemistry (IHC) is used to examine tumor cell proliferation. However, the diagnostic or prognostic value of the Ki-67 nuclear staining intensity and location, defined as nuclear gradient (NG), has not been assessed. This study examined the potential association between Ki-67 NG and cell cycle phases and its effect on the prognosis of pulmonary typical carcinoid (PTC) tumors. We propose a method for classifying the NG of Ki-67 during the cell cycle and compare the results between PTC, pulmonary adenocarcinoma (PAD), and breast ductal carcinoma (BDC). A literature review and objective analysis of IHC-stained paraffin sections were used to determine the Ki-67 labeling index and composed a stratification of the NG into NG1, NG2, and NG3/4 categories. A semi-automated image analysis protocol was established to determine the Ki-67 NG in PTC, PAD, and BDC. High intraobserver consistency and moderate interobserver agreement were achieved in the determination of Ki-67 NG in tumor specimens. NG1 and NG2 were lower in PTC than in PAD and BDC. Cox multivariate analysis of PTC after adjusting for age and number of metastatic lymph nodes showed that Ki-67 NG1 and NG2 significantly predicted clinical outcomes. The semi-automated method for quantification of Ki-67 nuclear immunostaining proposed in this study could become a valuable diagnostic and prognostic tool in PTC.
Robotic surgery training
(2023) ARAUJO, Pedro Henrique Xavier Nabuco de; PEGO-FERNANDES, Paulo Manuel
Exploration of a novel prognostic model based on nomogram in non-small cell lung cancer patients with distant organ metastasis: implications for immunotherapy
(2023) WANG, Min; ZHANG, Yong; LIU, Mingchuan; WANG, Yuanyong; NIU, Xiaona; QIU, Dan; XI, Hangtian; ZHOU, Ying; CHANG, Ning; XU, Tianqi; XING, Liangliang; YAMAUCHI, Yoshikane; TERRA, Ricardo Mingarini; TANE, Shinya; MOON, Mi Hyoung; YAN, Xiaolong; ZHAO, Feng; ZHANG, Jian
Background: Evidence for the effects of immunotherapy in non-small cell lung cancer (NSCLC) patients with distant organ metastasis is insufficient, and the predictive efficacy of established markers in tissue and blood is elusive. Our study aimed to determine the prognostic factors and develop a survival prognosis model for these patients.Methods: A total of 100 advanced NSCLC patients with distant organ metastases, who received single or combination immune checkpoint inhibitors (ICIs) in Xijing Hospital between June 2018 and June 2021, were enrolled for retrospective analysis. The major clinicopathological parameters were collected, and associated survival outcomes were followed up by telephone or inpatient follow-up for nearly 3 years to assess prognoses. The survival prognosis model was established based on univariate and multivariate Cox regression analyses to determine the candidate prognostic factors.Results: From the start of immunotherapy to the last follow-up, 77 patients progressed and 42 patients died, with a median follow-up of 18 months [95% confidence interval (CI): 15-19.9]. The median progression-free survival (PFS) and overall survival (OS) were 8 months (95% CI: 5.6-10.4) and 21 months (95% CI: 8.9-33.1), respectively. Multivariate Cox proportional hazards analysis showed Eastern Cooperative Oncology Group performance status (ECOG PS), body mass index (BMI), age-adjusted Charlson comorbidity index (ACCI), lactate dehydrogenase (LDH), and absolute neutrophil count (ANC) were correlated significantly with OS. Based on these five predictive factors, a nomogram and corresponding dynamic web page were constructed with a concordance index (C-index) of 0.81 and a 95% CI of 0.778-0.842. Additionally, the calibration plot and time-receiver operating characteristic (ROC) curve validated the precision of the model at 6-, 12-, and 18-month area under the curves (AUCs) reached 0.934, 0.829, and 0.846, respectively. According to the critical point of the model, patients were further divided into a high-risk total point score (TPS) >258, middle-risk (204< TPS 5258), and low-risk group (TPS 5204), and significant OS differences were observed among the three subgroups (median OS: 4.8 vs. 13.0 vs. 32.9 months).Conclusions: A feasible and practical model based on clinical characteristics has been developed to predict the prognosis of NSCLC patients with distant organ metastasis undergoing immunotherapy.
Use of OctopusTM Tissue Stabilizer for Minimal Manipulation Approach of Bronchial Anastomosis in Lung Transplant
(2023) RAZUK FILHO, Mauro; SANTOS, Samuel Lucas dos; REIS, Flavio Pola dos; ABDALLA, Luis Gustavo; FERNADES, Lucas Matos; PEGO-FERNANDES, Paulo Manuel
Bronchial anastomotic complications are a cause of grave concern for surgeons that perform lung transplantations. There are several risk factors that may lead to this complication, being inadequate surgical technique one of them, specifically regarding adequate exposure and manipulation of the bronchial stump and anastomosis. Here we report the use of OctopusTM Tissue Stabilizer as a mean to allow for a better exposure of the stump and facilitate a ""no-touch"" approach towards anastomosis. Systematic application of devices that facilitate the employment of the correct surgical techniques can have an effect in reducing the incidence of bronchial anastomotic complications.
Endovascular repair of ascending aorta pseudoaneurysm post-extracorporeal membrane oxygenation cannulation during pulmonary transplant
(2023) KANAMORI, Lucas Ruiter; MULATTI, Grace Carvajal; BARROS, Taina Curado Gomes de; ABDALLA, Luis Gustavo; BIHAN, David Costa de Souza Le; LUCCIA, Nelson De
We demonstrated an endovascular technique excluding an ascending aorta pseudoaneurysm using an aortic extension. A 32-year-old woman, 3 years after lung transplantation with extracorporeal membrane oxygenation presented with an ascending aortic pseudoaneurysm. Vascular surgery was consulted after open repair was deemed high risk. An aortic extension stent graft was placed in a hybrid operating room with the aid of intraoperative transesophageal echocardi-ography. Ascending aorta pseudoaneurysms are complex and life-threatening complications. Traditional repair involves high surgical and anesthetic risks whereas endovascular treatment is technically feasible.
Immunomodulatory response in an experimental model of brain death
(2023) SANTANA, Alexandre Chagas; ANDRAUS, Wellington; OBERMAN, Dan Zimelewicz; RABELO, Nicollas Nunes; SILVA, Filipe Miranda Oliveira; DELLE, Humberto; PEPINELI, Rafael; MORAES, Edvaldo Leal de; SCAVONE, Cristoforo; LIMA, Larissa de Sa; DEGASPARI, Sabrina; BRASIL, Sergio; SOLLA, Davi Jorge Fontoura; RUIZ, Liliane Moreira; OLIVEIRA-BRAGA, Karina Andrighetti de; NEPOMUCENO, Natalia Aparecida; PEGO-FERNANDES, Paulo Manuel; TULLIUS, Stefan Gunther; FIGUEIREDO, Eberval Gadelha
Liver transplantation has come a long way and is now regarded as the gold standard treatment for end-stage liver failure. The great majority of livers utilized in transplantation come from brain-dead donors. A broad inflammatory response characterizes BD, resulting in multiorgan damage. This process is primarily mediated by cytokines, which increase the immunogenicity of the graft. In male Lewis rats, we evaluated the immune response in a BD liver donor and compared it to that of a control group. We studied two groups: Control and BD (rats subjected to BD by increasing intracranial pressure). After the induction of BD, there was an intense rise in blood pressure followed by a fall. There were no significant differences observed between the groups. Blood tissue and hepatic tissue analyzes showed an increase in plasma concentrations of liver enzymes (AST, ALT, LDH and ALP), in addition to pro-inflammatory cytokines and macrophages in liver tissue in animals submitted to BD. The current study found that BD is a multifaceted process that elicits both a systemic immune response and a local inflammatory response in liver tissue. Our findings strongly suggested that the immunogenicity of plasma and liver increased with time following BD.
Characteristics of the learning curve in robotic thoracic surgery in an emerging country
(2023) REZENDE, Bruna Brandao de; ASSUMPCAO, Lia Roque; HADDAD, Rui; TERRA, Ricardo Mingarini; MARQUES, Ruy Garcia
It is not established which factors impact the learning curve (LC) in robotic thoracic surgery (RTS), especially in emerging countries. The aim of this study is to analyze LC in RTS in Brazil and identify factors that can accelerate LC. We selected the first cases of two Brazilian surgeons who started their LC. We used CUSUM and the Lowess technique to measure LC for each surgeon and Poisson regression to assess factors associated with shorter console time (CT). 58 patients were operated by each surgeon and included in the analysis. Surgeries performed were different: Surgeon I (SI) performed 54 lobectomies (93.11%), whereas Surgeon II (SII) had a varied mix of cases. SI was proctored in his first 10 cases (17.24%), while SII in his first 41 cases (70.68%). The mean interval between surgeries was 8 days for SI and 16 days for SII. There were differences in the LC phases of the two surgeons, mainly regarding complications and conversions. There was shorter CT by 30% in the presence of a proctor, and by 20% with the Da Vinci Xi. Mix of cases did not seem to contribute to faster LC. Higher frequency between surgeries seems to be associated with a faster curve. Presence of proctor and use of bolder technologies reduced console time. We wonder if in phase 3 it is necessary to keep a proctor on complex cases to avoid serious complications. More studies are necessary to understand which factors impact the LC.
Correspondence on Should the Ravitch Procedure to Correct Pectus Excavatum Be Avoided in Young Children?
(2022) TEDDE, M. L.; BEER, S. A. de; PARK, H. J.
To the editor: In addition to the excellent outcome they obtained, the case reported by Rim and Park [1] shows the boldness and inventiveness of the authors: boldness for performing the fourth surgical procedure (previously, the patient had undergone the Ravitch procedure, correction with 2 metal bars, and removal of the bars) for the repair of recurrent pectus excavatum (PE), and inventiveness for proposing a 3-dimensional-printed artificial thoracic wall, which as far as we know is an unprecedented treatment, to correct this serious defect © 2022. The Korean Society for Thoracic and Cardiovascular Surgery
Outcomes of Early Versus Late Tracheostomy in Patients With COVID-19: A Multinational Cohort Study
(2022) SHRECKENGOST, C. S. Harrell; FOIANINI, J. E.; ENCINAS, K. M. Moron; GUARACHI, H. Tola; ABRIL, K.; AMIN, D.; BERKOWITZ, D.; CASTATER, C. A.; DOUGLAS, J. M.; GRANT, A. A.; KHULLAR, O. V.; LANE, A. N.; LIN, A.; NIROULA, A.; NIZAM, A.; RASHIED, A.; REITZ, A. W.; ROSER, S. M.; SPYCHALSKI, J.; ARAP, S. S.; BENTO, R. F.; CIARALO, P. P. D.; IMAMURA, R.; KOWALSKI, L. P.; MAHMOUD, A.; MARIANI, A. W.; MENEGOZZO, C. A. M.; MINAMOTO, H.; MONTENEGRO, F. L. M.; PêGO-FERNANDES, P. M.; SANTOS, J.; UTIYAMA, E. M.; SREEDHARAN, J. K.; KALCHIEM-DEKEL, O.; NGUYEN, J.; DHAMSANIA, R. K.; ALLEN, K.; MODZIK, A.; PATHAK, V.; WHITE, C.; BLAS, J.; EL-ABUR, I. Talal; TIRADO, G.; BENíTEZ, C. Yánez; WEISER, T. G.; BARRY, M.; BOECK, M.; FARRELL, M.; GREENBERG, A.; MILLER, P.; PARK, P.; CAMAZINE, M.; DILLON, D.; SMITH, R. N.
OBJECTIVES: Timing of tracheostomy in patients with COVID-19 has attracted substantial attention. Initial guidelines recommended delaying or avoiding tracheostomy due to the potential for particle aerosolization and theoretical risk to providers. However, early tracheostomy could improve patient outcomes and alleviate resource shortages. This study compares outcomes in a diverse population of hospitalized COVID-19 patients who underwent tracheostomy either ""early""(within 14 d of intubation) or ""late""(more than 14 d after intubation). DESIGN: International multi-institute retrospective cohort study. SETTING: Thirteen hospitals in Bolivia, Brazil, Spain, and the United States. PATIENTS: Hospitalized patients with COVID-19 undergoing early or late tracheostomy between March 1, 2020, and March 31, 2021. INTERVENTIONS: Not applicable. MEASUREMENTS AND MAIN RESULTS: A total of 549 patients from 13 hospitals in four countries were included in the final analysis. Multivariable regression analysis showed that early tracheostomy was associated with a 12-day decrease in time on mechanical ventilation (95% CI, -16 to -8; p < 0.001). Further, ICU and hospital lengths of stay in patients undergoing early tracheostomy were 15 days (95% CI, -23 to -9 d; p < 0.001) and 22 days (95% CI, -31 to -12 d) shorter, respectively. In contrast, early tracheostomy patients experienced lower risk-adjusted survival at 30-day post-admission (hazard ratio, 3.0; 95% CI, 1.8-5.2). Differences in 90-day post-admission survival were not identified. CONCLUSIONS: COVID-19 patients undergoing tracheostomy within 14 days of intubation have reduced ventilator dependence as well as reduced lengths of stay. However, early tracheostomy patients experienced lower 30-day survival. Future efforts should identify patients most likely to benefit from early tracheostomy while accounting for location-specific capacity. Copyright © 2022 The Authors.
Pectus Excavatum: Consensus and Controversies in Clinical Practice
(2023) JANSSEN, Nicky; DAEMEN, Jean H. T.; POLEN, Elise J. van; COORENS, Nadine A.; JANSEN, Yanina J. L.; FRANSSEN, Aimee J. P. M.; HULSEWE, Karel W. E.; VISSERS, Yvonne L. J.; HAECKER, Frank -Martin; CAMPOS, Jose R. Milanez de; LOOS, Erik R. de; Chest Wall Int Grp Collaborator Grp
BACKGROUND Pectus excavatum is the most common congenital anterior chest wall deformity. Currently, a wide variety of diagnostic protocols and criteria for corrective surgery are being used. Their use is predominantly based on local preferences and experience. To date, no guideline is available, introducing heterogeneity of care as observed in current daily practice. The aim of this study was to evaluate consensus and controversies regarding the diagnostic protocol, indications for surgical correction, and postoperative evaluation of pectus excavatum. METHODS The study consisted of 3 consecutive survey rounds evaluating agreement on different statements regarding pectus excavatum care. Consensus was achieved if at least 70% of participants provided a concurring opinion. RESULTS All 3 rounds were completed by 57 participants (18% response rate). Consensus was achieved on 18 of 62 statements (29%). Regarding the diagnostic protocol, participants agreed to routinely include conventional photog-raphy. In the presence of cardiac impairment, electrocardiography and echocardiography were indicated. Upon sus-picion of pulmonary impairment, spirometry was recommended. In addition, consensus was reached on the indications for corrective surgery, including symptomatic pectus excavatum and progression. Participants moreover agreed that a plain chest radiograph must be acquired directly after surgery, whereas conventional photography and physical ex-amination should both be part of routine postoperative follow-up. CONCLUSIONS Through a multiround survey, international consensus was formed on multiple topics to aid stan-dardization of pectus excavatum care. (Ann Thorac Surg 2023;116:191-9) & COPY; 2023 by The Society of Thoracic Surgeons.
Modulation of Alveolar Macrophage Activity by Eugenol Attenuates Cigarette-Smoke-Induced Acute Lung Injury in Mice
(2023) BARBOSA-DE-OLIVEIRA, Maria Clara; OLIVEIRA-MELO, Paolo; SILVA, Marcos Henrique Goncalves da; SILVA, Flavio Santos da; SILVA, Felipe Andrade Carvalho da; ARAUJO, Bruno Vinicios Silva de; OLIVEIRA, Moacir Franco de; CORREIA, Aristides Tadeu; SAKAMOTO, Sidnei Miyoshi; VALENCA, Samuel Santos; LANZETTI, Manuella; SCHMIDT, Martina; KENNEDY-FEITOSA, Emanuel
This study investigates the role of eugenol (EUG) on CS-induced acute lung injury (ALI) and how this compound is able to modulate macrophage activity. C57BL/6 mice were exposed to 12 cigarettes/day/5days and treated 15 min/day/5days with EUG. Rat alveolar macrophages (RAMs) were exposed to CSE (5%) and treated with EUG. In vivo, EUG reduced morphological changes inflammatory cells, oxidative stress markers, while, in vitro, it induced balance in the oxidative stress and reduced the pro-inflammatory cytokine release while increasing the anti-inflammatory one. These results suggest that eugenol reduced CS-induced ALI and acted as a modulator of macrophage activity.
Evaluation of Structural Viability of Porcine Tracheal Scaffolds after 3 and 6 Months of Storage under Three Different Protocols
(2023) GUIMARAES, Alberto Bruning; CORREIA, Aristides Tadeu; SILVA, Ronaldo Soares da; SANTOS, Elizabete Silva dos; COSTA, Natalia de Souza Xavier; DOLHNIKOFF, Marisa; MAIZATO, Marina; CESTARI, Idagene Aparecida; PEGO-FERNANDES, Paulo Manuel; CARDOSO, Paulo Francisco Guerreiro
Tracheal replacement with a bioengineered tracheal substitute has been developed for long-segment tracheal diseases. The decellularized tracheal scaffold is an alternative for cell seeding. It is not defined if the storage scaffold produces changes in the scaffold's biomechanical properties. We tested three protocols for porcine tracheal scaffold preservation immersed in PBS and alcohol 70%, in the fridge and under cryopreservation. Ninety-six porcine tracheas (12 in natura, 84 decellularized) were divided into three groups (PBS, alcohol, and cryopreservation). Twelve tracheas were analyzed after three and six months. The assessment included residual DNA, cytotoxicity, collagen contents, and mechanical properties. Decellularization increased the maximum load and stress in the longitudinal axis and decreased the maximum load in the transverse axis. The decellularization of the porcine trachea produced structurally viable scaffolds, with a preserved collagen matrix suitable for further bioengineering. Despite the cyclic washings, the scaffolds remained cytotoxic. The comparison of the storage protocols (PBS at 4 degrees C, alcohol at 4 degrees C, and slow cooling cryopreservation with cryoprotectants) showed no significant differences in the amount of collagen and in the biomechanical properties of the scaffolds. Storage in PBS solution at 4 degrees C for six months did not change the scaffold mechanics.
The 500th Lung Transplantation at the Faculdade de Medicina da Universidade de Sao Paulo: Reflecting on Our Journey and Looking Ahead
(2023) REIS, Flavio Pola dos; PEGO-FERNANDES, Paulo Manuel
Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study
(2022) FOTOPOULOU, Christina; KHAN, Tabassum; BRACINIK, Juraj; GLASBEY, James; ABU-RUSTUM, Nadeem; CHIVA, Luis; FAGOTTI, Anna; FUJIWARA, Keiichi; GHEBRE, Rahel; GUTELKIN, Murat; KONNEY, Thomas O.; NG, Joseph; PAREJA, Rene; SEENIVASAGAM, Rajkumar Kottayasamy; SEHOULI, Jalid; SURAPPA, Shylasree T. S.; BHANGU, Aneel; LEUNG, Elaine; SUNDAR, Sudha
BACKGROUND: The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. OBJECTIVE: This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. STUDY DESIGN: This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. RESULTS: We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P<1/4>.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. CONCLUSION: One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed.
HANDS-ON: Training Simulation in Surgery
(2023) BRANDAO, Carlos Manuel de Almeida; PEGO-FERNANDES, Paulo Manuel
Early short course of neuromuscular blocking agents in patients with COVID-19 ARDS: a propensity score analysis
(2022) BASSI, Gianluigi Li; GIBBONS, Kristen; SUEN, Jacky Y.; DALTON, Heidi J.; WHITE, Nicole; CORLEY, Amanda; SHRAPNEL, Sally; HINTON, Samuel; FORSYTH, Simon; LAFFEY, John G.; FAN, Eddy; FANNING, Jonathon P.; PANIGADA, Mauro; BARTLETT, Robert; BRODIE, Daniel; BURRELL, Aidan; CHIUMELLO, Davide; ELHAZMI, Alyaa; ESPERATTI, Mariano; GRASSELLI, Giacomo; HODGSON, Carol; ICHIBA, Shingo; LUNA, Carlos; MARWALI, Eva; MERSON, Laura; MURTHY, Srinivas; NICHOL, Alistair; OGINO, Mark; PELOSI, Paolo; TORRES, Antoni; NG, Pauline Yeung; FRASER, John F.
Robotic Lung Volume Reduction Surgery With Extracorporeal Membrane Oxygenation
(2022) ROCHA JUNIOR, Eserval; TERRA, Ricardo Mingarini; CARDOSO, Paulo Francisco Guerreiro; ABDALLA, Luis Gustavo; FERNANDES, Lucas Matos; ALBUQUERQUE, Andre Luis Pereira de; BARRA, Silvia Maria Pinella Helaehil; PEGO-FERNANDES, Paulo Manuel
Lobectomy for consolidation of failed endoscopic lung volume reduction for emphysema has been reported in selected patients with favorable results but with considerable morbidity. The challenging issues in such patients are frailty caused by severe emphysema itself, poor tolerance to single-lung ventilation, target lobe hyperinflation, and inability to use gas inflation for the minimally invasive resection. Careful planning, including use of a robotic platform and extracorporeal membrane oxygenation support, can circumvent such difficulties and ensure a safe, minimally invasive resection in the high-risk emphysematous patient. (Ann Thorac Surg 2022;114:e351-e354) (c) 2022 by The Society of Thoracic Surgeons

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