PEDRO HENRIQUE XAVIER NABUCO DE ARAUJO
Projetos de Pesquisa
Unidades Organizacionais
Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
LIM/61 - Laboratório de Pesquisa em Cirurgia Torácica, Hospital das Clínicas, Faculdade de Medicina
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conferenceObject A Comparative Cost Analysis Study of Robotic and Video-Assisted Lobectomy: Results of Randomized Controlled Trial (Bravo Trial)(2021) TERRA, R.; TRINDADE, J.; CAMPOLINA, A.; ARAUJO, P. H. De; CAMPOS, J. R. De; PEGO-FERNANDES, P.conferenceObject THE IMPACT OF PLEURAL CATHETER POSITION ON THE SUCCESS OF BEDSIDE PLEURODESIS(2014) TERRA, Ricardo Mingarini; ARAUJO, Pedro Henrique Xavier Nabuco de; CHATE, Rodrigo Caruso; PEGO-FERNANDES, Paulo- Prolonged survival after thoracic metastasectomy in patients with nonseminomatous testicular cancer(2024) FONINI, Jaqueline Schaparini; ARAUJO, Pedro Henrique Xavier Nabuco de; 'AMBROSIO, Paula Duarte D.; SALERNO, Juliana Vieira de Oliveira; CIARALO, Pedro Prosperi Desenzi; TERRA, Ricardo Mingarini; PE, Paulo ManuelIntroduction: Almost 20 % of patients with Non-Seminomatous Germinative Cell Tumors (NSGCT) will require intrathoracic metastasectomy after chemotherapy. The authors aim to determine their long-term survival rates. Methods: Retrospective study including patients with NSGCT and intrathoracic metastasis after systemic therapy from January 2011 to June 2022. Treatment outcomes and overall survival were analyzed with the Kaplan-Meier method. Results: Thirty-seven male patients were included with a median age of 31.8 years. Six presented with synchronous mediastinum and lung metastasis, nine had only lung, and 22 had mediastinal metastasis. Over half had retroperitoneal lymph node metastasis. Twenty-two had dissimilar pathologies, with a discordance rate of 62 %. Teratoma and embryonal carcinoma were the prevalent primary tumor types, 40.5 % each, while teratoma was predominant (70.3 %) in the metastasis group. Thoracotomy was the main surgical approach (39.2 %) followed by VATS (37.2 %), cervico-sternotomy (9.8 %), sternotomy (5.8 %), and clamshell (3.9 %). Lung resection was performed in 40.5 % of cases. Overall, 10-year survival rates were 94.3 % with no surgical-related mortality. Conclusion: Multimodality treatment with systemic therapy followed by radical surgery offers a high cure rate to patients with intrathoracic metastatic testicular germ cell tumors.
- Segmentectomia pulmonar anatômica robótica: aspectos técnicos e desfechos(2019) TERRA, Ricardo Mingarini; LAURICELLA, Leticia Leone; HADDAD, Rui; DE-CAMPOS, José Ribas Milanes; NABUCO-DE-ARAUJO, Pedro Henrique Xavier; LIMA, Carlos Eduardo Teixeira; SANTOS, Felipe Carvalho Braga dos; PEGO-FERNANDES, Paulo ManuelABSTRACT Objective: to report our initial experience with pulmonary robotic segmentectomy, describing the surgical technique, the preferred positioning of portals, initial results and outcomes. Methods: we collected data, from a prospective robotic surgery database, on patients undergoing robotic segmentectomy between January 2017 and December 2018. All patients had lung cancer, primary or secondary, or benign diseases, and were operated on with the Da Vinci system, by the three portals technique plus one utilitarian incision of 3cm. We dissected the hilar structures individually and performed the ligatures of the arterial and venous branches, of the segmental bronchi, as well as a parenchymal transection, with endoscopic staplers. We carried out systematic dissection of mediastinal lymph nodes for non-small cell lung cancer (NSCLC) cases. Results: forty-nine patients, of whom 33 were women, underwent robotic segmentectomy. The average age was of 68 years. Most patients had NSCLC (n=34), followed by metastatic disease (n=11) and benign disease (n=4). There was no conversion to laparoscopic or open surgery, or to lobectomy. The median total operative time was 160 minutes, and the median console time, 117 minutes. Postoperative complications occurred in nine patients (18.3%), of whom seven (14.2%) had prolonged hospitalization (>7 days) due to persistent air fistula (n=4; 8.1%) or abdominal complications (n=2.4%). Conclusion: robotic segmentectomy is a safe and viable procedure, offering a short period of hospitalization and low morbidity.
bookPart Linfadenectomia em ressecção pulmonar oncológica (direita e esquerda)(2023) LIMA, Leonardo Pontual; TERRA, Ricardo Mingarini; ARAúJO, Pedro Henrique Xavier Nabuco de- What happens to the pleural space affected by malignant effusion after bedside pleurodesis?(2018) ARAUJO, Pedro H. X. N. de; TERRA, Ricardo M.; SANTOS, Thiago da Silva; CHATE, Rodrigo C.; PAIVA, Antonio F. L. de; PEGO-FERNANDES, Paulo M.Background and objectivesEvaluate radiological characteristics of postpleurodesis pleural space of patients with recurrent malignant pleural effusion(RMPE). MethodsProspective cohort study including patients with RPME treated with bedside pleurodesis. We used CT scans to calculate pleural cavity volume immediately before pleurodesis(iCT) and 30 days after(CT30). Radiological evolution was calculated by the difference between pleural volumes on CT30 and iCT(volume). We categorized initial pleural volume as small(<500mL) or large space(500mL) and volume as positive(>254.49mL), unchanged(-268.77-254.49mL), or negative(<-268.77mL). Futhermore, we analyzed clinical effectiveness, pleural elastance, and adverse events. ResultsA total of 87 patients were analyzed. Pleural volume varied from 35-2750mL in iCT and from 0-2995mL in CT30(P=0.753). A total of 54 patients had initial small pleural space(62.06%) and 33 large(37.93%). Clinical failure occurred in 7.4% of small space group and in 24.6% of large(P=0.051, OR4.0(CI:1.098-14.570)). In small space group, 27.77% evolved with positive, 66.66% with unchanged and 5.55% with negative volume. In the large space group these numbers were respectively 21.21%, 27.27%, and 51.51%. ConclusionsThere is significant variability on pleural space volume. However, pleural volume remains unchanged in many cases. Besides that, more than half patients with initial large space coursed with relevant reduction. Finally, patients with initial small space presented a greater chance of clinical success.
- Risk factors related to pleural empyema after talc slurry pleurodesis(2022) D'AMBROSIO, Paula Duarte; ARAUJO, Pedro Henrique Xavier Nabuco de; ROCHA JUNIOR, Eserval; RAZUK FILHO, Mauro; PEGO-FERNANDES, Paulo Manuel; TERRA, Ricardo MingariniObjective: Empyema is a complication of talc-pleurodesis that may lead to further surgical intervention and death. Therefore, the present study's objective was to identify the risk factors for the development of post-pleurodesis empyema after talc slurry pleurodesis in order to better select patients for this procedure and minimize its morbidity.Methods: Patients with malignant pleural effusion who underwent talc slurry pleurodesis at the present institution from January 2018 to January 2020 were retrospectively analyzed. Post-pleurodesis empyema was defined as pleural infection up to 30 days after pleurodesis. Using Cox regression analysis, significant prognostic factors for the development of empyema were examined.Results: Of the 86 patients identified for inclusion in the study, 62 were women (72%). Their mean age was 56.3 +/- 12.6 years. The median pleural drainage time was 9 days, and 20 patients (23.3%) developed empy-ema. In the univariate analysis, both drainage time (p = 0.038) and the use of antibiotics prior to pleurodesis (p < 0.001) were risk factors for pleural empyema. Multivariate analysis also identified the use of antibiotics as an independent risk factor (Odds Ratio [OR] 9.81; 95% Confidence Interval [95% CI] 2.87-33.54). Although the pulmonary expansion was not associated with empyema in the multivariate analysis, patients with less than 50% pulmonary expansion had a 4.5-times increased risk of empyema (95% CI 0.90-22.86; p = 0.067), and patients with 50-70% pulmonary expansion had a 3.8-times increased risk of empyema (95% CI 0.98-15; p = 0.053) after pleurodesis.Conclusion: The study suggests that antibiotic therapy prior to talc slurry pleurodesis may increase the risk of developing empyema. Furthermore, pleurodesis should be considered with caution in patients with long-duration chest tube placement and incomplete lung expansion.
conferenceObject Predictors of Hospital Discharge in Cancer Patients with Pericardial Effusion Who Undergo Surgical Pericardial Drainage(2015) KAZANTZIS, Thamara; TERRA, Ricardo M.; BIBAS, Benoit J.; LAURICELLA, Leticia L.; ARAUJO, Pedro N.; DELA-VEGA, Alberto J. M.; PEGO-FERNANDES, Paulo M.- Analysis of Quality of Life after Pleurodesis in Patients with Malignant Pleural Effusion(2019) TERRA, Ricardo Mingarini; COSTA, Priscila Berenice; VEGA, Alberto Jorge Monteiro Dela; ARAUJOB, Pedro Henrique Xavier Nabuco; TEIXEIRA, Lisete Ribeiro; PEGO-FERNANDES, Paulo ManuelBackground: Malignant pleural effusion is one of the most important complications of metastatic cancer, and recurrent pleural effusions do not only have an impact on survival but also cause a huge repercussion on a patient's quality of life. Objectives: The main objective was to describe quality of life status before and after pleurodesis in patients with malignant pleural effusion. Secondary, we aimed to find predictors of quality of life improvement in such a population. Methods: Retrospective analysis of a database collected prospectively. We included patients who underwent pleurodesis from June 2004 to July 2014. Quality of life was evaluated through the WHOQOL-BREF questionnaire and applied before and 30 days after pleurodesis. We used a paired t test and the Wilcoxon rank-sum to compare pre-/post-pleurodesis results, Kaplan-Meier curves for survival analysis, and multiple linear regressions to find predictors of quality of life improvement. Results: 183 patients were included (145 were women). Mean age was 58.3 +/- 12.3 years, the most numerous primary tumor was breast cancer. Median survival time was 9 months. Dyspnea was the most prevalent symptom. Baseline results showed that patients had low quality of life scores. After pleurodesis, there was a significant improvement in respiratory symptoms, physical domain, and general health. Linear regression showed an improvement in physical domain with the sclerosing agent nitrate (p = 0.005). Male gender (p = 0.002) and a higher lymphocyte count (p = 0.01) were inversely associated with improvement in physical domain. Conclusions: Pleurodesis improved symptoms and quality of life in patients with malignant pleural effusion. Gender, lymphocyte count, and sclerosing agent might interfere with quality of life improvement.
conferenceObject WEB-BASED THORACIC SURGERY ONLINE COURSE: INCREASING ACCESS, CONNECTING PEOPLE AND DECREASING INEQUALITIES. FEASIBILITY RESULTS.(2014) TERRA, Ricardo Mingarini; ARAUJO, Pedro Henrique Xavier Nabuco de; MARIANI, Alessandro Wasun; VEGA, Alberto Jorge Monteiro Dela; PEGO-FERNANDES, Paulo