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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bookPart Derrame pericárdico(2019) ARAúJO, Pedro Henrique Xavier Nabuco de; PêGO-FERNANDES, Paulo Manuel- 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.
- 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 Efficacy and safety of adjuvant chemotherapy in lung cancer: Real-world evidence(2019) ROITBERG, F. S. R.; NEFFA, M. F. B. V.; BONADIO, R. R. C. C.; HARADA, G.; MENDOZA, E. Z.; MAK, M. P.; TAKAHASHI, T. K.; MARTINS, R. E.; MESQUITA, C.; SANTINI, F. C.; ARAUJO, P. H. X. N. de; LAURICELLA, L. L.; PRADO, G. F.; TAKAGAKI, T. Y.; MELLO, E. S. de; GABRIELLI, F.; CARVALHO, H. D. A. de Andrade; TERRA, R. M.; CASTRO JR., G. de- Building a Large Robotic Thoracic Surgery Program in an Emerging Country: Experience in Brazil(2019) TERRA, Ricardo Mingarini; HADDAD, Rui; CAMPOS, Jose Ribas Milanese de; ARAUJO, Pedro Henrique Xavier Nabuco de; LIMA, Carlos Eduardo Teixeira; BRAGA, Felipe; BIBAS, Benoit Jacques; TRINDADE, Juliana Mol; LAURICELLA, Leticia Leone; PEGO-FERNANDES, Paulo ManuelBackground In the last decade, robotic video-assisted thoracic surgery (R-VATS) has grown significantly and consolidated as an alternative to video-assisted thoracic surgery. The objective of this study is to present the implementation as well as the experience with R-VATS accumulated by 2 Brazilian groups. We also compared the outcomes of procedures performed during the learning curve and after a more mature experience. Methods Retrospective cohort study included all R-VATS procedures performed since April 2015 until April 2018. We describe the process of implantation of robotic surgery, highlighting the peculiarities and difficulties found in a developing country. Moreover, we reported our descriptive results and compared the first 60 patients to the subsequent cases. Results Two hundred and five patients included 101 females/104 males. Mean age was 61.7 years. There were hundred and sixty-four pulmonary resections, 39 resections of mediastinal lesions, 1 diaphragmatic plication, and 1 resection of a hilar tumor. Median operative times were 205 min for lung resections and 129 min for mediastinal. There was no conversion to VATS or thoracotomy or major intraoperative complications. Median length of stay was 3 days for pulmonary resections and 1 day for mediastinal. Postoperative complications occurred in 35 cases (17.0%)-prolonged air leak was the most common (17 cases). One fatality occurred in an elderly patient with pneumonia and sepsis (0.4%). Comparison of the first 60 patients (learning curve) with subsequent 145 patients (consolidated experience) showed significant differences in surgical and ICU time, both favoring consolidated experience. Conclusions Our results were comparable to the literature. Robotic thoracic surgery can be safely and successfully implemented in tertiary hospitals in emerging countries provided that all stakeholders are involved and compromised with the implementation process.
- Predictors of hospital discharge in cancer patients with pericardial effusion undergoing surgical pericardial drainage(2019) KAZANTZIS, Thamara; BIBAS, Benoit Jacques; DELA-VEGA, Alberto Jorge; NABUCO, Pedro; LAURICELLA, Leticia Leone; PEGO-FERNANDES, Paulo Manuel; TERRA, Ricardo MingariniIntroduction Pericardial effusion (PE) is a complication of late-stage cancer and some patients never leave the hospital despite drainage. The main objective of this study was to identify predictors of hospital discharge in cancer patients with (PE) who underwent pericardial drainage. We also report the occurrence of paradoxical hemodynamic instability (PHI). Methods and Materials A retrospective study was carried out in a cancer center. Patients included had malignancy, PE, and underwent surgical drainage. An institutional database was reviewed for preoperative variables, analyzed for hospital discharge. Results One-hundred and thirteen patients were included, with a mean age of 54 years old (SD 14.3). Sixty-three patients were discharged from hospital (55.7%). Age (odds ratio [OR], 1.04; P = 0.004), higher ECOG status (OR, 0.63; P = 0.019), recent chemotherapy (OR, 3.40; P = 0.007), and renal failure (OR, 0.14; P = 0.002) were associated with hospital discharge. Median survival was 43 days (IQ 25%-75%; 15-162). Patients with pulmonary embolism or neutropenia were at greater risk of developing PHI (OR, 10.11; P = 0.009 and OR, 12.13; P = 0.015, respectively). Conclusion Almost half of the patients never left the hospital. Patients with no chemotherapy within 45 days of procedure, patients with renal failure and higher ECOG status are at greater risk of not getting discharged. PHI remains a serious condition with high mortality.