RICARDO MINGARINI TERRA
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Cardio-Pneumologia, Faculdade de Medicina - Docente
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
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
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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.- Evolution of the surgical treatment of lung cancer at a tertiary referral center in Brazil, 2011-2018(2021) SOARES, Mariana Schettini; COLTRO, Laura Maria; LEITE, Pedro Henrique Cunha; COSTA, Priscila Berenice; LAURICELLA, Leticia Leone; PEGO-FERNANDES, Paulo Manuel; TERRA, Ricardo MingariniObjective: To evaluate the evolution of clinical and epidemiological data, as well as data related to diagnosis, staging, treatment, and survival, among patients undergoing curative surgery for lung cancer at a tertiary referral center in the city of Sao Paulo, Brazil. Methods: This was a retrospective study of cases in the International Association for the Study of Lung Cancer database. We selected only cases of patients undergoing curative surgery between January of 2011 and April of 2018. We determined overall and disease-free survival at 36 months and compared the data between two periods (2011-2014 and 2015-2018). Results: Comparing the two periods (N = 437 cases), we observed trends toward increases in the number of female patients, as well as in the proportions of former smokers (44.09% vs. 53.59%), of patients diagnosed with adenocarcinoma (52.21% vs. 59.72%), and of patients diagnosed at an earlier pathological stage, together with a decrease in 30-day mortality (4.05% vs. 2.39%). There were significant increases in the proportions of cases diagnosed at an earlier clinical stage (p = 0.002) or incidentally (p = 0.003). Although lobectomy was the main surgical technique employed, there was a proportional increase in segmentectomies (2.67% vs. 7.11%; p = 0.026). Overall and disease-free survival rates were 79.4% (95% CI: 74.0-83.9%) and 75.1% (95% CI: 69.1-80.1%), respectively. The difference in overall survival between the periods lost statistical significance when adjusted for pathological stage, the only factor that affected survival (log-rank: p = 0.038 to p = 0.079). Conclusions: The clinical and epidemiological evolution presented in this study corroborates global trends. The decrease in 30-day mortality was probably due to better patient selection and improved surgical techniques.
- Effectiveness and toxicity of adjuvant chemotherapy in patients with non-small cell lung cancer(2021) HARADA, Guilherme; NEFFA, Maria Fernanda Batistuzzo Vicentini; BONADIO, Renata Colombo; MENDOZA, Elizabeth Zambrano; CAPARICA, Rafael; LAURICELLA, Leticia Leone; TAKAGAKI, Teresa Yae; ROITBERG, Felipe Santa Rosa; TERRA, Ricardo Mingarini; JR, Gilberto De CastroObjective: Adjuvant chemotherapy (AC) improves survival of patients with resected non-small cell lung cancer (NSCLC). However, the cisplatin-vinorelbine regimen has been associated with a significant risk of clinically relevant toxicity. We sought to evaluate the effectiveness, safety, and feasibility of AC for NSCLC patients in a real-world setting. Methods: This was a single-center, retrospective cohort study of patients with stage I-III NSCLC undergoing surgery with curative intent between 2009 and 2018. AC was administered at the discretion of physicians. The patients were divided into two groups: AC group and no AC (control) group. Study outcomes included overall survival (OS) and recurrence-free survival (RFS), as well as the safety profile and feasibility of the cisplatin-vinorelbine regimen in a real-world setting. Results: The study involved 231 patients, 80 of whom received AC. Of those, 55 patients received the cisplatin- vinorelbine regimen. Survival analyses stratified by tumor stage showed that patients with stage II NSCLC in the AC group had better RFS (p = 0.036) and OS (p = 0.017) than did those in the no AC group. Among patients with stage III NSCLC in the AC group, RFS was better (p < 0.001) and there was a trend toward improved OS (p = 0.060) in comparison with controls. Of those who received the cisplatin- vinorelbine regimen, 29% had grade 3-4 febrile neutropenia, and 9% died of toxicity. Conclusions: These results support the benefit of AC for NSCLC patients in a real-world setting. However, because the cisplatin-vinorelbine regimen was associated with alarming rates of toxicity, more effective and less toxic alternatives should be investigated.
- Robotic-assisted thoracic surgery reduces perioperative complications and achieves a similar long-term survival profile as posterolateral thoracotomy in clinical N2 stage non-small cell lung cancer patients: a multicenter, randomized, controlled trial(2021) HUANG, Jia; TIAN, Yu; LI, Chongwu; SHEN, Yaofeng; LI, Hecheng; LV, Fanzhen; LIN, Hao; LU, Peiji; LIN, Jules; LAU, Christopher; TERRA, Ricardo Mingarini; JIANG, Long; LUO, QingquanBackground: Our previous study demonstrated the safety and short-term efficacy of robotic-assisted thoracic surgery (RATS) in clinical N2 (c-N2) stage non-small cell lung cancer (NSCLC) patients. From this, the present study was devised, in which the follow-up time and sample size were both extended to explore the long-term efficacy and potential benefit in survival of RATS compared with lobectomy in c-N2 stage NSCLC patients. Methods: Patients with c-N2 NSCLS were randomly assigned in a 1:1 ratio to accept operation through thoracotomy or RATS. The da Vinci Surgical System (Si/Xi) was applied in the RATS group, while conventional lobectomy with a rib-spreading incision was applied in the posterolateral thoracotomy group. Primary endpoint was defined as disease free survival and overall survival (OS) of all recruited patients. Results: Compared with posterolateral thoracotomy group (N=72), the RATS group (N=76) had a reduced blood loss (P<0.001), decreased drainage duration (P=0.002), and decreased postoperative pain visual analog score (all P<0.001), but increased overall cost (P<0.001). Meanwhile, no difference in the other postoperative complications (such as air leakage, subcutaneous emphysema, atrial fibrillation etc.) was found between the RATS group and the posterolateral thoracotomy group (all P>0.05). Regarding long-term outcome, no difference in disease-free survival (DFS; P=0.925) or OS (P=0.853) was observed between the RATS group and posterolateral thoracotomy group. Subgroup analyses and multivariable Cox regression analyses also found no difference in DFS or OS between the RATS group and posterolateral thoracotomy groups. Conclusions: RATS reduced intraoperative bleeding, drainage duration, postoperative pain, and achieved similar long-term survival outcomes compared with posterolateral thoracotomy in c-N2 stage NSCLC patients.
bookPart Investigação do derrame pleural(2021) GOUVêA, Filippe Moura; TERRA, Ricardo Mingarini- Robotic lobectomy: how to teach thoracic residents(2021) TERRA, Ricardo Mingarini; LEITE, Pedro Henrique Cunha; VEGA, Alberto Jorge Monteiro DelaRobotic thoracic surgery emerged at the beginning of the 21st century and keep presenting the continuous development of its robotic systems, tools, and associated techniques. Strong clinical results including safety and oncological outcomes have fostered the dissemination of the robotic platform all over the world. However, there are still some safety concerns, especially regarding more elaborated procedures as lung resections, during the learning curve. In consequence, training programs for surgeons and surgery residents have been proposed to put into operation a strong and complete curriculum for robotic surgery and increase safety during the learning process. Also, the implementation of the training program makes the process complete and efficient. Lung lobectomies are complex procedures especially because of pulmonary arteries and pulmonary veins dissection, which demands quite accurate skills. Consequently, it is believed that specific training of thoracic surgery residents in robotic lobectomy is capital. The ideal curriculum must include technical content and broad psychomotor training using virtual reality models and also physical and animal models. Valid evaluation methods can be used from the first skill training to daily clinical practice. At the beginning as a console surgeon, the resident must initiate gradually with small procedures and progress to more complex surgeries before performing the whole lobectomy.
bookPart Investigação do nódulo pulmonar(2021) KAZANTZIS, Thamara; TERRA, Ricardo MingariniconferenceObject Lobectomy for Lung Cancer, What Is the Brazilian reality? Brazilian Society of Thoracic Surgeons Analysis(2021) TSUKAZAN, M. T.; SOARES, M.; MIOTTO, A.; SAUERESSIG, M.; FORTUNATO, G.; CAMARGO, S.; OLIVEIRA, H.; VIGO, A.; BRAND, L.; SATELES, S. De; TERRA, R.conferenceObject Nodal Upstaging Comparison of Open, Video-Assisted Thoracoscopic, and Robotic Lung Resections Form Non-Small Cell Lung Cancer(2021) TERRA, R.; VEGA, A. Dela; LAURICELLA, L.; ROCHA JR., E.; LIMA, L.; CREMONESE, M.; PEGO-FERNANDES, P.conferenceObject Machine Learning for Prediction of Survival and Risk of Mortality in Patients with Lung Cancer Undergoing Resection(2021) FACCIOLI, R.; HEISE, L.; FONSECA, C.; LIAW, W.; LAURICELLA, L.; PEGO-FERNANDES, P.; TERRA, R.