Eficácia da sublobectomia comparada à lobectomia no tratamento do câncer de pulmão de não pequenas células em estádios iniciais. Metanálise proporcional de série de casos / Effectiveness of sublobectomy compared to lobectomy for the treatment of lung cancer of non small cell in the early stages. Proportional meta-analysis of case series

A ressecção pulmonar é o tratamento de escolha no carcinoma brônquico, sendo a lobectomia o tipo de cirurgia de eleição nesta situação. A sublobectomia é um tipo de ressecção menos invasiva com maior preservação de parênquima pulmonar e pode ser uma alternativa à lobectomia em estágios iniciais da doença. Na literatura existe apenas um estudo clínico randomizado comparando as duas intervenções, e vários estudos de série de casos. Avaliar a eficácia da sublobectomia como tratamento cirúrgico no câncer de pulmão tipo carcinoma de não-pequenas células em estádios iniciais quando comparada com a lobectomia. Revisão e metanálise proporcional de série de casos em artigos que comparam os resultados da sublobectomia com os da lobectomia no tratamento do carcinoma de pulmão de não-pequenas células. Os estudos foram identificados na base de dados MEDLINE via PubMed, Embase e Lilacs. Referências bibliográficas também foram pesquisadas para encontrar estudos não indexados. A análise estatística foi realizada através do programa StatsDirect 2.7.9. Foram selecionados 21 artigos para essa metanálise, incluindo 19678 pacientes, sendo 17397 submetidos à lobectomia e 2281, à sublobectomia. Não houve diferença estatística na sobrevida em cinco anos entre os dois tipos de ressecção. A mortalidade pós-operatória analisada em 15 estudos também não apresentou diferença significante entre os dois tipos de ressecção. A recorrência local e a distância possíveis de serem avaliadas em nove artigos também não mostraram diferença estatisticamente significante, mas uma tendência da recorrência local ser maior na sublobectomia...

Pulmonary resection is the treatment of choice in bronchogenic carcinoma, lobectomy being the type of surgery of choice in this situation, the sublobectomy is a type of resection less invasive with greater preservation of lung parenchyma and can be an alternative to lobectomy for stage initial disease. In the literature there is only one randomized clinical trial comparing the two interventions, and several case series studies. To evaluate the effectiveness of sublobectomy as surgical treatment in non-small cell lung carcinoma in the early stages when compared with lobectomy. A review and meta-analysis proportional of cases series studies comparing the results with those of sublobectomy and lobectomy in the treatment of non-small cell lung carcinoma. Studies were identified in MEDLINE, Embase and Lilacs. References were also searched to find studies not indexed. Statistical analysis was performed using the program StatsDirect 2.7.9. 21 articles were selected for this meta-analysis, including 19678 patients, 17397 in lobectomy and 2281 in sublobectomy. There was no statistical difference in five-year survival between the two types of resection. The postoperative mortality analyzed in 15 studies also showed no significant difference between the two types of resection. The local and distant recurrence were able to be evaluated in nine studies showed no statistically significant difference, but a tendency of local recurrence was higher in sublobectomy...

Carcinoid tumor and pulmonary sequestration.

Pulmonary sequestration is defined as a mass of lung tissue separated from the tracheobronchial tree and irrigated by an anomalous systemic artery. It is rarely seen in conjunction with lung neoplasms. We report the case of a 39-year-old female patient diagnosed with a carcinoid tumor, located in the intermediate bronchus and accompanied by bronchiectasis in the right lower lobe. The patient underwent thoracotomy for the resection of the affected area. During surgery, she presented with significant hemorrhage resulting from the transection of the anomalous artery that irrigated an intralobar pulmonary sequestration, which was located in right lower lobe and had not been identified in pre-operative examinations.

Tumor carcinoide e sequestro pulmonar / Carcinoid tumor and pulmonary sequestration

O sequestro pulmonar é definido como uma massa de tecido pulmonar separada da árvore traqueobrônquica e irrigada por uma artéria sistêmica anômala. Sua associação com neoplasias pulmonares é rara. Relatamos o caso de uma paciente de 39 anos com o diagnóstico de tumor carcinoide localizado no brônquio intermediário, associado a alterações caracterizadas como bronquiectasias em lobo inferior direito. A paciente foi submetida à toracotomia para ressecção da área acometida e, durante a cirurgia, apresentou hemorragia importante decorrente da transecção da artéria anômala que nutria o sequestro pulmonar intralobar localizado em lobo inferior direito, não identificado nos exames pré-operatórios.

Pulmonary sequestration is defined as a mass of lung tissue separated from the tracheobronchial tree and irrigated by an anomalous systemic artery. It is rarely seen in conjunction with lung neoplasms. We report the case of a 39-year-old female patient diagnosed with a carcinoid tumor, located in the intermediate bronchus and accompanied by bronchiectasis in the right lower lobe. The patient underwent thoracotomy for the resection of the affected area. During surgery, she presented with significant hemorrhage resulting from the transection of the anomalous artery that irrigated an intralobar pulmonary sequestration, which was located in right lower lobe and had not been identified in pre-operative examinations.

Trauma torácico: análise de 124 pacientes submetidos à toracotomia / Thoracic trauma: analysis of 124 patients who underwent thoracotomy

OBJETIVO: Analisar os pacientes submetidos à toracotomia para o tratamento de traumatismo torácico. MÉTODOS: Estudo retrospectivo por meio da análise de prontuários nos dois principais hospitais de referência para trauma em adultos desta cidade, por um período de cinco anos, interessando dados epidemiológicos, agente causal, indicações, tipo de incisão, classificação do escore anatômico do trauma, fatores prognósticos e a mortalidade. RESULTADOS: Foi analisado neste estudo 124 pacientes submetidos à toracotomia com idade média de 28 anos, tendo como o agente causal mais incidente a arma branca (68 por cento dos casos). A principal indicação da toracotomia foi hemotórax maciço com 50,7 por cento dos casos, seguido de choque cardiogênico ou hipovolêmico com 48,4 por cento. Ocorreram 28 óbitos (20,6 por cento), sendo que os pacientes com lesões de veia cava (cinco pacientes) e aorta (dois pacientes) tiveram uma mortalidade de 100 por cento. Observou-se uma maior mortalidade em pacientes com escore anatômico do trauma superior a 14 (p=0,004) e maior quantidade de sangue transfundido (p=0,090). CONCLUSÃO: O perfil do paciente que foi vítima de traumatismo torácico e submetido à toracotomia exploradora é o seguinte: jovem, do sexo masculino e vítima de trauma por arma branca. Os fatores que mais contribuíram para o êxito letal foram o elevado escore anatômico do trauma e a associação com lesões vasculares importantes, como da artéria aorta e veia cava.

OBJECTIVE: To analyze patients who underwent thoracotomy for the treatment of chest trauma in the City of Manaus. METHODS: We performed a retrospective study through analyzed records in the two main reference hospitals for trauma adults in this city during a period of 5 years. We considered for this study the epidemiological data, causal agent, type of incision, anatomical classification score of trauma, prognostic factors and mortality. RESULTS: We analyzed 124 patients who underwent thoracotomy with a mean age of 28 years. Stab wounds were the most common casual agent (68 percent). The main indication for thoracotomy was massive hemothorax with 50.7 percent of cases, followed by cardiogenic or hypovolemic shock with 48.4 percent. There were 28 deaths (20.6 percent). Patients with vena cava injuries (5 patients) and aorta lesions (2 patients) had 100 percent mortality rate. There was a higher mortality in patients with major index of trauma (p = 0004), and largest quantity of blood transfused (p = 0090). CONCLUSION: Thoracic trauma patients submitted to exploratory thoracotomy were young, males and victims of stab wound trauma. The most contributing death factors were the lethal anatomical score, more than 15 points, and the association with major vascular lesions, as the aorta and vena cava.

Characteristics of patients with lung cancer in the city of Manaus, Brazil.

OBJECTIVE: To analyze the characteristics of patients with lung cancer. METHODS: A retrospective descriptive study of patients receiving a histopathological diagnosis of lung cancer between 1995 and 2002 in the city of Manaus, Brazil. Data were collected from the medical archives of three hospitals. Statistical analyses were carried out, and survival curves were generated by means of an actuarial estimator. RESULTS: Of the 352 patients selected, 262 (74.4%) were male and 90 (25.6%) were female. The mean age was 62 years. The following histological types were identified: squamous cell carcinoma, 62.8%; adenocarcinoma, 24.7%; small cell carcinoma, 9.1%; and large cell carcinoma, 3.4%. The most common stages were stages IIIB and IV, in 45% and 21.5%, respectively. Of the total sample, 73.4% were submitted to treatment. Of these, 51.4% underwent radiotherapy; 16.6%, surgery; 15.8%, chemotherapy; and 16.2%, radiotherapy in association with chemotherapy. Cumulative survival rates were low: three-year survival was 6.5%, and five-year survival was 3.5%. CONCLUSIONS: In this group of patients with lung cancer, survival rates were considerably lower than those reported in the literature. This might be attributable to the limited access to the specialized health care system and the advanced stage of the disease at diagnosis.

Características de pacientes com câncer de pulmão na cidade de Manaus / Characteristics of patients with lung cancer in the city of Manaus, Brazil

OBJETIVO: Analisar as características de pacientes com câncer de pulmão. MÉTODOS: Estudo retrospectivo e descritivo dos pacientes com diagnóstico histopatológico de câncer de pulmão entre 1995 e 2002 em Manaus (AM). Os dados dos pacientes foram coletados nos arquivos médicos de três hospitais. As análises estatísticas foram realizadas, e as curvas de sobrevida geradas a partir do estimador atuarial. RESULTADOS: Dos 352 pacientes selecionados, 262 (74,4 por cento) eram do sexo masculino e 90 (25,6 por cento) do feminino. A média de idade foi de 62 anos. Os seguintes tipos histológicos foram encontrados: carcinoma de células escamosas, 62,8 por cento; adenocarcinoma, 24,7 por cento; carcinoma de pequenas células, 9,1 por cento; e carcinoma de grandes células, 3,4 por cento. Os estádios IIIB e IV foram os mais comuns, com uma frequência de 45 por cento e 21,5 por cento, respectivamente. Da amostra total, 73,4 por cento foram submetidos a tratamento. Desses, 51,4 por cento foram submetidos à radioterapia; 16,6 por cento, à cirurgia; 15,8 por cento, à quimioterapia; e 16,2 por cento, à radioterapia associada à quimioterapia. Os níveis de sobrevida acumulada foram baixos: a sobrevida em três anos foi de 6,5 por cento e a sobrevida em cinco anos foi de 3,5 por cento. CONCLUSÕES: Este grupo de pacientes com câncer de pulmão apresentou uma sobrevida muito pequena, divergindo dos resultados encontrados na literatura. Isto é provavelmente decorrente da dificuldade de acesso ao sistema de saúde especializado e do estágio avançado do diagnóstico.

OBJECTIVE: To analyze the characteristics of patients with lung cancer. METHODS: A retrospective descriptive study of patients receiving a histopathological diagnosis of lung cancer between 1995 and 2002 in the city of Manaus, Brazil. Data were collected from the medical archives of three hospitals. Statistical analyses were carried out, and survival curves were generated by means of an actuarial estimator. RESULTS: Of the 352 patients selected, 262 (74.4 percent) were male and 90 (25.6 percent) were female. The mean age was 62 years. The following histological types were identified: squamous cell carcinoma, 62.8 percent; adenocarcinoma, 24.7 percent; small cell carcinoma, 9.1 percent; and large cell carcinoma, 3.4 percent. The most common stages were stages IIIB and IV, in 45 percent and 21.5 percent, respectively. Of the total sample, 73.4 percent were submitted to treatment. Of these, 51.4 percent underwent radiotherapy; 16.6 percent, surgery; 15.8 percent, chemotherapy; and 16.2 percent, radiotherapy in association with chemotherapy. Cumulative survival rates were low: three-year survival was 6.5 percent, and five-year survival was 3.5 percent. CONCLUSIONS: In this group of patients with lung cancer, survival rates were considerably lower than those reported in the literature. This might be attributable to the limited access to the specialized health care system and the advanced stage of the disease at diagnosis.

[Thoracic trauma: analysis of 124 patients who underwent thoracotomy]. / Trauma torácico: análise de 124 pacientes submetidos à toracotomia.

OBJECTIVE: To analyze patients who underwent thoracotomy for the treatment of chest trauma in the City of Manaus. METHODS: We performed a retrospective study through analyzed records in the two main reference hospitals for trauma adults in this city during a period of 5 years. We considered for this study the epidemiological data, causal agent, type of incision, anatomical classification score of trauma, prognostic factors and mortality. RESULTS: We analyzed 124 patients who underwent thoracotomy with a mean age of 28 years. Stab wounds were the most common casual agent (68%). The main indication for thoracotomy was massive hemothorax with 50.7% of cases, followed by cardiogenic or hypovolemic shock with 48.4%. There were 28 deaths (20.6%). Patients with vena cava injuries (5 patients) and aorta lesions (2 patients) had 100% mortality rate. There was a higher mortality in patients with major index of trauma (p = 0004), and largest quantity of blood transfused (p = 0090). CONCLUSION: Thoracic trauma patients submitted to exploratory thoracotomy were young, males and victims of stab wound trauma. The most contributing death factors were the lethal anatomical score, more than 15 points, and the association with major vascular lesions, as the aorta and vena cava.