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R.M. Terra



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    P1.08 - Poster Session with Presenters Present (ID 460)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Surgery
    • Presentations: 1
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      P1.08-058 - VATS Lung Resection Analysis from Brazilian Society of Thoracic Surgery Database (ID 6252)

      14:30 - 14:30  |  Author(s): R.M. Terra

      • Abstract

      Background:
      Lung cancer is the leading cause of cancer related death worldwide when considering both genders. The optimal treatment is complete surgical resection. The objective of this study was to analyze VATS anatomic lung resections in Brazil.

      Methods:
      The Brazilian Society of Thoracic Surgery (BSTS) uses a customized version of the ESTS platform as its national database (BSTS Database). From August to December 2015, 1367 patients were registered. In the current analysis, we included only patients who underwent lung cancer anatomic lung resections by VATS; wedge resections and unspecified cases were excluded.

      Results:
      Out of the 902 anatomical lung resections registered, 516 were lung cancer and VATS performed in 389. Patient’s mean age was 62.5 years, 57.7% were women. PFT were available in 239 with FEV1 81.7% and CFV 88%. ASA score (n=352) was 1 in 19.3%, 2 in 49.7%, 3 in 27.3%, 4 in 3.4% and 5 in 0.3%. The resections performed were lobectomy in 303 cases (77.9%), pneumonectomy in 9 (2.3%), bilobectomy in 5(1.3%) and segmentectomy in 72 (18.5%). Morbidity rate was 21.8% and it varied according to the procedure performed. Overall mortality rate was 1.6% (6). Pathological staging was In situ in 1.3%, IA 55.6%, IB 20.1%, IIA 11.7%, IIB 1.7%, IIIA 9.6% and no IV.

      Conclusion:
      Slightly female predominance and majority of early stage IA and IB lung cancer were found. Our BSTS Database has comparable complications and mortality rates to international series.

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    P2.02 - Poster Session with Presenters Present (ID 462)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Locally Advanced NSCLC
    • Presentations: 1
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      P2.02-050 - Gender and Smoking Influence on Non Small Cell Lung Cancer Histology and Tnm Stage in a Brazilian Population (ID 5672)

      14:30 - 14:30  |  Author(s): R.M. Terra

      • Abstract

      Background:
      Smoking is the most important lung cancer risk factor, although its not known if this risk is equal between men and women. The objective of the study is to analyze gender and smoking influence on lung cancer in a Brazilian population who underwent surgery for non small cell lung cancer (NSCLC).

      Methods:
      The study population derived from the Sao Paulo Lung Cancer Registry, which began in 2014 and includes patients with NSCLC who underwent surgery with curative intention.

      Results:
      Figure 1 Data of 423 patients were obtained from the registry and 12 cases were excluded due to incomplete data. Out of the 411 patients analyzed, 211(51%) were women. . The resections performed were lobectomy in 324 cases (80%), pneumonectomy in 26(6%), bilobectomy 18(4%), segmentectomy 20(5%), and wedge resection in 11(3%). Women were more likely to be never smokers than men (see Table); furthermore, males smoked for a longer period and had higher load of tobacco consumption. There were no differences between genders with regard to NSCLC detection method. There was a substantially higher percentage of squamous-cell carcinoma in men than in women (27%M, 17%W, p=0,008), while adenocarcinoma and carcinoid tumors werw more frequent in women (55% W, 50% M; 19% W, 12% M, respectively, p=0,008). However, when stratified by smoking, the difference in NSCLC histologic types by gender disappears. More women had early-stage NSCLC than men (64% W, 54% M, p=0,04). In a multivariate analysis female gender was an independent factor for early stage NSCLC (OR=0,4-1,01, p=0,05), but there was no influence of age, smoking history and histologic type.



      Conclusion:
      Currently, more women than men have been operated on due to NSCLC in Brazil and women tend to present in earlier stages of disease. We also found a large difference in smoking habitus between genders, which can explain the differences in their histologic profile.

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    P3.04 - Poster Session with Presenters Present (ID 474)

    • Event: WCLC 2016
    • Type: Poster Presenters Present
    • Track: Surgery
    • Presentations: 2
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      P3.04-033 - Digital Drainage System Reduces Chest Tube Duration and Hospitalization after Anatomic Pulmonary Resections for Malignancies (ID 6194)

      14:30 - 14:30  |  Author(s): R.M. Terra

      • Abstract

      Background:
      The management of the chest tube after anatomic lung resections is critical to determine the length of stay and the cost of the hospitalization. The new digital chest drainage systems promise to reduce the intervals to chest tube removal and to patient’s discharge from hospital. This study aims to compare the conventional water seal and the new digital drainage systems regarding chest tube duration and hospitalization.

      Methods:
      Between July 2015 and May 2016 consecutive patients submitted to elective pulmonary lobectomy, segmentectomy or bilobectomy for malignancies in the Cancer Institute of University of São Paulo (ICESP) used the digital drainage system Thopaz®. On the historic control group we included patients submitted to the same types of resection in our hospital between July 2014 and June 2015. All of them used the conventional water seal system. The groups were balanced for type of pulmonary resection and open versus minimally invasive techniques. Chest tubes were removed when the recorded airflow was less than 10 mL/min for the last 6 hours on the digital group and when there were no instantaneous air leaks during the daily rounds on the water seal group. The pleural drainage should be less than 400 ml/24 h for both groups. The patients were discharged from hospital according the same routine assistance protocols.

      Results:
      We included 110 patients. In each group, 50 lobectomies, 4 segmentectomies and 1 inferior bi-lobectomy were performed; thoracotomy was used in 19 patients and minimally invasive approaches in 36 cases per group. The groups were similar regarding gender (p=0.700), ASA Physical Status Classification System (p=0.838) and the Thoracic Surgery Scoring System (p=0.501). More patients had COPD in digital group (52.7%) than in water seal (30.9%) (p=0.033). Patients in the digital group were younger (median 65 years, IR:57-71) than in conventional group (median 70 years, IR:62-76) (p=0.016). The digital group had shorter chest tube interval (2 days, IR:1-4) than water seal (4 days, IR:3-5) (p=0.001). The same occurred on hospitalization: 4 days (IR:3-7) for digital and 5 days (IR:4-7) for conventional group (p=0.06). The morbidity was similar between groups, either for general (p=1.000) or for surgical complications (p=0.818).

      Conclusion:
      Patients undergoing anatomic lung resections for malignancies who were managed postoperatively with a digital drainage system experienced shorter chest tube duration and hospitalization, compared to those with conventional water seal drainage.

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      P3.04-034 - Differences between Pleurodesis Using Talc and Silver Nitrate at Different Times of Pleural Disease in Mice (ID 5340)

      14:30 - 14:30  |  Author(s): R.M. Terra

      • Abstract

      Background:
      Recurrent malignant pleural effusion occurs in approximately 50% of patients with metastatic tumors and their therapy is essentially palliative. The most used method is the chemical pleurodesis. However, we don’t know what would be the ideal time to submit the patient to the procedure, neither what the best sclerosing agent. The objective is to analyze if the progression of the pleural neoplastic disease is associated with the degree of fibrosis in mice subjected to pleurodesis with talc and nitrate, in animals injected with 10 thousand Lewis’s cells intrapleural.

      Methods:
      In this experimental study we used twenty C56-BL mice, with pleural cancer induced by injection of 10.000 Lewis cells/ml of 0.9% saline. On the third day of pleural disease, half of the animals were subjected to plerodese, 5 of them with talc at a concentration of 400mg/kg(called Group 3 Talc-"GT3") and other 5 with silver nitrate in a concentration of 0.05%(called nitrate Group-"GN3"). On the seventh day of pleural disease, the remaining subjects were again divided into 2 groups of 5 animals(GT7andGN7) and subjected to plerodesis with the same substances and concentrations. All animals were sacrificed 7 days after pleurodesis, regardless of which group they belonged.

      Results:
      All animals were pleural implants of cancer cells. Regarding the macroscopic findings were graded fibrosis in score been validated in other studies ranging from 0(no fibrosis) to 4(complete symphysis). In GT3 group, 2 animals had a score 2, and 2 animals obtained score 0.5. In the nitrate group(GN3) 3 animals had a score 0. In animals underwent pleurodesis after 7 days of illness, the talc group(GT7), 3 animals received a score of 0,2 and 2.5 respectively; the nitrate group(GN7) received scores of 0.5, 1 and 2. Microscopically, all had the presence of fibroblasts and fibrosis on visceral pleura. 2 blades each group(GT3 GN3, and GT7 GN7) were stained with picrosirius method for evaluating local fibrosis, and all had positive staining method including quantitation amount sufficient to further study. The animal control cutting blade, with only pleural disease had negative results.

      Conclusion:
      Animals with this number of implanted cells have sufficient survival and satisfactory answer to pleurodesis so we can quantify it according to the available methods. There was no weight loss or significant reduction in activity of the animals during time. Apparently, there is a greater amount of fibrosis in animals submitted to pleurodesis with talc.