ABSTRACT
Introduction: All restrictions and social isolation imposed by the COVID-19 pandemic did not prevent the evolution of non-infectious diseases, interfering in the diagnosis and the beginning of the treatment for other pathologies. This study aims to measure the impact caused by the pandemic on the diagnosis and staging of lung cancer in patients who underwent lung resection (LR) in 2020 compared to 2019, as well as to describe the epidemiological profile of these patients. Methods: In this retrospective study, data from patients who underwent LR (lobectomy, segmentectomy, wedge resection, and pneumonectomy) by PUCRS’s Sao Lucas Hospital Thoracic Surgery team in Brazil within 2019 and 2020 were collected from medical records in March 2021. Only primary lung cancer patients were included. A descriptive analysis was performed. Results: There were 144 LR analyzed, 80 in 2019 and 66 (45.83%) in 2020. The number of LR due to primary lung cancer was 42 (52.5%) in 2019 and 30 (45.45%) in 2020. The comparison between years indicates a reduction of 28.57% in the number of LR. Of the 30 surgeries in 2020, 23 were lobectomies (76.66%), 3 segmentectomies (10%), 1 wedge resection, and 3 pneumonectomies. The incidence of lobectomies in men decreased 35.29% (17 in 2019;11 in 2020) and remained stable in women (13 in 2019;12 in 2020). The average age of patients who were subjected to LR was 61.57 in 2019 and 57.9 in 2020. In cancer patients, the average age was 59.9 (61.9 in 2019;57.98 in 2020). The incidence of adenocarcinoma was 29 in 2019 (69%) and 19 in 2020 (63.3%), being the most prevalent histological type. According to our review, clinic staging (CS) for lung cancer with the highest incidence in the two years analyzed was IA2, with 26.6% of cases in 2020 and 28.5% in 2019. CS IIA corresponded to 20% in 2020 and 9.5% in 2019, IIB 16.6% in 2019 and 6.6% in 2020, IA1 16.6% in 2020 and 2.38% in 2019, IA3 19% in 2019 and 13.3 % in 2020. Of the 42 patients who were performed LR for primary cancer in 2019, 17 (40.47%) underwent video-assisted thoracoscopic surgery (VATS), and from 29 (55.17) in 2020, 16 were VATS. Conclusion: In general, the pandemic and its restrictions of access to tertiary diagnostic and treatment centers decreased the number of patients. There was a reduction of 28.57% in the number of procedures performed for primary lung. Most patients continued to receive a CS IA2 diagnosis, however, the percentage of diagnosis in CS IIA had grown. This percentage is worrying, as it shows that patients took longer to receive adequate treatment or were unable to make an early diagnosis. On the other hand, the average age of diagnosis decreased in 2020, which may indicate early diagnosis perhaps related to incidental findings in COVID19 CT scans. Our lower number of VATS is related to the lack of endoscopic staples in public healthcare system. Keywords: lung cancer, public healthcare, Surgery
ABSTRACT
Introduction: Thymic epithelial tumors (TET) are the most common neoplasms of the anterior mediastinum. The incidence of this disease is extremely low, and there is little data on the Brazilian context. This study aims to describe the experience from PUCRS's Sao Lucas Hospital Thoracic Surgery team on mediastinal tumor resections (MTR) during the investigation of TET. Methods: The Thoracic Surgery team from PUCRS's Sao Lucas Hospital maintains a prospective database with the Brazilian Thoracic Surgery Society. Data from patients who underwent investigation for TET within 2016 and 2020 were collected from medical records in March 2021. Descriptive analyses were performed on this data. We used the classification proposed by the World Health Organization (2004) to classify all cases found. Results: There were 90 MTR performed on a total of 87 patients between 2016 and 2020. Of these, 56 (64.36%) were female, and the average age was 54.28. Among performed MTR, 11 (12.22%) were due to TET, being 10 (11.11%) by thymoma and 1 (1.11%) by thymic carcinoma. From the 10 cases of thymoma, 7 (70%) were female, and the only patient diagnosed with thymic carcinoma was male. Of the 11 patients diagnosed with TET, the average age was 56. According to the TET classification used, 1 (9.09%) was type A, 5 (45.45%) was AB, 1 (9.09%) was B2, 1 (9.09%) was B3, 1 (9.09%) was C (thymic carcinoma was classified as type C), 1 (9.09%) classified as types B1 and B2, and another (9.09%) as types AB and B3. Among 10 cases of thymoma, 2 (20%) had myasthenia gravis (MG). Immediate postoperative mortality was zero. During yearly follow-up, only 1 (9.09%) patient had a recurrence of disease, and 1 (9.09%) died. It is important to highlight that from all 90 MTR performed, 80 (88.88%) occurred between 2016 to 2019 (18 in 2016, 16 in 2017, 21 in 2018, 25 in 2019), resulting in an average of 20 RTM per year. However, in 2020, only 10 (11.11%) RTM were performed, showing a significant reduction during the first year of the COVID-19 pandemic in Brazil. Conclusion: Our data converge to what is shown in the literature since a small portion of patients who underwent MTR had a thymoma diagnosis and only one had a diagnosis of thymic carcinoma. The most frequent type was AB. Studies demonstrate that 30-65% of patients with thymoma also have MG. On the other hand, our sample shows 20%. It is essential to emphasize the reduction in the number of procedures during the Sars-CoV-2 pandemic in 2020. Keywords: thymic carcinoma, thymoma, thoracic malignancies