ABSTRACT
Introduction: Due to restrictions caused by the COVID-19 pandemic, elective procedures were canceled or postponed. This study aims to compare the epidemiological profile of cases from Brazilian’s Public Healthcare System (SUS) and Private Healthcare (PH) in a teaching single-center facility between 2019 and 2021. Methods: Data were gathered from patients who underwent lung resection (LR) by PUCRS’s Sao Lucas Hospital Thoracic Surgery team between 2019 and 2021. Data were obtained by retrospective review of electronic charts in March 2022. A retrospective analysis was made. Results: There were 212 procedures performed, being 80 in 2019, 66 in 2020 and 66 in 2021. In 2019, there were 45 (56.2%), in 2020, 43 (65.1%), and in 2021, 34 (51,5%) LR on SUS. Lobectomies on SUS in 2019 were 19 (42.2%), in 2020, 13 (30.2%), and in 2021, 17;on PH were 19 (54.2%) in 2019, 12 (52.1%) in 2020, and 18 in 2021. On SUS, in 2019 were performed 41 (91%) open thoracic surgeries and in 2020, there were 33 (76%);on PH, in 2019 video-assisted thoracic surgery (VATS) was done in 24 (68.5%) patients, 17 (73.9%) in 2020 and 29 (75%) in 2021. Procedures for oncological disease (primary or metastatic) on SUS in 2019 were performed in 27 (60%) patients, 23 (53.4%) in 2020, and 13 (44,8%) in 2021;on PH, in 2019, there were 23 (65.5%) patients, in 2020 were 15 (65.2%), and 16 (55,2%) in 2021. On SUS there were 24 women in 2019 (53%) and in 2020 (55%);on PH, there were 23 (65%) men in 2019 and 13 (56%) in 2020. The mean age of patients on SUS was 59, and 66 on PH. Clinical staging (CS) for primary lung cancer on SUS in 2019 was 12 (50%) CS I, 8 CS II, 3 CS III, and 1 CS IV;in 2020 was 8 (47%) CS I, 6 CS II, and 3 CS III. On PH, in 2019, there were 12 (66.6%) CS I, 4 CSII, and 2 CS IV;in 2020, 11 (84.6%) CS I and 2 CS II. Conclusions: We found maintenance in the numbers of procedures in 2020 and 2021, but a global reduction in the number of LR on SUS, mainly because the pandemic became worst in its second year, leading to the closure of surgery centers. And a reduction of 17.5% in the number of LR in 2020, compared with 2019. Lobectomies lowered 36.8% on PH and 31.5% on SUS between 2019 and 2020. Albeit there was a reduction in general incidence, LR for oncological reasons predominated. In 2021 it represented 82,8%, with 44,8% on SUS, and 52,2% on PH. There was a higher average age on PH. Open thoracic surgery was most frequent on SUS due to limitations on offered equipment, while VATS predominated on PH (difference: 44.5%). The predominant CS remained equal on both healthcare systems, CS I, which indicates maintenance of early-stage diagnoses. Nevertheless, the overall incidence has diminished (33.33% [SUS] and 8.3% [PH]), a probable reflection of the pandemic. Keywords: COVID-19, Thoracic Surgery, Lung Cancer
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