Objective: The objective of this study was to describe the results of anatomic pulmonary resections performed by video-assisted thoracoscopy in Brazil. Methods: Thoracic surgeons (members of the Brazilian Society of Thoracic Surgery) were invited, via e-mail, to participate in the study. Eighteen surgeons participated in the project by providing us with retrospective databases containing information related to anatomic pulmonary resections performed by video-assisted thoracoscopy. Demographic, surgical, and postoperative data were collected with a standardized instrument, after which they were compiled and analyzed. Results: The surgeons provided data related to a collective total of 786 patients (mean number of resections per surgeon, 43.6). However, 137 patients were excluded because some data were missing. Therefore, the study sample comprised 649 patients. The mean age of the patients was 61.7 years. Of the 649 patients, 295 (45.5%) were male. The majority-521 (89.8%)-had undergone surgery for neoplasia, which was most often classified as stage IA. The median duration of pleural drainage was 3 days, and the median hospital stay was 4 days. Of the 649 procedures evaluated, 598 (91.2%) were lobectomies. Conversion to thoracotomy was necessary in 30 cases (4.6%). Postoperative complications occurred in 124 patients (19.1%), the most common complications being pneumonia, prolonged air leaks, and atelectasis. The 30-day mortality rate was 2.0%, advanced age and diabetes being found to be predictors of mortality. Conclusions: Our analysis of this representative sample of patients undergoing pulmonary resection by video-assisted thoracoscopy in Brazil showed that the procedure is practicable and safe, as well as being comparable to those performed in other countries.
Introduction
Pericardial effusion (PE) is a complication of late‐stage cancer and some patients never leave the hospital despite drainage. The main objective of this study was to identify predictors of hospital discharge in cancer patients with (PE) who underwent pericardial drainage. We also report the occurrence of paradoxical hemodynamic instability (PHI).
Methods and Materials
A retrospective study was carried out in a cancer center. Patients included had malignancy, PE, and underwent surgical drainage. An institutional database was reviewed for preoperative variables, analyzed for hospital discharge.
Results
One‐hundred and thirteen patients were included, with a mean age of 54 years old (SD 14.3). Sixty‐three patients were discharged from hospital (55.7%). Age (odds ratio [OR], 1.04; P = 0.004), higher ECOG status (OR, 0.63;
P = 0.019), recent chemotherapy (OR, 3.40;
P = 0.007), and renal failure (OR, 0.14;
P = 0.002) were associated with hospital discharge. Median survival was 43 days (IQ 25%‐75%; 15‐162). Patients with pulmonary embolism or neutropenia were at greater risk of developing PHI (OR, 10.11;
P = 0.009 and OR, 12.13;
P = 0.015, respectively).
Conclusion
Almost half of the patients never left the hospital. Patients with no chemotherapy within 45 days of procedure, patients with renal failure and higher ECOG status are at greater risk of not getting discharged. PHI remains a serious condition with high mortality.
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