Letícia Lauricella

Robotic pulmonary lobectomy for lung cancer treatment: program implementation and initial experience.

ABSTRACT Objective: To describe the implementation of a robotic thoracic surgery program at a public tertiary teaching hospital and to analyze its initial results. Methods: This was a planned interim analysis of a randomized clinical trial aimed at comparing video-assisted thoracoscopic surgery and robotic surgery in terms of the results obtained after pulmonary lobectomy. The robotic surgery program developed at the Instituto do Câncer do Estado de São Paulo, in the city of São Paulo, Brazil, is a multidisciplinary initiative involving various surgical specialties, as well as anesthesiology, nursing, and clinical engineering teams. In this analysis, we evaluated the patients included in the robotic lobectomy arm of the trial during its first three months (from April to June of 2015). Results: Ten patients were included in this analysis. There were eight women and two men. The mean age was 65.1 years. All of the patients presented with peripheral tumors. We performed right upper lobectomy in four patients, right lower lobectomy in four, and left upper lobectomy in two. Surgical time varied considerably (range, 135-435 min). Conversion to open surgery or video-assisted thoracoscopic surgery was not necessary in any of the cases. Intraoperative complications were not found. Only the first patient required postoperative transfer to the ICU. There were no deaths or readmissions within the first 30 days after discharge. The only postoperative complication was chest pain (grade 3), in two patients. Pathological examination revealed complete tumor resection in all cases. Conclusions: When there is integration and proper training of all of the teams involved, the implementation of a robotic thoracic surgery program is feasible and can reduce morbidity and mortality.

Measurement of the Inter-Rater Reliability Rate Is Mandatory for Improving the Quality of a Medical Database: Experience with the Paulista Lung Cancer Registry

BACKGROUND Database quality measurement should be considered a mandatory step to ensure an adequate level of confidence in data used for research and quality improvement. Several metrics have been described in the literature, but no standardized approach has been established. We aimed to describe a methodological approach applied to measure the quality and inter-rater reliability of a regional multicentric thoracic surgical database (Paulista Lung Cancer Registry). STUDY DESIGN Data from the first 3 years of the Paulista Lung Cancer Registry underwent an audit process with 3 metrics: completeness, consistency, and inter-rater reliability. The first 2 methods were applied to the whole data set, and the last method was calculated using 100 cases randomized for direct auditing. Inter-rater reliability was evaluated using percentage of agreement between the data collector and auditor and through calculation of Cohens κ and intraclass correlation. RESULTS The overall completeness per section ranged from 0.88 to 1.00, and the overall consistency was 0.96. Inter-rater reliability showed many variables with high disagreement (>10%). For numerical variables, intraclass correlation was a better metric than inter-rater reliability. Cohens κ showed that most variables had moderate to substantial agreement. CONCLUSIONS The methodological approach applied to the Paulista Lung Cancer Registry showed that completeness and consistency metrics did not sufficiently reflect the real quality status of a database. The inter-rater reliability associated with κ and intraclass correlation was a better quality metric than completeness and consistency metrics because it could determine the reliability of specific variables used in research or benchmark reports. This report can be a paradigm for future studies of data quality measurement.

P1.20: Lung Resection Analysis From Brazilian Society of Thoracic Surgery Database: Track: Early Stage NSCLC (Stage I - III)

Results: This series included 11 patients aged 50y or less. Ten patients were women (90.9%), nine of them were never-smokers (90%). 81.8% had lung adenocarcinoma (n1⁄49), 9.1% large-cell carcinoma (n1⁄41) and 9.1% giant-cell carcinoma (n1⁄41). Nine patients were diagnosed at stage-IV and two patients at stages IA and IIB. Six patients (54.5%) were positive for either EGFR mutations (n1⁄43) or EML4-ALK fusions (n1⁄43) and two of them received TT with a tyrosine kinase inhibitor. Interestingly, all patients under 40y were mutated. Regarding to follow-up, 63.6% were not able to be followed, 27.3% died. Only one patient, who received TT with erlotinib, was followed-up at our institution (Table 1).

Quality evaluation of medical care in clinical practice

Evaluation of the quality of medical care is an issue that is becoming topical in Brazil. However, this subject has been a recurrent issue in foreign medical associations. During the 1980s, the American medical community started to discuss the importance of comparative analysis of sur -gical results as a tool for improving the quality of surgical treatment. At that time, a need for a single register for combining data from different institutions arose, since the heterogeneity of the databases and definitions of outcomes in different services made this task impossible. However, the task of designing and implementing these registers was a challenge that required much leadership and funding.