急诊肿瘤外科的质量:是时候提供高级肿瘤生命支持了。

Quality of emergency oncological surgery: time for advanced oncological life support.

机构信息

Universidade de São Paulo, Clinical Hospital, Cancer Institute, Faculty of Medicine - São Paulo (SP), Brazil.

Universidade de São Paulo, Clinical Hospital, Cancer Institute, Faculty of Medicine, Surgical Clinic Division - São Paulo (SP), Brazil.

出版信息

Rev Assoc Med Bras (1992). 2024 Jun 7;70(suppl 1):e2024S109. doi: 10.1590/1806-9282.2024S109. eCollection 2024.

Abstract

OBJECTIVE

In the emergency care of cancer patients, in addition to cancer-related factors, two aspects influence the outcome: (1) where the patient is treated and (2) who will perform the surgery. In Brazil, a significant proportion of patients with surgical oncological emergencies will be operated on in general hospitals by surgeons without training in oncological surgery.

OBJECTIVE

The objective was to discuss quality indicators and propose the creation of an urgent oncological surgery advanced life support course.

METHODS

Review of articles on the topic.

RESULTS

Generally, nonelective resections are associated with higher rates of morbidity and mortality, as well as lower rates of cancer-specific survival. In comparison to elective procedures, the reduced number of harvested lymph nodes and the higher rate of positive margins suggest a compromised degree of radicality in the emergency scenario.

CONCLUSION

Among modifiable factors is the training of the emergency surgeon. Enhancing the practice of oncological surgery in emergency settings constitutes a formidable undertaking that entails collaboration across various medical specialties and warrants endorsement and support from medical societies and educational institutions. It is time to establish a national registry encompassing oncological emergencies, develop quality indicators tailored to the national context, and foster the establishment of specialized training programs aimed at enhancing the proficiency of physicians serving in emergency services catering to cancer patients.

摘要

目的

在癌症患者的急救中,除了与癌症相关的因素外,还有两个方面会影响治疗结果:(1)患者接受治疗的地点,以及(2)进行手术的医生。在巴西,相当一部分接受外科肿瘤急症手术的患者将由没有肿瘤外科培训经验的普通外科医生在综合医院进行手术。

目的

讨论质量指标并提出创建紧急肿瘤外科高级生命支持课程的建议。

方法

对相关主题的文章进行回顾。

结果

一般来说,非选择性切除术与更高的发病率和死亡率相关,以及更低的癌症特异性生存率。与择期手术相比,采集的淋巴结数量减少和更高的阳性边缘率表明在紧急情况下的根治性程度降低。

结论

可改变的因素之一是急诊外科医生的培训。加强在紧急情况下进行肿瘤外科手术的实践是一项艰巨的任务,需要跨多个医学专业的合作,并需要医学协会和教育机构的认可和支持。现在是时候建立一个涵盖肿瘤急症的国家登记处了,制定适合国情的质量指标,并促进专门培训计划的建立,旨在提高为癌症患者服务的急诊服务医生的水平。

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