Primary tumor (T)
TX Primary tumor cannot be assessed, or the tumor is proven by the presence of malignant cells in sputum or bronchial washing but is not visualized by imaging or bronchoscopy
T0 No evidence of primary tumor
Tis Carcinoma in situ
T1 Tumor ≤ 3 cm in greatest dimension, surrounded by lung or visceral pleura, no bronchoscopic evidence of invasion more proximal than the lobar bronchus (not in the main bronchus); superficial spreading of tumor in the central airways (confined to the bronchial wall )
T1a Tumor ≤ 2 cm in the greatest dimension
T1b Tumor > 2 cm but ≤ 3 cm in the greatest dimension
T2
Tumor > 3 cm but ≤ 7 cm or tumor with any of the following:
Invades visceral pleura
Involves the main bronchus ≥ 2 cm distal to the carina
Associated with atelectasis/obstructive pneumonitis extending to hilar region but not involving the entire lung T2a Tumor > 3 cm but ≤ 5 cm in the greatest dimension
T2b Tumor > 5 cm but ≤ 7 cm in the greatest dimension
T3
Tumor > 7 cm or one that directly invades any of the following:
Chest wall (including superior sulcus tumors), diaphragm, phrenic nerve, mediastinal pleura, or parietal pericardium;
Or tumor in the main bronchus < 2 cm distal to the carina but without involvement of the carina
Or associated atelectasis/obstructive pneumonitis of the entire lung or separate tumor nodule(s) in the same lobe
T4 Tumor of any size that invades any of the following: mediastinum, heart, great vessels, trachea, recurrent laryngeal nerve, esophagus, vertebral body, or carina; or separate tumor nodule(s) in a different ipsilateral lobe
Regional lymph nodes (N)
NX Regional lymph nodes cannot be assessed N0 No regional node metastasis
N1 Metastasis in ipsilateral peribronchial and/or ipsilateral hilar lymph nodes and intrapulmonary nodes, including involvement by direct extension
N2 Metastasis in the ipsilateral mediastinal and/or subcarinal lymph node(s)
N3 Metastasis in the contralateral mediastinal, contralateral hilar, ipsilateral or contralateral scalene, or supraclavicular lymph nodes Distant metastasis (M)
MX Distant metastasis cannot be assessed
46
M0 No distant metastasis M1 Distant metastasis
M1a Separate tumor nodule(s) in a contralateral lobe; tumor with pleural nodules or malignant pleural (or pericardial) effusion M1b Distant metastasis
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54 ABSTRACT
Objective: To assess the efficacy and safety of NIPPV for prevention of complications in patients who underwent pulmonary resection for lung cancer. Methods: It was developed a systematic review according to Cochrane Collaboration methodology. We searched the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, LILACS and PEDro (last search on 17 March 2015) to identify potentially eligible trials. We did not use any date or language restrictions in the electronic searches for trials. We searched the reference lists of relevant papers and contacted experts in the field for information about additional published and unpublished studies. Additionally we accessed the Register of Controlled Trials (www.controlled-trials.com) and ClinicalTrials.gov (clinicaltrials.gov) to identify ongoing studies. We considered randomised or quasi-randomised clinical trials that compared NIPPV in the immediate postoperative pulmonary resection with no intervention or conventional respiratory therapy. Two authors collected data and assessed trial risk of bias. Where possible, we pooled data from the individual studies using a fixed-effect model (quantitative synthesis) otherwise we tabulated or presented the data in the main text (qualitative synthesis). Where a substantial heterogeneity existed, we applied a random-effects model.
Results: From the 155 references retrieved from search strategies, six randomised clinical trials (RCTs) and one quasi-randomised trial fulfilled the eligibility criteria for this review, including a total of 436 patients. There was no statistical difference between the use or not of NIPPV when: (a) pulmonary complications rate (RR 1,03; IC 95% 0,72 to 1,47; five studies), (b) intubation rate (RR 0,55; IC 95% 0,25 to 1,20; three studies), (c) mortality (RR 0,60; 95% CI 0,24 to 1,53; five studies), (d) length of intensive care unit stay (DM-0,75; IC 95%
-3,93 to 2,43; two studies), (e) length of hospital stay (DM-0,12; 95% CI -6,15 to 5,90; four studies). None study describe any complications related to NIPPV. Regarding the quality of evidence, four studies were considered "low risk of bias" in all domains evaluated; two were considered 'high risk of bias" to allocation concealment domain where one of those also considered at "high risk of bias" to random sequence generation domain. One study was considered "high risk of bias" because inclusion of participants with more severe clinical conditions compared to participants from other studies. Conclusions: This review demonstrated that there was no additional benefit of using NIPPV in postoperative pulmonary resection for all outcomes analysed (pulmonary complications, rate of intubation, mortality, rate of non-pulmonary complications, postoperative consumption of antibiotics, length of intensive care unit stay, length of hospital stay and adverse effects related to NIPPV). However, the quality of evidence is "very low", "low" and
"moderate" since there were few studies, with small sample size and low frequency of outcomes. New well-designed and well-conducted randomised trials are needed to answer the questions of this review with greater certainty.
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55 APÊNDICE 1 - Documento de aprovação do Comitê de Ética em Pesquisa Local
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57 APÊNCIDE 2 - Revisão publicada na Biblioteca Cochrane
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