{"id":2068,"date":"2026-06-06T20:00:00","date_gmt":"2026-06-06T23:00:00","guid":{"rendered":"https:\/\/sevenresiduosaude.com.br\/blog\/?p=2068"},"modified":"2026-06-06T20:00:00","modified_gmt":"2026-06-06T23:00:00","slug":"pgrss-figado-oncologico-hepatectomia-alpps-rfa-mwa-y-90-tx-hepatico-cancer-figado-hcc","status":"publish","type":"post","link":"https:\/\/sevenresiduosaude.com.br\/blog\/pgrss-figado-oncologico-hepatectomia-alpps-rfa-mwa-y-90-tx-hepatico-cancer-figado-hcc\/","title":{"rendered":"PGRSS f\u00edgado onc: hepatec, ALPPS, RFA, Y-90"},"content":{"rendered":"

A regula\u00e7\u00e3o brasileira de RSS \u00e9 frequentemente desafiada por gestores de centros de cirurgia hep\u00e1tica oncol\u00f3gica. Em 2026, h\u00e1 uma demanda crescente de hospitais com unidade f\u00edgado oncol\u00f3gico \u2014 hepatocarcinoma HCC<\/strong> com cirrose Child-Pugh A\/B + Barcelona Clinic Liver Cancer BCLC, met\u00e1stase hep\u00e1tica colorretal CRC<\/strong> com FOLFOX\/FOLFIRI + bevacizumab + cetuximab, colangiocarcinoma intra-hep\u00e1tico CCA-i<\/strong> + CCA peri-hilar Klatskin<\/strong> + CCA distal<\/strong>, hepatectomia direita \/ esquerda \/ segmentar \/ at\u00edpica<\/strong> com ressec\u00e7\u00e3o de segmentos II-VIII Couinaud + Pringle clamp + CUSA, ALPPS Associating Liver Partition and Portal vein ligation for Staged hepatectomy<\/strong> para f\u00edgado remanescente <30%, TIPS \/ PVE Portal Vein Embolization<\/strong> pr\u00e9-op para hipertrofia hep\u00e1tica, TX hep\u00e1tico<\/strong> doador vivo split \/ falecido + bypass venovenoso + m\u00e1quina de perfus\u00e3o normot\u00e9rmica OCS Liver Transmedics \/ hipot\u00e9rmica HMP, abla\u00e7\u00e3o por radiofrequ\u00eancia RFA<\/strong> Cool-tip Medtronic \/ RITA Angiodynamics + abla\u00e7\u00e3o por micro-ondas MWA Emprint Medtronic + HIFU High Intensity Focused Ultrasound<\/strong> + IRE irreversible electroporation, TACE TransArterial ChemoEmbolization<\/strong> com doxorrubicina + lipiodol \/ DEB-TACE drug-eluting beads, TARE TransArterial RadioEmbolization Y-90<\/strong> Yttrium-90 com SIR-Spheres \/ TheraSphere R$ 35-65k\/dose CNEN-NN-3.05, immune checkpoint inhibitor<\/strong> atezolizumab Tecentriq + bevacizumab Avastin (regimen IMbrave150) + nivolumab Opdivo + sorafenibe Nexavar \/ lenvatinibe Lenvima TKI Lista C5. A consequ\u00eancia \u00e9 a urg\u00eancia de PGRSS dedicado para f\u00edgado oncol\u00f3gico<\/strong> \u2014 captura de pe\u00e7a operat\u00f3ria hepatectomia<\/strong> com 200-1.500g volumoso A4 + an\u00e1lise patol\u00f3gica complexa + margem cir\u00fargica + Glissonian sheath, CUSA Cavitron Ultrasonic Surgical Aspirator<\/strong> Integra R$ 12-25k consum\u00edvel + ponteira descart\u00e1vel, bisturi Harmonic ACE \/ LigaSure Maryland<\/strong> + clampe Pringle<\/strong> + SIVA-thopex stapler vascular<\/strong>, agulha RFA Cool-tip \/ RITA \/ Octopus<\/strong> R$ 4-10k + agulha MWA Emprint<\/strong> R$ 4-12k + eletrodos IRE NanoKnife<\/strong>, cateter TACE\/TARE<\/strong> com lipiodol + doxorrubicina + DEB beads, microspheres Y-90<\/strong> SIR-Spheres \/ TheraSphere R$ 35-65k\/dose CNEN-NN-3.05 + livro reten\u00e7\u00e3o 5 anos, atezolizumab Tecentriq + bevacizumab Avastin<\/strong> Lista C5 R$ 18-25k+8-15k\/dose IMbrave150, sorafenibe Nexavar \/ lenvatinibe Lenvima<\/strong> Lista C5 R$ 12-25k\/m\u00eas comprimido, OCS Liver Transmedics \/ HMP Hibernating<\/strong> circuito perfus\u00e3o R$ 80-150k descart\u00e1vel. A realidade \u00e9 que f\u00edgado oncol\u00f3gico produz RSS de alt\u00edssima complexidade. PGRSS de f\u00edgado oncol\u00f3gico \u00e9 cadeia integrada<\/strong> \u2014 come\u00e7a no diagn\u00f3stico<\/strong> (CT trif\u00e1sica + RM hepatoespec\u00edfica Eovist + biopsia + AFP\/CEA\/CA 19-9), passa pela terapia<\/strong> (hepatectomia + ALPPS + RFA\/MWA + TACE\/TARE + TX) e termina na adjuv\u00e2ncia<\/strong> (atezo+bev IMbrave150 + sorafenibe). O conjunto soma R$ 38.000-78.000\/m\u00eas<\/strong> que muitos gestores subestimam.<\/p>\n

Para o gestor que opera ou planeja unidade f\u00edgado oncol\u00f3gico, \u00e9 fundamental considerar a complexidade desde o in\u00edcio.<\/p>\n

Os procedimentos f\u00edgado oncol\u00f3gico e os RSS espec\u00edficos<\/h2>\n

Em uma opera\u00e7\u00e3o de qualquer porte, a cadeia gera RSS espec\u00edficos.<\/p>\n\n\n\n\n\n\n\n\n\n
Procedimento<\/th>\nInsumo cr\u00edtico<\/th>\nAnatomopatol\u00f3gico<\/th>\nRisco RSS<\/th>\n<\/tr>\n<\/thead>\n
Hepatectomia direita<\/td>\nCUSA + Pringle + Harmonic<\/td>\nF\u00edgado 200-1.500g<\/td>\nA4 volumoso + ergo<\/td>\n<\/tr>\n
ALPPS<\/td>\nPringle + transec\u00e7\u00e3o+ligadura<\/td>\nF\u00edgado em est\u00e1gios<\/td>\nA4 + RBI<\/td>\n<\/tr>\n
RFA \/ MWA<\/td>\nCool-tip\/Emprint R$ 4-12k<\/td>\nN\u00e3o-aplic\u00e1vel<\/td>\nA4 + RAEE eletrodo<\/td>\n<\/tr>\n
TACE \/ TARE Y-90<\/td>\nLipiodol+Y-90 SIR-Spheres<\/td>\nMicrospheres CNEN<\/td>\nA4 + radioativo CNEN<\/td>\n<\/tr>\n
Atezo+Bev IMbrave150<\/td>\nTecentriq+Avastin Lista C5<\/td>\nN\u00e3o-aplic\u00e1vel<\/td>\nA4 + B Lista C5<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

A soma t\u00edpica \u00e9 entre R$ 38.000-78.000\/m\u00eas<\/strong> em PGRSS dedicado de f\u00edgado oncol\u00f3gico vs R$ 14.000-28.000<\/strong> em PGRSS gen\u00e9rico subdimensionado.<\/p>\n

A hepatectomia direita\/esquerda + ALPPS: o procedimento volum\u00e9trico<\/h2>\n

A primeira camada do desafio \u00e9 a hepatectomia. Padr\u00e3o setorial inclui (a) acesso laparotomia mediana<\/strong> ou Mercedes (J-incision) ou laparo\/rob\u00f3tica; (b) manobra de Pringle<\/strong> clampeamento ped\u00edculo hep\u00e1tico intermitente; (c) CUSA Cavitron Ultrasonic Surgical Aspirator<\/strong> Integra R$ 12-25k + ponteira + bisturi Harmonic ACE \/ LigaSure Maryland<\/strong>; (d) transec\u00e7\u00e3o parenquimatosa<\/strong> com clip Hem-O-Lok + ligadura + sutura PDS; (e) livro RBI CUSA + cartucho<\/strong> reten\u00e7\u00e3o 10 anos.<\/p>\n

Hospital com 50-200 hepatectomias\/ano + 8-25 ALPPS\/ano \u00d7 R$ 15-25k consum\u00edveis = R$ 870k-5.6M\/ano em hepatectomia + ALPPS. Como discutimos no post sobre PGRSS de hepatobiliar<\/a>, tecnovigil\u00e2ncia \u00e9 estruturante.<\/p>\n

A RFA + MWA + TACE + TARE Y-90: o est\u00e1gio intervencional radioativo<\/h2>\n

A segunda camada \u00e9 o intervencional. Padr\u00e3o setorial inclui (a) RFA Cool-tip Medtronic<\/strong> R$ 4-8k \/ RITA Angiodynamics<\/strong> \/ Octopus electrode<\/strong>; (b) MWA Emprint Medtronic<\/strong> R$ 4-12k descart\u00e1vel; (c) TACE TransArterial ChemoEmbolization<\/strong> com doxorrubicina 50-150mg + lipiodol Lipoid + microsferas \/ DEB-TACE drug-eluting beads<\/strong> LC Bead\/HepaSphere R$ 4-12k; (d) TARE TransArterial RadioEmbolization Y-90<\/strong> Yttrium-90 microspheres SIR-Spheres Sirtex \/ TheraSphere Boston Scientific R$ 35-65k\/dose; (e) livro CNEN-NN-3.05 Y-90<\/strong> reten\u00e7\u00e3o 5 anos + transporte SED + planejamento dosim\u00e9trico SPECT\/CT pr\u00e9 + PET p\u00f3s.<\/p>\n

Hospital com 100-300 RFA\/MWA\/ano + 30-100 TACE\/TARE\/ano \u00d7 R$ 8-50k = R$ 800k-15M\/ano em intervencional + livro CNEN.<\/p>\n

O TX hep\u00e1tico + IMbrave150 + TKI sist\u00eamico: o est\u00e1gio Lista C5<\/h2>\n

A terceira camada \u00e9 o sist\u00eamico + transplante. Padr\u00e3o setorial inclui (a) TX hep\u00e1tico<\/strong> doador vivo split right\/left lobe + falecido com bypass venovenoso + m\u00e1quina OCS Liver Transmedics<\/strong> normot\u00e9rmica R$ 100-150k descart\u00e1vel + HMP Hibernating<\/strong> hipot\u00e9rmica R$ 80-100k; (b) IMbrave150 regimen<\/strong> atezolizumab Tecentriq Lista C5 1.200mg + bevacizumab Avastin Lista C5 15mg\/kg cada 3 semanas R$ 26-40k\/ciclo; (c) nivolumab Opdivo + ipilimumab Yervoy<\/strong> alternativa CheckMate-040; (d) sorafenibe Nexavar<\/strong> Bayer Lista C5 400mg 12\/12h R$ 12-20k\/m\u00eas \/ lenvatinibe Lenvima<\/strong> Eisai 8-12mg\/dia R$ 15-25k\/m\u00eas; (e) regorafenibe Stivarga<\/strong> 2\u00aa linha R$ 18-28k\/m\u00eas.<\/p>\n

Hospital com 30-100 TX hep\u00e1ticos\/ano + 100-300 advanced HCC \u00d7 IMbrave150 24 meses + 50-150 sorafenibe\/lenvatinibe = R$ 5-50M\/ano em TX + Lista C5.<\/p>\n

Tr\u00eas perfis de PGRSS para f\u00edgado oncol\u00f3gico<\/h2>\n

PGRSS gen\u00e9rico subdimensionado.<\/strong> Sem cobertura espec\u00edfica para Y-90 + Lista C5 + OCS Liver. Custo mensal R$ 14.000-28.000<\/strong>, efic\u00e1cia limitada.<\/p>\n

PGRSS dedicado intermedi\u00e1rio.<\/strong> Cobertura para hepatectomia + RFA, sem Y-90 + IMbrave150 + TX. Custo mensal R$ 28.000-50.000<\/strong>, efic\u00e1cia 100-200%.<\/p>\n

PGRSS dedicado completo f\u00edgado oncol\u00f3gico.<\/strong> Hepatectomia + ALPPS + RFA + MWA + TACE + TARE Y-90 + TX + IMbrave150 + integra\u00e7\u00e3o com PGRSS de hepatobiliar<\/a>. Custo mensal R$ 50.000-78.000<\/strong>, ROI 250-500%.<\/p>\n

Os tr\u00eas erros que aparecem em PGRSS f\u00edgado oncol\u00f3gico subdimensionado<\/h2>\n

O primeiro \u00e9 o subdimensionamento de Y-90 microspheres CNEN<\/strong>. SIR-Spheres\/TheraSphere R$ 35-65k\/dose com livro CNEN-NN-3.05 + reten\u00e7\u00e3o 5 anos.<\/p>\n

O segundo \u00e9 a aus\u00eancia de Lista C5 IMbrave150<\/strong>. Tecentriq+Avastin R$ 26-40k\/ciclo + cofre + cadeia fria + livro 344.<\/p>\n

O terceiro \u00e9 o descarte de OCS Liver \/ HMP como Grupo D<\/strong>. Circuito R$ 80-150k \u00e9 tecnovigil\u00e2ncia + livro RBI 10 anos.<\/p>\n

A regula\u00e7\u00e3o de PGRSS no Brasil est\u00e1 em fase de moderniza\u00e7\u00e3o t\u00e9cnica acelerada com f\u00edgado oncol\u00f3gico como prioridade. As institui\u00e7\u00f5es que estruturam PGRSS dedicado desde o in\u00edcio \u2014 alinhadas com calend\u00e1rio 2026 de compliance<\/a> \u2014 atravessam o crescimento sem solavanco. Para gestores que precisam alinhar com gest\u00e3o paralela industrial, o portal Seven Res\u00edduos sobre servi\u00e7os completos<\/a> traz a perspectiva integrada. A SBH Sociedade Brasileira de Hepatologia<\/a> \u00e9 refer\u00eancia t\u00e9cnica.<\/p>\n

Solicite cota\u00e7\u00e3o PGRSS de f\u00edgado oncol\u00f3gico<\/a><\/strong> \u2014 cap\u00edtulo dedicado a hepatectomia + CUSA + Pringle, ALPPS staged, RFA Cool-tip + MWA Emprint, TACE\/TARE Y-90 SIR-Spheres\/TheraSphere, IMbrave150 atezo+bev + sorafenibe\/lenvatinibe Lista C5.<\/p>\n","protected":false},"excerpt":{"rendered":"

F\u00edgado oncol\u00f3gico gera RSS espec\u00edfico \u2014 hepatectomia, ALPPS, RFA, Y-90, TX. PGRSS dedicado.<\/p>\n","protected":false},"author":3,"featured_media":2067,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[2882,2881,2814,2276],"class_list":["post-2068","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance-legislacao","tag-alpps","tag-figado-oncologico","tag-hepatectomia","tag-y-90"],"_links":{"self":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2068","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/comments?post=2068"}],"version-history":[{"count":1,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2068\/revisions"}],"predecessor-version":[{"id":4260,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2068\/revisions\/4260"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media\/2067"}],"wp:attachment":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media?parent=2068"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/categories?post=2068"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/tags?post=2068"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}