{"id":2274,"date":"2026-06-11T00:00:00","date_gmt":"2026-06-11T03:00:00","guid":{"rendered":"https:\/\/sevenresiduosaude.com.br\/blog\/?p=2274"},"modified":"2026-06-11T00:00:00","modified_gmt":"2026-06-11T03:00:00","slug":"pgrss-clinica-medicina-cir-oncologica-toracica-lobectomia-vats-rats-pneumectomia-sbrt-osimertinib","status":"publish","type":"post","link":"https:\/\/sevenresiduosaude.com.br\/blog\/pgrss-clinica-medicina-cir-oncologica-toracica-lobectomia-vats-rats-pneumectomia-sbrt-osimertinib\/","title":{"rendered":"PGRSS tor\u00e1cica: VATS, RATS, lobect, SBRT"},"content":{"rendered":"

A regula\u00e7\u00e3o brasileira de RSS \u00e9 frequentemente subaproveitada por gestores de cl\u00ednicas de cirurgia oncol\u00f3gica tor\u00e1cica que reduzem PGRSS a descarte de bisturi e gaze<\/strong>. Em 2026, h\u00e1 um cen\u00e1rio desafiador \u2014 cl\u00ednicas de cir oncol\u00f3gica tor\u00e1cica<\/strong> + CPNPC carcinoma pulm\u00e3o n\u00e3o-pequenas c\u00e9lulas 85%+CPCP carcinoma pequenas c\u00e9lulas 15%<\/strong> + adenoCa 50% + escamoso 30% + grandes c\u00e9lulas 10% + outros 10%<\/strong> + lobectomia VATS Video-Assisted Thoracoscopic Surgery + RATS Robotic-Assisted Thoracic Surgery Da Vinci Xi+SP<\/strong> + pneumectomia + bilobectomia + segmentectomia<\/strong> + SBRT Stereotactic Body Radiation Therapy CyberKnife+TrueBeam STx + IGRT image-guided<\/strong> + osimertinib Tagrisso EGFR + alectinib Alecensa ALK + lorlatinib Lorbrena ALK 1L+ + selpercatinib Retevmo RET + entrectinib Rozlytrek ROS1\/NTRK + trastuzumab deruxtecan Enhertu HER2 + sotorasib Lumakras KRAS-G12C + datopotamab Datroway TROP-2<\/strong> geram fluxos heterog\u00eaneos de RSS Grupo A1 (CPNPC adenoCa+escamoso+grandes c\u00e9lulas + CPCP small cell + carcinoide bronquico typical\/atypical + mesotelioma pleural epitelioide+sarcomatoide+bif\u00e1sico) + Grupo A4 (linfa mediastinal esta\u00e7\u00e3o 1-14 + N1 hilar + N2 ipsilateral mediastinal + N3 contralateral\/supraclavicular + Mountain-Dresler IASLC) + Grupo C (Iridium-192 brachy intraluminal raro + Y-90 SIRT met\u00e1stase hep\u00e1tica raro) + Grupo E (perfuro EBUS-TBNA endobronchial ultrasound + EUS-FNA + bi\u00f3psia core CT-guided + agulha core 18G+20G) + Lista C5 (osimertinib Tagrisso AstraZeneca EGFR T790M+L858R+exon 19 FLAURA+ADAURA + erlotinib Tarceva+gefitinib Iressa+afatinib Giotrif+dacomitinib Vizimpro EGFR + alectinib Alecensa Roche ALEX+lorlatinib Lorbrena Pfizer CROWN ALK 1L+brigatinib Alunbrig+ceritinib Zykadia+crizotinib Xalkori+ + selpercatinib Retevmo Lilly LIBRETTO-001 RET+pralsetinib Gavreto + entrectinib Rozlytrek Roche ROS1\/NTRK+repotrectinib Augtyro+ + larotrectinib Vitrakvi NTRK + sotorasib Lumakras Amgen CodeBreaK+adagrasib Krazati Mirati KRYSTAL KRAS-G12C + trastuzumab deruxtecan Enhertu DESTINY-Lung01\/02 HER2+ + datopotamab deruxtecan Datroway AstraZeneca\/Daiichi Sankyo TROP-2 TROPION-Lung01 + pembrolizumab Keytruda KEYNOTE-189\/407+nivolumab Opdivo+atezolizumab Tecentriq+durvalumab Imfinzi PACIFIC+cemiplimab Libtayo+amivantamab Rybrevant EGFR exon 20+lazertinib Leclaza Lista C5).<\/p>\n

Para o gestor que opera ou planeja cl\u00ednica de cir oncol\u00f3gica tor\u00e1cica, \u00e9 fundamental dimensionar PGRSS espec\u00edfico desde o in\u00edcio.<\/p>\n

Os 5 fluxos oncol\u00f3gicos tor\u00e1cicos<\/h2>\n

Em uma opera\u00e7\u00e3o de qualquer porte, o PGRSS tor\u00e1cica tem 5 fluxos.<\/p>\n\n\n\n\n\n\n\n\n\n
Fluxo<\/th>\nVolume<\/th>\nFrequ\u00eancia<\/th>\nParticularidade<\/th>\n<\/tr>\n<\/thead>\n
A1 CPNPC+CPCP+meso<\/td>\n5-13 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nAdeno+escamoso+SCLC<\/td>\n<\/tr>\n
A4 linfa mediastinal<\/td>\n4-12 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nN1+N2+N3 IASLC<\/td>\n<\/tr>\n
C SBRT+brachy raro<\/td>\n0,5-1,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nCyberKnife+TrueBeam<\/td>\n<\/tr>\n
E EBUS-TBNA+bi\u00f3psia<\/td>\n0,8-2,5 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nOlympus EBUS+core CT<\/td>\n<\/tr>\n
Lista C5 targeted+imuno<\/td>\n1,5-4,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nTagrisso+Alecensa+pembro<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

A soma t\u00edpica \u00e9 11,8-33,5 kg\/dia<\/strong> em cl\u00ednica cir oncol\u00f3gica tor\u00e1cica m\u00e9dia porte.<\/p>\n

A1 CPNPC adenoCa + escamoso + CPCP + mesotelioma + biomarker comprehensive: o est\u00e1gio cir\u00fargico<\/h2>\n

A primeira camada do PGRSS tor\u00e1cica \u00e9 A1. Padr\u00e3o setorial inclui (a) CPNPC carcinoma pulm\u00e3o n\u00e3o-pequenas c\u00e9lulas 85%<\/strong> com adenoCa 50% mais comum + escamoso 30% + grandes c\u00e9lulas 10% + outros 10% + EGFR muta\u00e7\u00e3o 15-20% asi\u00e1tico+25-50% nunca-fumante + ALK 5% + ROS1 1-2% + KRAS 25-30% + BRAF 2-3% + HER2 2-3% + RET 1-2% + NTRK <1% + MET 3-5% + TROP-2; (b) CPCP small cell carcinoma 15%<\/strong> com origem neuroend\u00f3crino + tabagismo + extens\u00e3o limited+extensive + EP etoposide+platina + atezolizumab IMpower133 + durvalumab CASPIAN; (c) mesotelioma pleural<\/strong> com asbestos exposi\u00e7\u00e3o + epitelioide+sarcomatoide+bif\u00e1sico + nivolumab+ipilimumab CheckMate-743 1L + EPP extrapleural pneumonectomy + decortication; (d) estadiamento IASLC TNM 8\u00aa edi\u00e7\u00e3o<\/strong> com Tis+T1a-c+T2a\/b+T3+T4+N0\/N1\/N2\/N3+M0\/M1a-c + ENETS carcinoide bronquico + CID C34; (e) biomarker comprehensive NGS<\/strong> com FoundationOne CDx + Guardant360 ctDNA + Liquid biopsy MRD ClonoSEQ Adaptive + tumor mutational burden TMB + PD-L1 TPS Tumor Proportion Score 22C3 Dako+SP263 Ventana+SP142+ + Lynch+HRD homologous recombination deficiency.<\/p>\n

Cl\u00ednica com A1 tor\u00e1cica madura garante margem R0<\/strong> + previne recidiva regional<\/strong> + otimiza estadiamento IASLC+biomarker NGS comprehensive<\/strong>. Como discutimos no post sobre pneumo<\/a>, A1 tor\u00e1cica \u00e9 base.<\/p>\n

A4 lobectomia VATS + RATS + pneumectomia + linfadenectomia mediastinal: o est\u00e1gio cir\u00fargico<\/h2>\n

A segunda camada \u00e9 t\u00e9cnica. Padr\u00e3o setorial inclui (a) lobectomia anat\u00f4mica padr\u00e3o<\/strong> com lobo superior+m\u00e9dio+inferior direito+esquerdo + ressec\u00e7\u00e3o br\u00f4nquica + arterial + venosa hilar + linfadenectomia sistem\u00e1tica mediastinal; (b) VATS Video-Assisted Thoracoscopic Surgery<\/strong> com 2-3 portais + utilidade incision 4-6cm sem afastador costal + Storz\/Olympus camera 10mm 0\u00b0\/30\u00b0\/45\u00b0 + LigaSure Maryland+Harmonic Ace+; (c) RATS Robotic-Assisted Thoracic Surgery<\/strong> com Da Vinci Xi multi-port + Da Vinci SP single-port + Medtronic Hugo + 4-arm + Endowrist + 3D c\u00e2mera Firefly ICG + EndoWrist Stapler; (d) pneumectomia<\/strong> com remo\u00e7\u00e3o pulm\u00e3o completo + indica\u00e7\u00e3o tumor central + fissura incompleta + pr\u00e9-operat\u00f3rio PFP fun\u00e7\u00e3o pulmonar + ergoespirometria CPET + perfus\u00e3o V\/Q quantitativa; (e) segmentectomia + bilobectomia + sleeve resection<\/strong> com CALGB 140503+JCOG 0802 segmentectomia non-inferior lobectomia \u22642cm CPNPC + sleeve preserva par\u00eanquima manga + GTR.<\/p>\n

Cl\u00ednica com A4 lobectomia VATS+RATS madura escala R0 90+%<\/strong> + escala VATS lobectomia 60-80% caso eleg\u00edvel<\/strong> + escala segmentectomia \u22642cm non-inferior CALGB 140503<\/strong>. Conex\u00e3o com hospital especializado<\/a>.<\/p>\n

SBRT CyberKnife + osimertinib FLAURA + alectinib ALEX + KEYNOTE-189 + datopotamab TROPION: o est\u00e1gio sist\u00eamico+radio<\/h2>\n

A terceira camada \u00e9 SBRT+targeted+imuno. Padr\u00e3o setorial inclui (a) SBRT Stereotactic Body Radiation Therapy CyberKnife Accuray + TrueBeam STx Varian + IGRT image-guided + 4D-CT respiratory motion<\/strong> com 50-60 Gy em 3-5 fra\u00e7\u00f5es + early stage non-surgical CPNPC + RTOG 0236 + LungTech + STARS+ROSEL phase III; (b) osimertinib Tagrisso AstraZeneca EGFR mutation 1L<\/strong> FLAURA OS 38,6m vs 31,8m TKI 1\u00aa gera\u00e7\u00e3o + ADAURA adjuvante OS hazard ratio 0,49 + LAURA chemoradiation maintenance unresectable LASCLC; (c) alectinib Alecensa Roche ALK 1L<\/strong> ALEX OS 5y 62,5% vs 45,5% crizotinib + lorlatinib Lorbrena Pfizer CROWN OS 5y 60% 1L + brigatinib Alunbrig + ceritinib Zykadia 2L + crizotinib Xalkori original; (d) KEYNOTE-189 pembrolizumab+pemetrexed+platina<\/strong> non-squamous PD-L1 unselected OS 22m vs 10,7m chemo + KEYNOTE-407 pembro+carbo+paclitaxel\/nab-paclitaxel squamous OS 17,1m + nivolumab+ipilimumab+chemo CheckMate-9LA + atezolizumab+bevacizumab+chemo IMpower150 + cemiplimab Libtayo Regeneron PD-L1 \u226550% EMPOWER-Lung 1; (e) datopotamab deruxtecan Datroway AstraZeneca\/Daiichi Sankyo TROP-2 ADC<\/strong> TROPION-Lung01 6mg\/kg q3w 2L+ NSCLC + amivantamab Rybrevant Janssen EGFR-MET bispecific exon 20 insertion CHRYSALIS+PAPILLON + lazertinib Leclaza+osimertinib MARIPOSA + sotorasib KRAS+adagrasib + selpercatinib RET+pralsetinib + entrectinib ROS1\/NTRK+repotrectinib + larotrectinib NTRK + trastuzumab deruxtecan Enhertu HER2 DESTINY-Lung01\/02 Lista C5.<\/p>\n

Cl\u00ednica com SBRT+osimertinib+alectinib+KEYNOTE-189+datopotamab madura escala SBRT early-stage local control 90+% 3y<\/strong> + escala FLAURA OS 38,6m EGFR 1L<\/strong> + escala ALEX OS 5y 62,5% ALK 1L<\/strong> + escala KEYNOTE-189 OS 22m 1L imuno+chemo<\/strong>. Conex\u00e3o com Lista C5<\/a>.<\/p>\n

Tr\u00eas perfis de PGRSS por capacidade tor\u00e1cica<\/h2>\n

Cl\u00ednica tor\u00e1cica s\u00f3 A1.<\/strong> 1 fluxo. Custo mensal R$ 9.000-26.000<\/strong> mas perda de A4+SBRT+E+sist\u00eamico.<\/p>\n

Cl\u00ednica tor\u00e1cica A1 + A4 + KEYNOTE-189.<\/strong> 3 fluxos. Custo mensal R$ 22.000-54.000<\/strong>, captura cirurgia + sist\u00eamico padr\u00e3o.<\/p>\n

Cl\u00ednica tor\u00e1cica 5 fluxos completos.<\/strong> A1+A4+SBRT+E+sist\u00eamico + integra\u00e7\u00e3o com servi\u00e7os hospitalares<\/a>. Custo mensal R$ 40.000-95.000<\/strong>, efic\u00e1cia 95%, ROI 800-2.500% via captura completa tor\u00e1cica + osimertinib FLAURA OS 38,6m + alectinib ALEX OS 5y 62,5% + KEYNOTE-189 OS 22m.<\/p>\n

Os tr\u00eas erros que aparecem em cir oncol\u00f3gica tor\u00e1cica<\/h2>\n

O primeiro \u00e9 a subdimensionamento Lista C5 targeted+imuno NSCLC<\/strong>. Sem segrega\u00e7\u00e3o osimertinib+alectinib+lorlatinib+selpercatinib+entrectinib+sotorasib+adagrasib+trastuzumab deruxtecan+datopotamab+amivantamab+lazertinib+pembrolizumab+nivolumab+atezolizumab+durvalumab+cemiplimab+pemetrexed+carboplatina+paclitaxel + Lista C5 = n\u00e3o-conformidade ANVISA RDC 222 + risco contamina\u00e7\u00e3o cruzada profissional + impacto financeiro.<\/p>\n

O segundo \u00e9 a mistura A1 CPNPC + CPCP + mesotelioma<\/strong>. Confunde rastreabilidade tumor + impossibilita IASLC TNM+biomarker NGS comprehensive + risco indica\u00e7\u00e3o inadequada (osimertinib EGFR vs alectinib ALK vs sotorasib KRAS vs imuno PD-L1).<\/p>\n

O terceiro \u00e9 a falta de protocolo NGS molecular profiling pr\u00e9-targeted<\/strong>. Sem FoundationOne CDx+Guardant360 ctDNA+EGFR+ALK+ROS1+RET+NTRK+KRAS+BRAF+HER2+MET+TROP-2+PD-L1 TPS comprehensive panel = perda elegibilidade targeted+imuno + zero precision medicine.<\/p>\n

A regula\u00e7\u00e3o de PGRSS tor\u00e1cica no Brasil est\u00e1 em fase de moderniza\u00e7\u00e3o t\u00e9cnica acelerada com cir oncol\u00f3gica preservadora como prioridade. As institui\u00e7\u00f5es que estruturam fluxos completos desde o in\u00edcio \u2014 alinhadas com PGRSS cl\u00ednicas especializadas<\/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 INCA C\u00e2ncer Pulm\u00e3o<\/a> \u00e9 refer\u00eancia t\u00e9cnica nacional.<\/p>\n

Solicite cota\u00e7\u00e3o PGRSS tor\u00e1cica 5 fluxos oncol\u00f3gicos<\/a><\/strong> \u2014 cap\u00edtulo dedicado a A1 CPNPC adenoCa 50%+escamoso 30%+grandes c\u00e9lulas 10%+EGFR 15-20%+ALK 5%+ROS1 1-2%+KRAS 25-30%+BRAF 2-3%+HER2 2-3%+RET 1-2%+NTRK <1%+MET 3-5%+TROP-2+CPCP small cell 15% EP etoposide+platina+atezolizumab IMpower133+durvalumab CASPIAN+mesotelioma asbestos+nivolumab+ipilimumab CheckMate-743+EPP+decortication+IASLC TNM 8\u00aa+CID C34+FoundationOne CDx+Guardant360 ctDNA+TMB+PD-L1 TPS 22C3 Dako+SP263 Ventana, A4 lobectomia VATS Video-Assisted+RATS Robotic Da Vinci Xi+SP+Medtronic Hugo+EndoWrist+Firefly ICG+pneumectomia+segmentectomia CALGB 140503+JCOG 0802 \u22642cm+sleeve resection+linfadenectomia mediastinal sistem\u00e1tica N1+N2+N3 Mountain-Dresler IASLC, C SBRT Stereotactic Body Radiation Therapy CyberKnife Accuray+TrueBeam STx Varian+IGRT image-guided+4D-CT+50-60 Gy 3-5 fra\u00e7\u00f5es+RTOG 0236+LungTech+STARS+ROSEL+Iridium-192 brachy raro+Y-90 SIRT raro+CNEN-NN-3.05, E EBUS-TBNA Olympus endobronchial ultrasound+EUS-FNA+bi\u00f3psia core CT-guided+agulha core 18G+20G+navega\u00e7\u00e3o eletromagn\u00e9tica superDimension Medtronic+Veran SPiN, Lista C5 osimertinib Tagrisso AstraZeneca FLAURA OS 38,6m+ADAURA+LAURA+erlotinib+gefitinib+afatinib+dacomitinib+alectinib Alecensa Roche ALEX OS 5y 62,5%+lorlatinib Lorbrena Pfizer CROWN+brigatinib+ceritinib+crizotinib+selpercatinib Retevmo Lilly LIBRETTO RET+pralsetinib Gavreto+entrectinib Rozlytrek Roche ROS1\/NTRK+repotrectinib Augtyro+larotrectinib Vitrakvi+sotorasib Lumakras Amgen CodeBreaK KRAS-G12C+adagrasib Krazati Mirati KRYSTAL+trastuzumab deruxtecan Enhertu DESTINY-Lung01\/02 HER2+datopotamab deruxtecan Datroway AstraZeneca\/Daiichi Sankyo TROP-2 TROPION-Lung01+pembrolizumab Keytruda KEYNOTE-189\/407+nivolumab Opdivo CheckMate-9LA+atezolizumab Tecentriq IMpower150+durvalumab Imfinzi PACIFIC+cemiplimab Libtayo EMPOWER-Lung 1+amivantamab Rybrevant Janssen EGFR-MET bispecific PAPILLON+lazertinib Leclaza+osimertinib MARIPOSA.<\/p>\n","protected":false},"excerpt":{"rendered":"

PGRSS oncologia tor\u00e1cica: lobect VATS+RATS + pneumect + SBRT. Veja.<\/p>\n","protected":false},"author":3,"featured_media":2273,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[2712,2894,2749,2601],"class_list":["post-2274","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance-legislacao","tag-cirurgia-oncologica","tag-sbrt","tag-toracica","tag-vats"],"_links":{"self":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2274","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=2274"}],"version-history":[{"count":1,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2274\/revisions"}],"predecessor-version":[{"id":4360,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2274\/revisions\/4360"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media\/2273"}],"wp:attachment":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media?parent=2274"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/categories?post=2274"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/tags?post=2274"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}