{"id":2284,"date":"2026-06-11T05:00:00","date_gmt":"2026-06-11T08:00:00","guid":{"rendered":"https:\/\/sevenresiduosaude.com.br\/blog\/?p=2284"},"modified":"2026-06-11T05:00:00","modified_gmt":"2026-06-11T08:00:00","slug":"pgrss-clinica-medicina-cir-oncologica-endometrial-figo-robotica-sln-lenvatinib-pembrolizumab-msi-h-dostarlimab-ruby","status":"publish","type":"post","link":"https:\/\/sevenresiduosaude.com.br\/blog\/pgrss-clinica-medicina-cir-oncologica-endometrial-figo-robotica-sln-lenvatinib-pembrolizumab-msi-h-dostarlimab-ruby\/","title":{"rendered":"PGRSS endometrial: FIGO, rob\u00f3tica, SLN, RUBY"},"content":{"rendered":"

A regula\u00e7\u00e3o brasileira de RSS \u00e9 frequentemente subaproveitada por gestores de cl\u00ednicas de cirurgia oncol\u00f3gica endometrial 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 endometrial<\/strong> + CE carcinoma endometrial endometrioide tipo I+seroso\/c\u00e9lulas claras tipo II+carcinossarcoma<\/strong> + FIGO 2023 reclassifica\u00e7\u00e3o molecular POLE-mutated+MMR-deficient+p53-abnormal+NSMP<\/strong> + histerectomia radical+total laparosc\u00f3pica+rob\u00f3tica Da Vinci Xi+SP<\/strong> + SLN sentinela ICG indocyanine green NCCN preferencial<\/strong> + omentectomia tipos serous\/clear cell<\/strong> + lenvatinib Lenvima Eisai+pembrolizumab Keytruda KEYNOTE-775 LEAP-001 + dostarlimab Jemperli GSK RUBY-1+RUBY-2 + tisotumab vedotin Tivdak ADC + selinexor Xpovio XPO1 + trastuzumab+tucatinib HER2<\/strong> geram fluxos heterog\u00eaneos de RSS Grupo A1 (CE endometrioide tipo I 80%+seroso 5%+c\u00e9lulas claras 3%+carcinossarcoma MMMT 5%+escamoso raro+adenoescamoso) + Grupo A4 (linfa p\u00e9lvica obturador+il\u00edaca interna externa primitiva + para-a\u00f3rtica + sentinela SLN ICG + TLH total laparoscopic hysterectomy + robotic hysterectomy Da Vinci Xi + omentectomia) + Grupo C (Iridium-192 brachy intracavit\u00e1ria HDR cilindro vaginal + Cesium-137 LDR raro + Y-90 SIRT raro) + Grupo E (perfuro bi\u00f3psia endometrial Pipelle Cornier + curetagem fracionada D&C dilation+curettage + histeroscopia diagnostic+operative) + Lista C5 (carboplatina+paclitaxel GOG 209 1L padr\u00e3o + cisplatina+doxorrubicina TAP + lenvatinib Lenvima Eisai 20mg PO QD + pembrolizumab Keytruda Merck KEYNOTE-775+LEAP-001 + dostarlimab Jemperli GSK PD-1 RUBY-1 1L MMR-d+RUBY-2 maintenance + tisotumab vedotin Tivdak InnovativeBio Pfizer ADC tissue factor + selinexor Xpovio Karyopharm SIENDO p53wt 2L + trastuzumab+tucatinib HER2 + larotrectinib NTRK + dabrafenib+trametinib BRAF + olaparib Lynparza PARP raro + atezolizumab Tecentriq + nivolumab Opdivo + ipilimumab Yervoy CheckMate-358).<\/p>\n

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

Os 5 fluxos oncol\u00f3gicos endometriais<\/h2>\n

Em uma opera\u00e7\u00e3o de qualquer porte, o PGRSS endometrial 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 CE endometrioide+seroso<\/td>\n5-13 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nTipo I+II+MMMT<\/td>\n<\/tr>\n
A4 PLND+SLN ICG+rob\u00f3tica<\/td>\n4-12 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nDa Vinci Xi+ICG<\/td>\n<\/tr>\n
C brachy HDR vaginal<\/td>\n0,8-2,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nCilindro+CTV+CNEN<\/td>\n<\/tr>\n
E Pipelle+D&C+histero<\/td>\n0,5-1,5 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nCornier+operative<\/td>\n<\/tr>\n
Lista C5 KEYNOTE+RUBY<\/td>\n1,5-4,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nCarbo+pacli+lenva+dost<\/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 endometrial m\u00e9dia porte.<\/p>\n

A1 CE endometrioide tipo I + seroso + c\u00e9lulas claras + classifica\u00e7\u00e3o molecular FIGO 2023: o est\u00e1gio cir\u00fargico<\/h2>\n

A primeira camada do PGRSS endometrial \u00e9 A1. Padr\u00e3o setorial inclui (a) CE carcinoma endometrial<\/strong> com endometrioide tipo I 80% + seroso tipo II 5% + c\u00e9lulas claras 3% + carcinossarcoma MMMT mixed mullerian m\u00fcllerian tumor 5% + escamoso raro + adenoescamoso + transtorno mesonefrico raro; (b) classifica\u00e7\u00e3o molecular ProMisE+TCGA TransPORTEC<\/strong> com POLE-mutated 7% ultramutated melhor progn\u00f3stico + MMR-deficient dMMR\/MSI-H 30% intermedi\u00e1rio + p53-abnormal 12% pior + NSMP no specific molecular profile 50% intermedi\u00e1rio; (c) FIGO 2023 staging molecular<\/strong> Stage I-IV combinado morfologia+molecular + IA1m POLEmut early disease + ISmm dMMR+NSMP + ICmp p53abn early disease + estadio cir\u00fargico-patol\u00f3gico imperativo; (d) biomarker comprehensive<\/strong> com IHC MMR MLH1+MSH2+MSH6+PMS2 + p53 wild-type vs aberrant + POLE sequencing + ER\/PR receptor + HER2 ASCO recomenda\u00e7\u00e3o seroso + LVI lymphovascular invasion; (e) histerectomia tipo padr\u00e3o<\/strong> com TLH total laparoscopic+RH robotic+TAH abdominal + BSO bilateral salpingo-oophorectomy + omentectomia tipos seroso\/clear cell + estadiamento cir\u00fargico FIGO 2023.<\/p>\n

Cl\u00ednica com A1 endometrial madura garante margem R0<\/strong> + previne recidiva regional<\/strong> + otimiza FIGO 2023 molecular ProMisE<\/strong>. Como discutimos no post sobre vulvovaginal<\/a>, A1 ginecol\u00f3gica \u00e9 base.<\/p>\n

A4 rob\u00f3tica Da Vinci Xi + SLN ICG + PLND + para-a\u00f3rtica: o est\u00e1gio cir\u00fargico<\/h2>\n

A segunda camada \u00e9 t\u00e9cnica. Padr\u00e3o setorial inclui (a) TLH total laparoscopic hysterectomy<\/strong> com 4 trocartes 5-12mm + Storz\/Olympus camera 10mm 0\u00b0\/30\u00b0 + LigaSure Maryland+Harmonic Ace+ + Ethicon Endopath + V-Loc autocomprometente; (b) robotic hysterectomy Da Vinci Xi+SP+Medtronic Hugo<\/strong> com 4-arm + EndoWrist + Firefly ICG + 3D c\u00e2mera HD + redu\u00e7\u00e3o convers\u00e3o+sangramento; (c) SLN sentinela ICG indocyanine green<\/strong> com 4 ml 1,25 mg\/ml cervical injection + Firefly fluoresc\u00eancia + NCCN preferencial 1L IB + FIRES+SENTI-ENDO trials + isolamento ultrastaging IHC; (d) PLND linfadenectomia p\u00e9lvica<\/strong> com obturador + il\u00edaca interna externa primitiva + 15-25 LN dissecados + indica\u00e7\u00e3o intermedi\u00e1rio-alto risco + omitir baixo risco SLN-negativo; (e) para-a\u00f3rtica linfadenectomia<\/strong> com at\u00e9 veia mesent\u00e9rica inferior IMA + at\u00e9 veia renal + indica\u00e7\u00e3o seroso+c\u00e9lulas claras+FIGO IIIA\/B\/C+ + complica\u00e7\u00e3o chyloperitoneum 5-10% + les\u00e3o vascular.<\/p>\n

Cl\u00ednica com A4 rob\u00f3tica+SLN+PLND madura escala R0 95+%<\/strong> + escala SLN ICG ultrastaging detection<\/strong> + otimiza Da Vinci Xi+SP single-port acesso<\/strong>. Conex\u00e3o com cervical<\/a>.<\/p>\n

Lenvatinib KEYNOTE-775 + dostarlimab RUBY + KEYNOTE-868 + selinexor SIENDO + trastuzumab+tucatinib HER2: o est\u00e1gio sist\u00eamico+targeted<\/h2>\n

A terceira camada \u00e9 sist\u00eamico+targeted. Padr\u00e3o setorial inclui (a) carboplatina+paclitaxel GOG 209 1L padr\u00e3o<\/strong> carbo AUC 5-6 + paclitaxel 175 mg\/m\u00b2 q3w \u00d7 6 ciclos + AP+TAP comparator + recurrent\/advanced\/metastatic; (b) lenvatinib Lenvima Eisai+pembrolizumab Keytruda Merck KEYNOTE-775 2L<\/strong> lenvatinib 20mg PO QD + pembrolizumab 200mg q3w + pMMR proficient MMR + OS 18,3m vs 11,4m chemo HR 0,68 + LEAP-001 1L lenvatinib+pembro vs chemo; (c) dostarlimab Jemperli GSK PD-1 RUBY-1 1L dMMR\/MSI-H<\/strong> + carbo+paclitaxel + dostarlimab manuten\u00e7\u00e3o + PFS 11,8m vs 7,9m placebo HR 0,28 + RUBY-2 maintenance + KEYNOTE-868 NRG-GY018 pembrolizumab+chemo+pembro maintenance dMMR + pMMR; (d) tisotumab vedotin Tivdak InnovativeBio Pfizer tissue factor TF ADC<\/strong> innovaTV-208 endometrial + selinexor Xpovio Karyopharm XPO1 inhibitor SIENDO p53wt subgroup PFS 13,7m vs 3,7m HR 0,38; (e) trastuzumab+tucatinib HER2 seroso 30%<\/strong> Fader trial + ENGOT-en9+lazertinib + dabrafenib+trametinib BRAF V600E raro + larotrectinib+entrectinib NTRK + olaparib Lynparza PARP raro + atezolizumab AtTEnd + nivolumab+ipilimumab CheckMate-358 Lista C5.<\/p>\n

Cl\u00ednica com KEYNOTE-775+RUBY+SIENDO+HER2 madura escala KEYNOTE-775 OS 18,3m pMMR 2L<\/strong> + escala RUBY-1 PFS 11,8m dMMR 1L<\/strong> + escala SIENDO PFS 13,7m p53wt selinexor<\/strong>. Conex\u00e3o com Lista C5<\/a>.<\/p>\n

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

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

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

Cl\u00ednica endometrial 5 fluxos completos.<\/strong> A1+A4+brachy+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 endometrial + KEYNOTE-775 OS 18,3m pMMR + RUBY-1 PFS 11,8m dMMR + SIENDO p53wt + Da Vinci Xi+SLN ICG.<\/p>\n

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

O primeiro \u00e9 a subdimensionamento Lista C5 imuno+targeted endometrial<\/strong>. Sem segrega\u00e7\u00e3o carbo+pacli+lenvatinib+pembrolizumab+dostarlimab+tisotumab vedotin+selinexor+trastuzumab+tucatinib+nivolumab+ipilimumab + Lista C5 = n\u00e3o-conformidade ANVISA RDC 222 + risco contamina\u00e7\u00e3o cruzada profissional + impacto financeiro.<\/p>\n

O segundo \u00e9 a falta de classifica\u00e7\u00e3o molecular ProMisE FIGO 2023<\/strong>. Sem POLE+dMMR+p53+NSMP testing universal + IHC MMR + p53 IHC + POLE sequencing + RUBY-1+KEYNOTE-868 dMMR vs pMMR vs p53wt + SIENDO = perda elegibilidade targeted + zero precision medicine + risco indica\u00e7\u00e3o inadequada.<\/p>\n

O terceiro \u00e9 a subdimensionamento SLN ICG NCCN preferencial<\/strong>. Sem Firefly ICG + cervical injection 4ml + ultrastaging IHC + FIRES+SENTI-ENDO + Da Vinci Xi mapeamento = perda detection precoce + zero SLN ICG ultrastaging + risco PLND completa desnecess\u00e1ria.<\/p>\n

A regula\u00e7\u00e3o de PGRSS endometrial 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 Endometrial<\/a> \u00e9 refer\u00eancia t\u00e9cnica nacional.<\/p>\n

Solicite cota\u00e7\u00e3o PGRSS endometrial 5 fluxos oncol\u00f3gicos<\/a><\/strong> \u2014 cap\u00edtulo dedicado a A1 CE endometrioide tipo I 80%+seroso tipo II 5%+c\u00e9lulas claras 3%+carcinossarcoma MMMT 5%+ProMisE+TCGA TransPORTEC POLE-mutated 7% ultramutated+dMMR\/MSI-H 30%+p53-abnormal 12%+NSMP 50%+FIGO 2023 staging molecular IA1m POLEmut+ISmm dMMR+ICmp p53abn+IHC MMR MLH1+MSH2+MSH6+PMS2+p53+POLE+ER\/PR+HER2+LVI+CID C54, A4 TLH total laparoscopic 4 trocartes+robotic Da Vinci Xi+SP+Medtronic Hugo+EndoWrist+Firefly ICG+3D c\u00e2mera+SLN sentinela ICG indocyanine green cervical injection 4ml+NCCN preferencial+FIRES+SENTI-ENDO+ultrastaging+PLND obturador+il\u00edaca+15-25 LN+para-a\u00f3rtica IMA+veia renal+omentectomia seroso\/clear cell, C brachy intracavit\u00e1ria HDR Iridium-192 cilindro vaginal+CTV+EMBRACE+ICRU-89+EBRT 50,4 Gy 28 fra\u00e7\u00f5es+IGRT+IMRT+CNEN-NN-3.05, E bi\u00f3psia Pipelle Cornier+D&C dilation+curettage+histeroscopia diagnostic+operative+Olympus EVIS X1, Lista C5 carbo+pacli GOG 209 1L+cisplatina+doxorrubicina TAP+lenvatinib Lenvima Eisai+pembrolizumab Keytruda Merck KEYNOTE-775 OS 18,3m pMMR+LEAP-001 1L+dostarlimab Jemperli GSK PD-1 RUBY-1 1L dMMR PFS 11,8m+RUBY-2 maintenance+KEYNOTE-868 NRG-GY018+tisotumab vedotin Tivdak InnovativeBio Pfizer innovaTV-208+selinexor Xpovio Karyopharm SIENDO p53wt PFS 13,7m+trastuzumab+tucatinib HER2 Fader+ENGOT-en9+olaparib Lynparza PARP+atezolizumab AtTEnd+nivolumab+ipilimumab CheckMate-358.<\/p>\n","protected":false},"excerpt":{"rendered":"

PGRSS endometrial: FIGO + rob\u00f3tica + SLN + lenvatinib + RUBY. Veja.<\/p>\n","protected":false},"author":3,"featured_media":2283,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[2712,3119,3120,3121],"class_list":["post-2284","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance-legislacao","tag-cirurgia-oncologica","tag-endometrial","tag-figo","tag-ruby"],"_links":{"self":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2284","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=2284"}],"version-history":[{"count":1,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2284\/revisions"}],"predecessor-version":[{"id":4365,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2284\/revisions\/4365"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media\/2283"}],"wp:attachment":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media?parent=2284"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/categories?post=2284"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/tags?post=2284"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}