{"id":2287,"date":"2026-06-11T06:00:00","date_gmt":"2026-06-11T09:00:00","guid":{"rendered":"https:\/\/sevenresiduosaude.com.br\/blog\/?p=2287"},"modified":"2026-06-11T06:00:00","modified_gmt":"2026-06-11T09:00:00","slug":"pgrss-clinica-medicina-cir-oncologica-ovariana-figo-citoreducao-r0-hipec-olaparib-niraparib-mirvetuximab","status":"publish","type":"post","link":"https:\/\/sevenresiduosaude.com.br\/blog\/pgrss-clinica-medicina-cir-oncologica-ovariana-figo-citoreducao-r0-hipec-olaparib-niraparib-mirvetuximab\/","title":{"rendered":"PGRSS ovariana: FIGO, R0, HIPEC, olaparib"},"content":{"rendered":"

A regula\u00e7\u00e3o brasileira de RSS \u00e9 frequentemente subaproveitada por gestores de cl\u00ednicas de cirurgia oncol\u00f3gica ovariana 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 ovariana<\/strong> + CO carcinoma ovariano epitelial 90%+sex cord-stromal+germinativo+borderline+EOC HGSC high-grade serous 70%<\/strong> + FIGO 2014 IA-IVB + GOG\/ENGOT staging cir\u00fargico-patol\u00f3gico<\/strong> + citorredu\u00e7\u00e3o prim\u00e1ria PDS+intervalo IDS R0 macroscopic-residual zero<\/strong> + HIPEC Hyperthermic Intraperitoneal Chemotherapy OVHIPEC-1+OVHIPEC-2 PRODIGE<\/strong> + carbo+paclitaxel GOG 218 + ICON7 + bevacizumab Avastin manuten\u00e7\u00e3o<\/strong> + olaparib Lynparza SOLO-1+PAOLA-1+SOLO-2 BRCA + niraparib Zejula PRIMA + rucaparib Rubraca + veliparib + mirvetuximab soravtansine Elahere FR\u03b1 alfa-folate receptor MIRASOL + tisotumab vedotin<\/strong> geram fluxos heterog\u00eaneos de RSS Grupo A1 (CO HGSC+LGSC+endometrioide+c\u00e9lulas claras+mucinoso+borderline+sex cord-stromal+germinativo) + Grupo A4 (linfa p\u00e9lvica + para-a\u00f3rtica at\u00e9 veia renal + omentectomia infrac\u00f3lica\/total + citorredu\u00e7\u00e3o multivisceral) + Grupo C (HIPEC mitomicina+oxaliplatina+cisplatina + Y-90 SIRT raro) + Grupo E (perfuro paracentese + bi\u00f3psia asc\u00edtica core + EUS-FNA omento) + Lista C5 (carbo+paclitaxel GOG 218 1L + bevacizumab Avastin Genentech VEGF GOG 218+ICON7+OCEANS+AURELIA + olaparib Lynparza AstraZeneca SOLO-1+PAOLA-1+SOLO-2 BRCA + niraparib Zejula GSK PRIMA+NORA + rucaparib Rubraca Clovis ARIEL3 + veliparib AbbVie VELIA + mirvetuquimab soravtansine Elahere ImmunoGen\/AbbVie FR\u03b1-positivo MIRASOL + tisotumab vedotin Tivdak InnovativeBio Pfizer ADC tissue factor + pembrolizumab Keytruda KEYNOTE-826\/A18+nivolumab CheckMate-358+ipilimumab Yervoy + atezolizumab IMagyn050 + dostarlimab Jemperli MMR-d Lista C5).<\/p>\n

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

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

Em uma opera\u00e7\u00e3o de qualquer porte, o PGRSS ovariana 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 EOC+HGSC+borderline<\/td>\n5-13 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nHGSC 70%+CID C56<\/td>\n<\/tr>\n
A4 PDS+IDS+omentect<\/td>\n4-12 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nR0 macroscopic-residual<\/td>\n<\/tr>\n
C HIPEC+Y-90<\/td>\n1-3 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nMitomicina+oxali+cis<\/td>\n<\/tr>\n
E paracentese+bi\u00f3psia<\/td>\n0,5-1,5 kg\/dia<\/td>\nDi\u00e1ria<\/td>\nAsc\u00edtica+core+EUS<\/td>\n<\/tr>\n
Lista C5 PARP+ADC+imuno<\/td>\n1,5-4,5 kg\/dia<\/td>\nP\u00f3s-procedimento<\/td>\nSOLO-1+MIRASOL+RUBY<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

A soma t\u00edpica \u00e9 12-34 kg\/dia<\/strong> em cl\u00ednica cir oncol\u00f3gica ovariana m\u00e9dia porte.<\/p>\n

A1 EOC HGSC + borderline + sex cord + germinativo + biomarker BRCA+HRD: o est\u00e1gio cir\u00fargico<\/h2>\n

A primeira camada do PGRSS ovariana \u00e9 A1. Padr\u00e3o setorial inclui (a) EOC carcinoma ovariano epitelial 90%<\/strong> com HGSC high-grade serous 70% mais comum + LGSC low-grade serous 5% + endometrioide 10% + c\u00e9lulas claras 5% + mucinoso 3% + indiferenciado 2%; (b) borderline tumors LMP low malignant potential<\/strong> com serous+mucinoso+endometrioide + atypical proliferation + estadiamento conservador + fertility-sparing; (c) non-epitelial 10%<\/strong> com sex cord-stromal granulosa+Sertoli-Leydig+ginandroblastoma + germinativo dysgerminoma+yolk sac+immature teratoma + carcinosarcoma + sarcoma uterino; (d) biomarker comprehensive<\/strong> com CA-125 + HE4 + ROMA Risk Ovarian Malignancy Algorithm + IOTA ADNEX ultrasound + BRCA1\/2 germline+somatic + HRD homologous recombination deficiency Myriad myChoice CDx + FoundationOne CDx + MSI-H + PD-L1; (e) estadiamento FIGO 2014<\/strong> Stage I-IV + IA limitado ov\u00e1rio+IB bilateral+IC ruptura+IIA p\u00e9lvica+IIB+IIIA-C peritoneal+IV dist\u00e2ncia + CID C56 + tipo histol\u00f3gico WHO 2014 + grade FIGO+Silverberg.<\/p>\n

Cl\u00ednica com A1 ovariana madura garante margem R0<\/strong> + previne recidiva regional<\/strong> + otimiza estadiamento FIGO 2014+BRCA+HRD comprehensive<\/strong>. Como discutimos no post sobre endometrial<\/a>, A1 ginecol\u00f3gica \u00e9 base.<\/p>\n

A4 PDS primary + IDS interval + R0 macroscopic-residual + omentectomia: o est\u00e1gio cir\u00fargico<\/h2>\n

A segunda camada \u00e9 t\u00e9cnica. Padr\u00e3o setorial inclui (a) PDS Primary Debulking Surgery<\/strong> com citorredu\u00e7\u00e3o m\u00e1xima 1L FIGO IIIC-IV + R0 macroscopic-residual disease zero + R1 <1cm + R2 \u22651cm + OS ganho proporcional R0; (b) IDS Interval Debulking Surgery<\/strong> com NACT neoadjuvant 3 ciclos carbo+pacli + citorredu\u00e7\u00e3o intervalo + IDS R0 + EORTC 55971+CHORUS+SCORPION trials non-inferior PDS; (c) omentectomia infrac\u00f3lica vs total<\/strong> com infrac\u00f3lica padr\u00e3o + total estendida HGSC+invas\u00e3o omental + para-a\u00f3rtica linfadenectomia at\u00e9 veia renal indica\u00e7\u00e3o aparente Stage I; (d) citorredu\u00e7\u00e3o multivisceral<\/strong> com peritonectomia diafragm\u00e1tica + esplenectomia + colectomia + hepatic capsulectomy + diaphragmatic stripping + Sugarbaker upper abdominal; (e) complica\u00e7\u00e3o cir\u00fargica<\/strong> ileus 10-25% + f\u00edstula intestinal 3-8% + linforr\u00e9ia + sepse p\u00e9lvica + pneumonia p\u00f3s-op + DVT\/TEP + transfus\u00e3o massiva + LOS Length of Stay 7-14 dias.<\/p>\n

Cl\u00ednica com A4 PDS+IDS+R0+omentectomia madura escala R0 60-80%<\/strong> + previne complica\u00e7\u00e3o 10-25% ileus<\/strong> + otimiza OS ganho R0 vs R1 12-24 meses<\/strong>. Conex\u00e3o com hospital especializado<\/a>.<\/p>\n

HIPEC OVHIPEC + olaparib SOLO-1 + niraparib PRIMA + mirvetuximab MIRASOL + RUBY dostarlimab: o est\u00e1gio sist\u00eamico+targeted+ADC<\/h2>\n

A terceira camada \u00e9 HIPEC+PARP+ADC+imuno. Padr\u00e3o setorial inclui (a) HIPEC Hyperthermic Intraperitoneal Chemotherapy<\/strong> OVHIPEC-1 cisplatina 100 mg\/m\u00b2 41-43\u00b0C 90min + OVHIPEC-2 platinum-resistant + OS gain 11,8m vs 33,9m FIGO IIIC IDS+HIPEC HR 0,67 + PRODIGE; (b) carbo+paclitaxel GOG 218 1L padr\u00e3o<\/strong> + bevacizumab Avastin Genentech VEGF GOG 218+ICON7 OS extens\u00e3o + manuten\u00e7\u00e3o 21 ciclos; (c) PARP inhibitor maintenance 1L+2L<\/strong> olaparib Lynparza AstraZeneca SOLO-1 BRCA-mutated 1L PFS 56,0m vs 13,8m placebo HR 0,33 + PAOLA-1 olaparib+bevacizumab BRCA+\/HRD+ + SOLO-2 2L recurrent + niraparib Zejula GSK PRIMA 1L all-comers PFS 13,8m HRR0,62+NORA 2L+rucaparib Rubraca Clovis ARIEL3 2L+veliparib AbbVie VELIA 1L; (d) mirvetuquimab soravtansine Elahere ImmunoGen\/AbbVie FR\u03b1 alfa-folate receptor positive ADC<\/strong> MIRASOL 6 mg\/kg IV q3w 2L+ + ORR 42% vs 16% chemo + OS extens\u00e3o; (e) outras mol\u00e9culas<\/strong> tisotumab vedotin Tivdak InnovativeBio Pfizer ADC tissue factor + pembrolizumab Keytruda Merck KEYNOTE-826\/A18 + nivolumab Opdivo+ipilimumab Yervoy CheckMate-358 + atezolizumab Tecentriq IMagyn050 + dostarlimab Jemperli GSK MMR-d RUBY-1 raro + farletuzumab+farletuzumab ecteribulin FR\u03b1 + LIVE-PCa Lista C5.<\/p>\n

Cl\u00ednica com HIPEC+PARP+mirvetuximab madura escala HIPEC OVHIPEC-1 OS 33,9m FIGO IIIC<\/strong> + escala SOLO-1 PFS 56,0m BRCA 1L maintenance<\/strong> + escala MIRASOL ORR 42% FR\u03b1 2L+<\/strong>. Conex\u00e3o com Lista C5<\/a>.<\/p>\n

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

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

Cl\u00ednica ovariana 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 ovariana 5 fluxos completos.<\/strong> A1+A4+HIPEC+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 ovariana + HIPEC OS 33,9m + SOLO-1 PFS 56m BRCA + mirvetuximab MIRASOL FR\u03b1.<\/p>\n

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

O primeiro \u00e9 a subdimensionamento PARP+ADC+imuno Lista C5<\/strong>. Sem segrega\u00e7\u00e3o carbo+pacli+bevacizumab+olaparib+niraparib+rucaparib+veliparib+mirvetuximab+tisotumab vedotin+pembrolizumab+nivolumab+ipilimumab+atezolizumab+dostarlimab + Lista C5 = n\u00e3o-conformidade ANVISA RDC 222 + risco contamina\u00e7\u00e3o cruzada profissional + impacto financeiro.<\/p>\n

O segundo \u00e9 a mistura A1 EOC HGSC + LGSC + endometrioide + c\u00e9lulas claras + mucinoso<\/strong>. Confunde rastreabilidade tipo histol\u00f3gico + impossibilita FIGO 2014+BRCA+HRD comprehensive + risco indica\u00e7\u00e3o inadequada PARP (BRCA+ vs HRD+ vs HRD-).<\/p>\n

O terceiro \u00e9 a falta de protocolo BRCA1\/2 germline+somatic + HRD testing universal<\/strong>. Sem Myriad myChoice CDx HRD + FoundationOne CDx + comprehensive panel + germline+somatic + cascade testing familiar = perda elegibilidade PARP maintenance + zero precision medicine.<\/p>\n

A regula\u00e7\u00e3o de PGRSS ovariana 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 Ov\u00e1rio<\/a> \u00e9 refer\u00eancia t\u00e9cnica nacional.<\/p>\n

Solicite cota\u00e7\u00e3o PGRSS ovariana 5 fluxos oncol\u00f3gicos<\/a><\/strong> \u2014 cap\u00edtulo dedicado a A1 EOC carcinoma ovariano epitelial 90%+HGSC high-grade serous 70%+LGSC low-grade+endometrioide+c\u00e9lulas claras+mucinoso+indiferenciado+borderline LMP+sex cord-stromal granulosa+germinativo dysgerminoma+CA-125+HE4+ROMA+IOTA ADNEX+BRCA1\/2 germline+somatic+HRD Myriad myChoice CDx+FoundationOne CDx+MSI-H+PD-L1+FIGO 2014+CID C56+WHO 2014+Silverberg, A4 PDS Primary Debulking R0 macroscopic-residual+IDS Interval+EORTC 55971+CHORUS+SCORPION+omentectomia infrac\u00f3lica+total+para-a\u00f3rtica at\u00e9 veia renal+peritonectomia diafragm\u00e1tica+esplenectomia+colectomia+hepatic capsulectomy+diaphragmatic stripping+Sugarbaker, C HIPEC OVHIPEC-1 cisplatina 100 mg\/m\u00b2 41-43\u00b0C 90min+OVHIPEC-2 platinum-resistant+OS 33,9m FIGO IIIC HR 0,67+PRODIGE+Y-90 raro+CNEN-NN-3.05, E paracentese+bi\u00f3psia asc\u00edtica core+EUS-FNA omento, Lista C5 carbo+pacli GOG 218 1L+bevacizumab Avastin Genentech GOG 218+ICON7+OCEANS+AURELIA+olaparib Lynparza AstraZeneca SOLO-1 BRCA 1L PFS 56,0m+PAOLA-1 olaparib+bev BRCA+\/HRD+SOLO-2 2L+niraparib Zejula GSK PRIMA 1L all-comers PFS 13,8m+NORA 2L+rucaparib Rubraca Clovis ARIEL3+veliparib AbbVie VELIA+mirvetuximab soravtansine Elahere ImmunoGen\/AbbVie FR\u03b1 MIRASOL ORR 42%+tisotumab vedotin Tivdak InnovativeBio Pfizer ADC+pembrolizumab Keytruda KEYNOTE-826+nivolumab Opdivo+ipilimumab Yervoy CheckMate-358+atezolizumab Tecentriq IMagyn050+dostarlimab Jemperli GSK RUBY MMR-d.<\/p>\n","protected":false},"excerpt":{"rendered":"

PGRSS ovariana: FIGO + R0 citorredu\u00e7\u00e3o + HIPEC + olaparib BRCA. Veja.<\/p>\n","protected":false},"author":3,"featured_media":2286,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[2712,3123,3124,3122],"class_list":["post-2287","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-compliance-legislacao","tag-cirurgia-oncologica","tag-hipec","tag-olaparib","tag-ovariana"],"_links":{"self":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2287","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=2287"}],"version-history":[{"count":1,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2287\/revisions"}],"predecessor-version":[{"id":4366,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/posts\/2287\/revisions\/4366"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media\/2286"}],"wp:attachment":[{"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/media?parent=2287"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/categories?post=2287"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/sevenresiduosaude.com.br\/blog\/wp-json\/wp\/v2\/tags?post=2287"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}