Curetagem e eletrocoagulação versus exérese cirúrgica no tratamento do carcinoma basocelular de baixo risco: um ensaio clínico randomizado.
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2020-06-29
Autores
Bastos, Luan Moura Hortencio
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Universidade Estadual Paulista (Unesp)
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Fundamentos: O carcinoma basocelular (CBC) corresponde a 70-80% das neoplasias malignas de pele, demandando significativos recursos de saúde. Curetagem e eletrocoagulação (C&E) foi descrita no tratamento do CBC há algumas décadas, apresentando custos reduzidos e taxas de cura satisfatórias. Por outro lado, existem poucos estudos randomizados que compararam este tratamento com a cirurgia convencional em tumores de baixo risco. Objetivo: comparar os resultados após três meses da C&E versus cirurgia convencional para CBC de baixo risco em relação as complicações cirúrgicas, recuperação pós-operatória, aspecto estético e satisfação do paciente. Métodos: Ensaio clínico randomizado, paralelo e aberto comparando C&E com cirurgia convencional no tratamento de CBCs de baixo risco, com até 1 cm de diâmetro. Realizado com pacientes do ambulatório de dermatologia da Faculdade de Medicina de Botucatu. Foram avaliadas complicações, recuperação pós-operatória, satisfação e aspecto da cicatriz após três meses do procedimento. Resultados: Foram incluídos 116 tumores de 82 participantes, sendo 61 lesões no grupo da cirurgia convencional e 55 lesões no grupo da C&E alocados por meio de um app Javascript desenvolvido pela equipe pesquisadores. Quarenta e nove porcento mulheres e idade mediana de 72 anos. O diâmetro mediano das lesões foi de 7 mm, 76% de padrão clínico nodular e 55% localizados na região crânio-cervical de baixo risco. Em análise multivariada, as cicatrizes de C&E apresentaram maior alteração de cor (p<0,01), rigidez (p<0,01) e espessura (p=0,02). Não houve diferença quanto à satisfação e aos cuidados e complicações pós-operatórias, como infecção local, deiscência, sangramento ou retração cicatricial (p>0,33). Limitações: Estudo monocêntrico, não cegado, com seguimento de até três meses. Conclusões: Ambos os procedimentos foram bem tolerados pelos participantes, com altos níveis de satisfação e baixos níveis de complicações. Porém, cicatrizes mais inestéticas, após três meses, quando realizada C&E.
Background: Basal cell carcinoma (BCC) corresponds to 70-80% of malignant skin neoplasms, requiring significant health resources. Curettage and electrocoagulation (C&E) has been described in the treatment of BCC a few decades ago, with reduced costs and satisfactory cure rates. On the other hand, there are few randomized studies that compared this treatment with conventional surgery in low-risk tumors. Objective: to compare the results after three months of C&E versus conventional surgery for low-risk BCC in relation to surgical complications, postoperative recovery, aesthetic appearance and patient satisfaction. Methods: Randomized, parallel and open clinical trial comparing C&E with conventional surgery in the treatment of low-risk BCCs, up to 1 cm in diameter. Performed with patients from the dermatology outpatient clinic of the Faculty of Medicine of Botucatu. Complications, postoperative recovery, satisfaction and scar appearance were evaluated three months after the procedure. Results: 116 tumors from 82 participants were included, 61 lesions in the conventional surgery group and 55 lesions in the C&E group allocated through a Javascript app developed by the research team. Forty-nine percent women and a median age of 72 years. The median diameter of the lesions was 7 mm, 76% with a nodular clinical pattern and 55% located in the low-risk craniocervical region. In multivariate analysis, C&E scars showed greater color change (p <0.01), stiffness (p <0.01) and thickness (p = 0.02). There was no difference regarding satisfaction and care and postoperative complications, such as local infection, dehiscence, bleeding or scar retraction (p> 0.33). Limitations: Monocentric study, not blinded, with a follow-up of up to three months. Conclusions: Both procedures were well tolerated by the participants, with high levels of satisfaction and low levels of complications. However, more unsightly scars, after three months, when performed C&E.
Background: Basal cell carcinoma (BCC) corresponds to 70-80% of malignant skin neoplasms, requiring significant health resources. Curettage and electrocoagulation (C&E) has been described in the treatment of BCC a few decades ago, with reduced costs and satisfactory cure rates. On the other hand, there are few randomized studies that compared this treatment with conventional surgery in low-risk tumors. Objective: to compare the results after three months of C&E versus conventional surgery for low-risk BCC in relation to surgical complications, postoperative recovery, aesthetic appearance and patient satisfaction. Methods: Randomized, parallel and open clinical trial comparing C&E with conventional surgery in the treatment of low-risk BCCs, up to 1 cm in diameter. Performed with patients from the dermatology outpatient clinic of the Faculty of Medicine of Botucatu. Complications, postoperative recovery, satisfaction and scar appearance were evaluated three months after the procedure. Results: 116 tumors from 82 participants were included, 61 lesions in the conventional surgery group and 55 lesions in the C&E group allocated through a Javascript app developed by the research team. Forty-nine percent women and a median age of 72 years. The median diameter of the lesions was 7 mm, 76% with a nodular clinical pattern and 55% located in the low-risk craniocervical region. In multivariate analysis, C&E scars showed greater color change (p <0.01), stiffness (p <0.01) and thickness (p = 0.02). There was no difference regarding satisfaction and care and postoperative complications, such as local infection, dehiscence, bleeding or scar retraction (p> 0.33). Limitations: Monocentric study, not blinded, with a follow-up of up to three months. Conclusions: Both procedures were well tolerated by the participants, with high levels of satisfaction and low levels of complications. However, more unsightly scars, after three months, when performed C&E.
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Palavras-chave
Carcinoma basocelular, Curetagem, Eletrocoagulação, Oncologia Cirúrgica, Ensaio clínico, Basal cell carcinoma, Curettage, Eletrocoagulation, Surgical Oncology, Clinical trial