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Several series indicated that surgical stress suppresses the immune system and that the use of cardiopulmonary bypass (CPB), cardiac arrest and ischemia contributes to this[1,2]. The most significant contributors to immune suppression are still yet to be determined. It seems that the survival of cancer patients who undergo cardiac surgery is more closely related to the progression of the tumor than the surgical procedure[3]. The reported results show a non-statistically significant increase in the risk of cancer-specific mortality for patients who underwent CPB before any diagnosis of cancer. In addition, a non-statistically significant increase was observed in the case-fatality rate for those cancer patients who underwent CPB surgery before the cancer diagnosis, and no difference was found in cancer stage at the time of diagnosis, with no impact on the relative risk of mortality. Further research is needed to know whether the transient immunosuppression associated with CPB can promote the spread and growth of pre-existing cancer cells, emphasizing that lung cancer and skin melanoma have had the most extensive association studies. In conclusion, adverse effects of CPB on cancer prognosis are expected but have not been confirmed. This editorial was motivated by the experience of an isolated case of an emphysematous, chronic smoker patient, who presented an impressive spread of an oat cell lung tumor 20 to 30 days after myocardial revascularization. After our traditional “highlight”, we recommend an attentive reading of the editorial by Prof. Rui Almeida that marks the beginning of his presidency at the Sociedade Brasileira de Cirurgia Cardiovascular (Brazilian Society of Cardiovascular Surgery). In addition, a second exciting editorial, written by Professors Luciano Albuquerque and Walter Gomes, who give us in this edition of the Brazilian Journal of Cardiovascular Surgery (BJCVS), a magnificent analytical study about the ORBITA trial that deserves the full attention of our readers. Prof. Rui's reflections on training new generations of cardiac surgeons is a top priority for the future of our specialty, beginning with scientific initiation, medical residency, and class defense. It Domingo M. Braile1; Paulo Roberto B. Évora2

Cardiopulmonary Bypass and Cancer Dissemination: A Logical But Unlikely Association