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Objective Lung cancer (LC) is the leading cause of death from cancer worldwide. More than 27,000 LCs are diagnosed annually in Spain, and most are unresectable. Early detection and treatment reduce LC mortality. This study describes surgical outcomes in a longstanding LC screening cohort in Spain. Methods We conducted a retrospective study of surgical outcomes in a LC screening (LCS) program using low dose computed tomography (LDCT) since the year 2000. A descriptive analysis of clinical and radiological parameters, presence or absence of a preoperative diagnosis, pathological staging, morbidity, mortality, and survival was performed. Results Ninety-seven (2.5%) LC were diagnosed in 3825 screened. Twenty individuals with LC had no surgery due to advanced stage or small cell histology. Eighty-seven surgical procedures were carried out for suspected or biopsy proven LC, detected by LDCT. Most operated patients were male (57[85%]) aged 64 ± 9.1 years. Nine patients underwent a second operation for a metachronous primary lung cancer. Mean tumor size was 15.2 ± 7.6 mm. Eight nodules were benign (9.2%). Lobectomy was performed in 56 cases (83.6%). Adenocarcinoma (n = 39; 58.2%) was the most frequent histological type followed by squamous cell carcinoma (n = 17; 25.4%). Fifty-nine (88%) tumors were in Stage I. Thirteen patients (15.4%) had 16 complications. The estimated survival rates at 5 and 10 years for stage I were 93% (95% CI: 79%–98%) and 83% (95% CI: 65%–92%), respectively. Conclusion Lung cancer screening was associated with excellent surgical outcomes with 5 and 10-year survival rates exceeding 90 and 80%, respectively.

Resumen Introduccion La Guia espanola de la EPOC (GesEPOC) ha sido recientemente modificada. El objetivo de este trabajo es valorar la clasificacion y el pronostico de los enfermos segun la nueva clasificacion de la gravedad. Metodos Se siguio a 700 enfermos con EPOC (83,9% varones) durante un periodo medio de 5 anos en hospitales espanoles y de EE. UU. Se midieron datos antropometricos, funcion pulmonar, disnea medida con la escala mMRC, asi como exacerbaciones y los indices de BODE y Charlson. Se clasificaron segun el riesgo proporcionado por GesEPOC y se valoro el pronostico a 5 anos. Resultados Los pacientes tenian una edad media de 66 ± 9,6 anos y un FEV1% de 59,7 ± 20,2. El 40,43% de la muestra se encontraba en bajo riesgo. Los sujetos del grupo de alto riesgo presentaban un indice de BODE significativamente mayor que los de bajo riesgo (2,92 ± 0,66 vs. 0,52 ± 1,91, p Conclusiones La nueva clasificacion de la gravedad de GesEPOC predice la mortalidad de forma adecuada. No obstante, tanto el FEV1% como la disnea tienen la misma potencia para predecir mortalidad.

Lung Cancer (LC) screening with low dose chest computed tomography (LDCT) in smokers reduces LC mortality. Patients with Obstructive Lung Disease (OLD) are at high risk for LC. The potential effect of LC screening in this population is unknown.To determine if screening with LDCT reduces LC mortality in smokers with spirometrically defined OLD.The National Lung Screening Trial-American College of Radiology Imaging Network (NLST-ACRIN) study included 13,831 subjects (55-74 years of age with ≥30 pack-year history of smoking) that had a baseline spirometry. Randomly assigned to LDCT or Chest X-ray, all had 3 annual rounds of screening. LC mortality was compared between the LDCT and chest X-ray arms during the 1st year and at 6 years of follow up. Landmark analysis explored LC mortality differences between arms after the first year.From the 4584 subjects with OLD (FEV1/FVC0.7), 152 (3.3%) died from LC. Multivariable analysis showed that screening trended to decrease LC mortality at 6 years (HR, 95%CI: 0.75, 0.55-1.04, p=0.09). During the 1st year no differences were found between arms (p=0.65). However, after this year, LDCT significantly decreased LC mortality (HR, 95%CI: 0.63, 0.44-0.91, p=0.01). The number needed to screen to avoid one LC death in these subjects was 108 while in those without OLD was 218.LC screening with LDCT in smokers with spirometrically diagnosed OLD, showed a trend to reduce lung cancer mortality but a study with a larger number of patients and with a more robust design would be needed to confirm these findings.

Resumen La Sociedad Espanola de Neumologia y Cirugia Toracica (SEPAR), a traves de las areas de Cirugia Toracica y de Oncologia Toracica, ha promovido la realizacion de un manual de recomendaciones para el diagnostico y el tratamiento del cancer de pulmon de celulas no pequenas. Las elevadas incidencia y mortalidad de esta patologia hacen necesaria una constante actualizacion de las mejores evidencias cientificas para su consulta por parte de los profesionales de la salud. Para su confeccion se ha contado con un amplio grupo de profesionales de distintas especialidades que han elaborado una revision integral, que se ha concretado en 4 apartados principales. En el primero se ha estudiado la prevencion y el cribado de la enfermedad, incluyendo los factores de riesgo, el papel de la deshabituacion tabaquica y el diagnostico precoz mediante programas de cribado. En un segundo apartado se ha analizado la presentacion clinica, los estudios de imagen y el riesgo quirurgico, incluyendo el cardiologico y la evaluacion funcional respiratoria. Un tercero trata sobre los estudios de confirmacion cito-histologica y de estadificacion, con un analisis de las clasificaciones TNM e histologica, metodos no invasivos y minimamente invasivos, asi como las tecnicas quirurgicas para el diagnostico y estadificacion. En un cuarto y ultimo capitulo se han abordado aspectos del tratamiento, como el papel de las tecnicas quirurgicas, la quimioterapia, la radioterapia, el abordaje multidisciplinar por estadios y otros tratamientos dirigidos frente a dianas especificas, terminando con recomendaciones acerca del seguimiento del cancer de pulmon y los tratamientos paliativos quirurgicos y endoscopicos en estadios avanzados.

Introduction The Spanish COPD guidelines (GesEPOC) have been recently modified. The aim of this study is to assess this revision and evaluate the prognosis of patients according to the new classification of severity. Methods A total of 700 COPD patients (83.9% men) were prospectively followed up for a mean period of 5 years in tertiary hospitals in Spain and the USA. Anthropometric data, lung function tests, dyspnea (according to the mMRC scale), BODE and Charlson index were collected. We calculated mortality at 5 years following the risk criteria proposed by the new GesEPOC. Results Mean age was 66±9.6 years and mean FEV1% was 59.7±20.2. The proportion of patients in the low-risk group was 40.43%. Patients in the high-risk group had a significantly higher BODE index than those in the low-risk group (2.92±0.66 vs 0.52±1.91, P Conclusions The new severity index proposed by GesEPOC accurately predicts 5-year mortality. However, dyspnea and FEV1% have the same strength in predicting mortality.

Resumen Introduccion y objetivos La experiencia europea en relacion con el cribado de cancer de pulmon con tomografia de baja dosis de radiacion (TBDR) es amplia. Sin embargo, la evidencia sobre la experiencia en Espana es limitada. Nuestro objetivo es presentar los resultados del programa de cribado de cancer de pulmon mas largo de Espana. Metodos El Programa Internacional de Deteccion Precoz de Cancer de Pulmon con TBDR de Pamplona (P-IELCAP) viene reclutando individuos de manera activa desde el ano 2000 siguiendo el protocolo IELCAP. Se incluyen individuos ≥ 40 anos de edad, fumadores o ex fumadores (consumo acumulado ≥ 10 paquetes-ano). Los resultados se comparan con los de otros estudios europeos. Resultados Un total de 2.989 participantes fueron reclutados hasta marzo de 2014 (73% varones), realizando una mediana de 2 (IQR 1-3) rondas de cribado por individuo. Se detectaron 60 canceres de pulmon en 53 participantes (73% en estadio i ). Adenocarcinoma fue el tipo histologico mas frecuente. La proporcion de prevalencia e incidencia de cancer de pulmon fue del 1,0 y del 1,4%, respectivamente, con una tasa de deteccion anual de 0,41. La tasa de supervivencia a 10 anos de los pacientes con cancer de pulmon fue del 70%. La enfermedad pulmonar obstructiva cronica y el enfisema son importantes factores de riesgo para desarrollar cancer de pulmon. Conclusiones La experiencia del programa de cribado de cancer de pulmon mas largo de Espana es comparable con lo descrito en el resto de Europa y confirma la viabilidad y la eficacia del cribado mediante TBDR.

The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals.To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages. (C) 2016 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.

La navegaci?n electromagn?tica es una t?cnica novedosa capaz de facilitar la obtenci?n mediante broncoscopio de muestras de lesiones nodulares perif?ricas de peque?o tama?o y adenopat?as mediast?nicas. Permite realizar tanto biospias transbronquiales como punciones con aguja citol?gica, y por ello es muy vers?til. Publicamos el resultado de 2 casos en los que la combinaci?n de navegaci?n con el sistema superDimension/Bronchus y de t?cnicas diagn?sticas convencionales facilit? el diagn?stico definitivo mediante broncoscopia. La navegaci?n electromagn?tica ofrece la posibilidad de evitar m?todos diagn?sticos invasivos como la cirug?a, con el consiguiente ahorro econ?mico, de tiempo y de complicaciones.

European experience regarding lung cancer screening using low-dose chest CT (LDCT) is available. However, there is limited data on the Spanish experience in this matter. Our aim is to present the results from the longest ongoing screening program in Spain.The Pamplona International Early Lung Cancer Detection Program (P-IELCAP) is actively screening participants for lung cancer using LDCT since year 2000 following the IELCAP protocol, including spirometric assessments. Men and women, ≥40 years of age, current or former smokers with a tobacco history of ≥10 pack-years are included. Results are compared to those from other European trials.A total of 2989 participants were screened until March 2014 (73% male). A median of 2 (IQR 1-3) annual screening rounds were performed. Sixty lung cancers were detected in 53 participants (73% in StageI). Adenocarcinoma was the most frequent. The lung cancer prevalence and incidence proportion was 1.0% and 1.4%, respectively, with an annual detection rate of 0.41. The estimated 10-year survival rate among individuals with lung cancer was 70%. Chronic obstructive pulmonary disease and emphysema are important lung cancer predictors.The experience in Spain's longest lung cancer screening program is comparable to what has been described in the rest of Europe, and confirms the feasibility and efficacy of lung cancer screening using LDCT.

El manejo hospitalario del derrame pleural maligno incluye la colocacion de un tubo de toracostomia convencional, drenaje y esclerosis mediante talcaje, y/o el abordaje quirurgico mediante videotoracoscopia. Ambas tecnicas requieren ingresos prolongados, de hasta una semana de duracion. Lamentablemente, la esperanza de vida en pacientes con esta enfermedad no suele superar los 6 meses, motivo por el que toda intervencion paliativa destinada a mejorar la calidad de vida debe tener como objetivo primordial el evitar, en la medida de lo posible, el ingreso hospitalario y aliviar el dolor. Hay pocas alternativas ambulatorias al manejo hospitalario. De ellas, la toracocentesis de repeticion es la mas frecuentemente utilizada. Describimos el uso de un cateter tunelizado en el manejo ambulatorio del derrame pleural maligno de un paciente con adenocarcinoma de pulmon en estadio IIIB. Consideramos que este cateter ofrece una alternativa viable y mejor tolerada que el tratamiento convencional.

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a widely-accepted method for obtaining both benign and malignant mediastinal lymph node samples. We present the results obtained with a modification that simplifies sampling, known as fine-needle capillary sampling or EBUS-FNC.A prospective observational study with 44 consecutive patients who underwent EBUS at the University of Navarra Clinic in Pamplona (Spain). All samples were obtained by EBUS-FNC instead of by conventional EBUS-TBNA. No suction was used, and the internal stylus was not completely withdrawn at any time.The examination of the mediastinum by means of EBUS identified the presence of lymphadenopathies or mediastinal masses in 38 patients (86.4%). Samples were taken from more than one lymph node in 23 patients (52.3%). EBUS-FNC provided adequate and representative material for interpretation in all patients, and diagnostic performance was 87%. Sensitivity for the detection of lung cancer with EBUS-FNC was 84%. Mild complications were only recorded in two patients (4.5%).Our study suggests that EBUS-FNC is a safe technique, comparable to EBUS-TBNA in efficacy, and is able to obtain adequate samples.

Lung reduction has been show to be a promising treatment for the final phases of non-bullous pulmonary emphysema. The role of video-assisted thoracoscopy (VAT) in this disease has not yet been established. We report a case of bilateral non-bullous pulmonary emphysema in which transplantation was ruled out because of laryngeal neoplasm treated three months earlier. Using VAT, we performed bilateral lung reduction in the apical zones with good therapeutic results. We find that in patients reduction by VAT, although not a curative treatment, leads to immediate postoperative improvement in lung function and dyspnea, and does not exclude the possibility of later performing lung transplantation.

Inpatient management of malignant pleural effusion includes the placement of a conventional thoracostomy tube for drainage and talc slurry pleurodesis and/or a surgical approach consisting of video-assisted thoracoscopic talc insufflation. Both techniques require prolonged hospital stays of up to 1 week. Unfortunately, life expectancy in patients with this disease does not usually exceed 6 months, and so the primary aim of any palliative intervention intended to improve quality of life should be to avoid hospital admissions and to relieve pain as far as possible. Of the few outpatient alternatives to hospital management the most frequently used is repeated thoracentesis. We describe the outpatient management of malignant pleural effusion by placement of a tunneled pleural catheter in a patient with stage IIIB lung adenocarcinoma. In our opinion, the use of this catheter offers a viable alternative to conventional therapy and is better tolerated.