Search

BACKGROUND: The Spanish Customized Adjuvant Therapy (SCAT) trial assessed the role of individualized adjuvant therapy in clinical N0 incidental pN1 and/or N2 non-small cell lung cancer (NSCLC) completely resected. We assessed surgical topics with an in-depth analysis of quality of lymphadenectomy based on International Association for the Study of Lung Cancer (IASLC) recommendations. METHODS: Patients with information about lymphadenectomy available were included (N=451). Prospectively collected data about tumor, type of resection, and postoperative morbidity and quality of lymph node dissection (LND) were retrospectively evaluated. Role of lymph node assessment on survival was analyzed using Kaplan-Meier curves, using regression models to identify prognostic factors. RESULTS: In 33.7%, 17.7% and 49.9% of cases, regions 7, 10 and 11 respectively were not assessed. In 21.1% of patients, less than three lymph node regions were biopsied, while in 19.6% of patients less than six lymph nodes were assessed. In 53,4% of patients only one N1 region was evaluated. From patients with positive N2, 8.9% had no N1 regions biopsied. Twenty-nine percent of patients with at least one N2 lymph node resected shown the highest region involved. Thirty-day postoperative mortality was unknown. Five-year overall survival (OS) was 61.7% (95% CI: 55.4–67.4%), 51.5% (95% CI: 39.2–62.4%) and 42.3% (95% CI: 32.1–52.2%) for patients with N1, N2 and N1+N2 disease, respectively (P

Background Gastrointestinal complications after lung transplatation are associated with an increased risk of morbidity and mortality. This study aims to describe severe gastrointestinal complications (SGC) after lung transplantation. Methods We performed a prospective, observational study that included 136 lung transplant patients during a seven year period in a tertiary care universitary hospital. SGC were defined as any diagnosis related to the gastrointestinal or biliary tract leading to lower survival rates or an invasive therapeutic procedure. Early and late complications were defined as those occurring p Results There were 17 (12.5%) SGC in 17 patients. Five were defined as early. Twelve patients (70.6%) required surgical treatment. Mortality was 52.9% (n = 9). Patients with SGC had a lower overall survival rate compared to those who did not (14 vs 28 months, p = 0.0099). The development of arrhythmias in the first 48 h of transplantation was a risk factor for gastrointestinal complications (p = 0.0326). Conclusions SGC are common after lung transplantation and are associated with a considerable increase in morbidity-mortality. Early recognition is necessary to avoid delays in treatment, since a clear predictor has not been found in order to forecast this relevant comorbidity.

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.

Resumen Objetivo Describir las caracteristicas clinicas y los factores de riesgo de los pacientes con traumatismo toracico, y evaluar su relacion en el desarrollo de complicaciones. Metodologia Estudio de tipo descriptivo, prospectivo y analitico de una cohorte de pacientes con traumatismo toracico a los que se les hizo seguimiento durante un periodo de 30 dias. Se excluyeron pacientes con traumatismo craneoencefalico moderado a severo, fracturas de huesos largos, traumatismo abdominal, y pacientes que requirieron ventilacion mecanica. Resultados Un total 376 pacientes cumplieron criterios de inclusion, y de ellos 220 eran varones (58,5%). Las causas mas frecuentes de traumatismo fueron las caidas (218 casos; 57,9%) y los accidentes de trafico (57 casos; 15,1%). El tipo de traumatismo mas frecuente fue la contusion costal (248 casos; 65,9%) y la fractura de un arco costal (61 casos; 16,2%). Se observaron complicaciones en 43 pacientes (11,4%), principalmente por hemotorax (13 casos), neumotorax (9 casos), neumonia (6 casos) e insuficiencia renal aguda (4 casos). De estos pacientes, 4 fallecieron por neumonia y hemotorax. Treinta y tres pacientes (8,7%) fueron ingresados y 10 (2,6%) requirieron reingreso hospitalario. El riesgo de complicaciones aumenta significativamente en pacientes con mas de 2 fracturas costales, en mayores de 85 anos y en presencia de algunas comorbilidades como la EPOC y patologias que requieren anticoagulacion. El riesgo de reingreso es mayor en pacientes con mas de 60 anos. Conclusiones Los pacientes con traumatismo toracico que presentan algunas comorbilidades, son mayores de 85 anos y tienen mas de 2 fracturas costales pueden presentar mas complicaciones, y se deben considerar estos factores en su evaluacion, manejo y seguimiento.

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.

a b s t r a c t Objective: To describe the characteristics and the result of surgical treatment in a series of patients with primary pulmonary sarcomatoid carcinoma (PSC). Methodology: A descriptive study of 11 patients with primary PSC who were treated by the Thoracic Surgery Department at the Hospital Universitario 12 de Octubre in Madrid (Spain) between 2005 and 2009. We analyzed age, gender, histologic type, pathological stage, type of surgery and survival (in months). Results: Ten patients were male and 11 were smokers; mean age of was 55. The pathologic stages were: 4 stage IIA, 3 stage IIB, 2 stage IB and 2 stage IA. The most frequent histologic type was pleomorphic carcinoma, which was found in 5 cases. Complete resection was performed in 10 cases, and 7 received adjuvant therapy. Seven are disease-free after a mean follow-up period of 49 months. Conclusions: Complete surgery in the initial stages of primary PSC can improve survival.

Resumen Objetivo Describir las caracteristicas y el resultado del tratamiento quirurgico de una serie de pacientes con carcinomas sarcomatoides pulmonares primarios (CSPP). Metodologia Estudio descriptivo de 11 pacientes con CSPP operados en el Servicio de Cirugia Toracica del Hospital Universitario 12 de Octubre de Madrid entre 2005 a 2009. Se analizo: edad, genero, tipo histologico, estadio patologico, tipo de cirugia y supervivencia en meses. Resultados Diez pacientes eran varones y 11 eran fumadores, con una edad media de 55 anos. Los estadios patologicos fueron 4 estadios IIA, 3 estadios IIB, 2 estadios IB y 2 estadios IA. El tipo histologico mas frecuente fue el carcinoma pleomorfico, con 5 casos. Se realizo reseccion completa en 10 casos, y 7 recibieron terapia adyuvante. Siete de ellos se encuentran libres de enfermedad en un periodo de seguimiento con una media de 49 meses. Conclusiones La cirugia completa en estadios iniciales de los CSPP puede mejorar la supervivencia.

Objective To describe the clinical characteristics and risk factors of patients with chest trauma, and to evaluate their correlation with the development of complications. Methods Descriptive, prospective and analytical study of a patient cohort with chest trauma who underwent follow-up for a period of 30 days. Excluded from the study were those patients with moderate to severe traumatic brain injury, long-bone fractures, abdominal trauma and patients requiring mechanical ventilation. Results A total of 376 patients met the inclusion criteria, 220 of whom were males (58.5%). The most frequent causes of trauma were falls (218 cases; 57.9%) and motor vehicle accidents (57 cases; 15.1%). The most frequent type of trauma was rib contusion (248 cases; 65.9%) and rib fractures (61 cases; 16.2%). Complications were observed in 43 patients (11.4%), mainly hemothorax (13 cases), pneumothorax (9 cases), pneumonia (6 cases) and acute renal failure (4 cases). Four patients died due to pneumonia and hemothorax. Thirty-three patients were hospitalized (8.7%) and 10 (2.6%) required later re-admittance. The risk for complications increased significantly in patients with more than 2 rib fractures, in those over the age of 85 and in the presence of certain comorbidities, such as COPD and pathologies requiring anticoagulation therapy. The risk for re-admittance is higher in patients over the age of 60. Conclusions Patients with chest trauma who present certain comorbidities, are over the age of 85 and have more than 2 rib fractures may present more complications. These factors should be contemplated in the evaluation, management and follow-up of these subjects.

Background . Extended cervical mediastinoscopy (ECM) is a technique in the staging of bronchogenic carcinoma described first by Ginsberg in 1984. To update our experience we have prospectively evaluated our results on 106 patients who underwent the technique from 1985 to 1998. Methods . The ECM technique is performed once the operability of the patient has been evaluated, according to the computed tomography findings. The intervention is carried out at the same time as a standard cervical mediastinoscopy through the same incision following the same technique as previously published. The ECM is considered positive when metastatic nodes or tumor involvement directly in the paraaortic or subaortic regions is detected and confirmed histologically. Negative cases of ECM and positive cases of standard cervical mediastinoscopy are excluded from this study. A false-negative ECM is defined as the presence of infiltrated adenopathies at the paraortic level detected on postoperative histologic study. Results . We had performed ECM in 106 patients, and a total of 13 were subsequently excluded for the reasons stated above. Of the remaining cases, 26 were positive, 61 negative and 6 had false-negative results with no false-positive results. Sensitivity was 81.2%, specificity 100%, accuracy 93.3%, positive predictive value 100%, and negative predictive value 91%. There were no complications with the technique. Conclusions . We conclude that ECM is a useful technique for staging bronchogenic carcinoma that allows samples to be taken from paraortic and subaortic regions with minimally invasive techniques.