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1. Thoracoscopic segmentectomy versus lobectomy: A propensity score–matched analysisCentral MessagePerspective

Author

Julio Sesma, MD, Sergio Bolufer, MD, PhD, Antonio García-Valentín, MD, PhD, Raúl Embún, MD, PhD, Íker Javier López, MD, PhD, Nicolás Moreno-Mata, MD, PhD, Unai Jiménez, MD, Florentino Hernando Trancho, MD, PhD, Antonio Eduardo Martín-Ucar, MD, Juana Gallar, MD, PhD, Raul Embun, Iñigo Royo-Crespo, José Luis Recuero Díaz, Sergio Bolufer, Julio Sesma, Sergi Call, Miguel Congregado, David Gómez-de Antonio, Marcelo F. Jimenez, Nicolas Moreno-Mata, Borja Aguinagalde, Sergio Amor-Alonso, Miguel Jesús Arrarás, Ana Isabel Blanco Orozco, Marc Boada, Alberto Cabañero Sánchez, Isabel Cal Vázquez, Ángel Cilleruelo Ramos, Silvana Crowley Carrasco, Elena Fernández-Martín, Santiago García-Barajas, Maria Dolores García-Jiménez, Jose María García-Prim, Jose Alberto Garcia-Salcedo, Juan José Gelbenzu-Zazpe, Carlos Fernando Giraldo-Ospina, María Teresa Gómez Hernández, Jorge Hernández, Jennifer D. Illana Wolf, Alberto Jauregui Abularach, Unai Jiménez, Iker López Sanz, Néstor J. Martínez-Hernández, Elisabeth Martínez-Téllez, Lucía Milla Collado, Roberto Mongil Poce, Francisco Javier Moradiellos-Díez, Ramón Moreno-Balsalobre, Sergio B. Moreno Merino, Carme Obiols, Florencio Quero-Valenzuela, María Elena Ramírez-Gil, Ricard Ramos-Izquierdo, Eduardo Rivo, Alberto Rodríguez-Fuster, Rafael Rojo-Marcos, David Sanchez-Lorente, Laura Sanchez Moreno, Carlos Simón, Juan Carlos Trujillo-Reyes, and Florentino Hernando Trancho

Subjects
anatomic segmentectomy, lobectomy, lung cancer, sublobar resection, thoracoscopy, VATS, Diseases of the circulatory (Cardiovascular) system, RC666-701, Surgery, RD1-811
Abstract

Objectives: The aim of this study is to compare the postoperative complications, perioperative course, and survival among patients from the multicentric Spanish Video-assisted Thoracic Surgery Group database who received video-assisted thoracic surgery lobectomy or video-assisted thoracic surgery anatomic segmentectomy. Methods: From December 2016 to March 2018, a total of 2250 patients were collected from 33 centers. Overall analysis (video-assisted thoracic surgery lobectomy = 2070; video-assisted thoracic surgery anatomic segmentectomy = 180) and propensity score–matched adjusted analysis (video-assisted thoracic surgery lobectomy = 97; video-assisted thoracic surgery anatomic segmentectomy = 97) were performed to compare postoperative results. Kaplan–Meier and competing risks method were used to compare survival. Results: In the overall analysis, video-assisted thoracic surgery anatomic segmentectomy showed a lower incidence of respiratory complications (relative risk, 0.56; confidence interval, 0.37-0.83; P = .002), lower postoperative prolonged air leak (relative risk, 0.42; 95% confidence interval, 0.23-0.78; P = .003), and shorter median postoperative stay (4.8 vs 6.2 days; P = .004) than video-assisted thoracic surgery lobectomy. After propensity score–matched analysis, prolonged air leak remained significantly lower in video-assisted thoracic surgery anatomic segmentectomy (relative risk, 0.33; 95% confidence interval, 0.12-0.89; P = .02). Kaplan–Meier and competing risk curves showed no differences during the 3-year follow-up (median follow-up in months: 24.4; interquartile range, 20.8-28.3) in terms of overall survival (hazard ratio, 0.73; 95% confidence interval, 0.45-1.7; P = .2), tumor progression–related mortality (subdistribution hazard ratio, 0.41; 95% confidence interval, 0.11-1.57; P = .2), and disease-free survival (subdistribution hazard ratio, 0.73; 95% confidence interval, 0.35-1.51; P = .4) between groups. Conclusions: Video-assisted thoracic surgery segmentectomy showed results similar to lobectomy in terms of postoperative outcomes and midterm survival. In addition, a lower incidence of prolonged air leak was found in patients who underwent video-assisted thoracic surgery anatomic segmentectomy.

Published
2022
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2. Impact of neoadjuvant therapy on postoperative complications in non-small-cell lung cancer patients subjected to anatomic lung resection

Author

Alberto Cabañero Sánchez, Gemma María Muñoz Molina, Sara Fra Fernández, Alfonso Muriel García, Angel Cilleruelo Ramos, Néstor Martínez Hernández, Florentino Hernando Trancho, Nicolás Moreno Mata, Borja Aguinagalde de Valiente, Sergio Amor Alonso, Miguel Jesús Arrarás, Ana Isabel Blanco Orozco, Marc Boada Collado, Sergio Bolufer Nadal, Isabel Cal Vázquez, Sergi Call Caja, Ángel Cilleruelo Ramos, Miguel Congregado Loscertales, Silvana Crowley Carrasco, Raúl Embún Flor, Elena Fernández Martín, Juan José Fibla Alfara, Santiago García Barajas, Maria Dolores García Jiménez, Jose María García Prim, Jose Alberto García Salcedo, Carlos Fernando Giraldo Ospina, David Gómez de Antonio, María Teresa Gómez Hernández, Juan José Gelbenzu Zazpe, Jorge Henández Ferrández, Jennifer D. Illana Wolf, Alberto Jauregui Abularach, Marcelo Jiménez López, Unai Jiménez Maestre, Cipriano López García, Iker López Sanz, Elisabeth Martínez Téllez, Lucía Milla Collado, Roberto Mongil Poce, Francisco Javier Moradiellos Díez, Ramón Moreno Balsalobre, Sergio B. Moreno Merino, Carme Obiols Fornell, Florencio Quero Valenzuela, María Elena Ramírez Gil, Ricard Ramos Izquierdo, José Luis Recuero Díaz, Eduardo Rivo Vázquez, Alberto Rodríguez Fuster, Rafael Rojo Marcos, Iñigo Royo Crespo, David Sánchez Lorente, Laura Sanchez Moreno, Julio Sesma Romero, Carlos Simón Adiego, and Juan Carlos Trujillo Reyes

Subjects
Lung Neoplasms, Postoperative Complications, Treatment Outcome, Oncology, Carcinoma, Non-Small-Cell Lung, Humans, Surgery, Chemoradiotherapy, General Medicine, Pneumonectomy, Lung, Neoadjuvant Therapy
Abstract

To study the impact of neoadjuvant therapies on postoperative complications and mortality among non-small-cell lung cancer (NSCLC) patients subjected to anatomic lung resection and included in the Spanish cohort of the video-assisted thoracic surgery (GE-VATS) multicenter database.The study included a total of 3085 patients from 33 centers between December 2016 and March 2018. We performed a comparative analysis of the complications and mortality in patients who received neoadjuvant therapies (n = 263) versus those who did not (n = 2822). A propensity score-matched analysis was used to adjust for potential confounders. Association between exposure in two groups and outcomes were estimated by logistic regression weighted by inverse of probability of receiving the treatment that actually received.In the unadjusted analysis, the chemotherapy (CT) and chemoradiotherapy (CRT) group presented a higher frequency of ICU readmissions, reinterventions, empyema, cardiovascular complications, a greater frequency of atrial fibrillation, and an increased need for blood product transfusions. In the adjusted group, CT and CRT patients had a higher rate of cardiovascular complications (CT p = 0.002; OR 2.29; 95% CI 1.34-3.94 and CRT p = 0.001; OR 2.90; 95% CI 1.52-5-52), arrhythmias (CT p = 0.013; OR 2.23; 95% CI 1.18-4.20 and CRT p = 0.046; OR 2.22; 95% CI 1.01-4.90) and transfussions (CT p = 0.042; OR 2.95; 95% CI 1.04-8.35 and CRT p 0.001; OR 7.74; 95% CI 3.01-19-92).Based on our series, neoadjuvant CT and CRT were associated with a higher rate of cardiovascular complications, arrhythmias and transfussions in patients with NSCLC subjected to anatomic lung resection.

Published
2022

3. [Translated article] Surgical Risk Following Anatomic Lung Resection in Thoracic Surgery: A Prediction Model Derived From a Spanish Multicenter Database

Author

David Gómez de Antonio, Silvana Crowley Carrasco, Alejandra Romero Román, Ana Royuela, Álvaro Sánchez Calle, Carme Obiols Fornell, Sergi Call Caja, Raúl Embún, Íñigo Royo, José Luis Recuero, Alberto Cabañero, Nicolás Moreno, Sergio Bolufer, Miguel Congregado, Marcelo F. Jimenez, Borja Aguinagalde, Sergio Amor-Alonso, Miguel Jesús Arrarás, Ana Isabel Blanco Orozco, Marc Boada, Isabel Cal, Ángel Cilleruelo Ramos, Elena Fernández-Martín, Santiago García-Barajas, María Dolores García-Jiménez, Jose María García-Prim, José Alberto Garcia-Salcedo, Juan José Gelbenzu-Zazpe, Carlos Fernando Giraldo-Ospina, María Teresa Gómez Hernández, Jorge Hernández, Jennifer D. Illana Wolf, Alberto Jáuregui Abularach, Unai Jiménez, Iker López Sanz, Néstor J. Martínez-Hernández, Elisabeth Martínez-Téllez, Lucía Milla Collado, Roberto Mongil Poce, Francisco Javier Moradiellos-Díez, Ramón Moreno-Basalobre, Sergio B. Moreno Merino, Florencio Quero-Valenzuela, María Elena Ramírez-Gil, Ricard Ramos-Izquierdo, Eduardo Rivo, Alberto Rodríguez-Fuster, Rafael Rojo-Marcos, David Sanchez-Lorente, Laura Sánchez Moreno, Carlos Simón, Juan Carlos Trujillo-Reyes, Cipriano López García, Juan José Fibla Alfara, Julio Sesma Romero, and Florentino Hernando Trancho

Subjects
Pulmonary and Respiratory Medicine
Published
2022

4. Surgical risk following anatomic lung resection in thoracic surgery: a prediction model derived from a spanish multicenter database

Author

Alberto Cabañero, Santiago García-Barajas, María Elena Ramírez-Gil, David Sánchez-Lorente, Sergio B. Moreno Merino, Borja Aguinagalde, Florentino Hernando Trancho, Ana Royuela, Jose María García-Prim, Ángel Cilleruelo Ramos, Juan José Gelbenzu-Zazpe, Elisabeth Martínez-Téllez, Roberto Mongil Poce, Laura Sanchez Moreno, Marcelo F. Jiménez, Carme Obiols Fornell, Íñigo Royo, Álvaro Sánchez Calle, Alberto Rodríguez-Fuster, Julio Sesma Romero, Francisco Javier Moradiellos-Díez, Ana Isabel Blanco Orozco, Rafael Rojo-Marcos, Carlos Simón, Juan Carlos Trujillo-Reyes, Elena Fernández-Martín, Cipriano López García, Miguel Congregado, Ramón Moreno-Basalobre, Iker López Sanz, María Dolores García-Jiménez, Jose Alberto Garcia-Salcedo, Eduardo Rivo, Jennifer D. Illana Wolf, David Gómez de Antonio, Lucía Milla Collado, Unai Jiménez, Silvana Crowley Carrasco, Sergi Call Caja, Sergio Bolufer, Isabel Cal, Jorge Hernández, Alejandra Romero Román, Alberto Jauregui Abularach, Ricard Ramos-Izquierdo, María Teresa Gómez Hernández, Juan José Fibla Alfara, Carlos Fernando Giraldo-Ospina, Miguel Jesús Arrarás, Marc Boada, Sergio Amor-Alonso, Nicolás Moreno, Raul Embun, José Luis Recuero, Néstor J. Martínez-Hernández, and Florencio Quero-Valenzuela

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Anatomic lung resection, Predictive risk model, Morbimortalidad posquirúrgica, 03 medical and health sciences, Modelo predictivo de riesgo, 0302 clinical medicine, Minimally invasive surgery, Post-surgical morbidity and mortality, Mortalitat, Medicine, Mortality, Lung, Gynecology, Cirurgia, Riesgo quirúrgico, business.industry, Pulmó, Surgical risk, Cirugía mínimamente invasiva, Thoracic surgery, Resección pulmonar anatómica, 030228 respiratory system, Cirugía torácica, Surgery, business
Abstract

Resumen Introduccion El objetivo es obtener un modelo predictor de riesgo quirurgico en pacientes sometidos a resecciones pulmonares anatomicas a partir del registro del Grupo Espanol de Cirugia Toracica Videoasistida. Metodos Se recogen datos de 3.533 pacientes sometidos a reseccion pulmonar anatomica por cualquier diagnostico entre el 20 de diciembre de 2016 y el 20 de marzo de 2018. Definimos una variable resultado combinada: mortalidad o complicacion Clavien Dindo IV a 90 dias tras intervencion quirurgica. Se realizo analisis univariable y multivariable por regresion logistica. La validacion interna del modelo se llevo a cabo por tecnicas de remuestreo. Resultados La incidencia de la variable resultado fue del 4,29% (IC 95%: 3,6-4,9). Las variables que permanecen en el modelo logistico final fueron: edad, sexo, reseccion pulmonar oncologica previa, disnea (mMRC), neumonectomia derecha y DLCOppo. Los parametros de rendimiento del modelo, ajustados por remuestreo, fueron: C-statistic 0,712 (IC 95%: 0,648-0,750), Brier score 0,042 y Booststrap shrinkage 0,854. Conclusiones El modelo predictivo de riesgo obtenido a partir de la base de datos Grupo Espanol de Cirugia Toracica Videoasistida es un modelo sencillo, valido y fiable, y constituye una herramienta muy util a la hora de establecer el riesgo de un paciente que se va a someter a una reseccion pulmonar anatomica.

Published
2021

5. VATS lobectomy morbidity and mortality is lower in patients with the same ppoDLCO: Analysis of the database of the Spanish Video-Assisted Thoracic Surgery Group

Author

Borja Aguinagalde, Asier Insausti, Iker Lopez, Laura Sanchez, Sergio Bolufer, Raul Embun, Iñigo Royo-Crespo, José Luis Recuero Díaz, Sergi Call, Miguel Congregado, David Gómez-de Antonio, Marcelo F. Jimenez, Nicolas Moreno-Mata, Sergio Amor-Alonso, Miguel Jesús Arrarás, Ana Isabel Blanco Orozco, Marc Boada, Alberto Cabañero Sánchez, Isabel Cal Vázquez, Ángel Cilleruelo Ramos, Silvana Crowley Carrasco, Elena Fernández-Martín, Santiago García-Barajas, Maria Dolores García-Jiménez, Jose María García-Prim, Jose Alberto Garcia-Salcedo, Juan José Gelbenzu-Zazpe, Carlos Fernando Giraldo-Ospina, María Teresa Gómez Hernández, Jorge Hernández, Jennifer D. Illana Wolf, Alberto Jauregui Abularach, Unai Jiménez, Iker López Sanz, Néstor J. Martínez-Hernández, Elisabeth Martínez-Téllez, Lucía Milla Collado, Roberto Mongil Poce, Francisco Javier Moradiellos-Díez, Ramón Moreno-Balsalobre, Sergio B. Moreno Merino, Carme Obiols, Florencio Quero-Valenzuela, María Elena Ramírez-Gil, Ricard Ramos-Izquierdo, Eduardo Rivo, Alberto Rodríguez-Fuster, Rafael Rojo-Marcos, David Sanchez-Lorente, Laura Sanchez Moreno, Carlos Simón, Juan Carlos Trujillo-Reyes, Florentino Hernando Trancho, Cipriano López, Juan José Fibla, and Julio Sesma

Subjects
Lung cancer surgery, medicine.medical_specialty, Lung Neoplasms, business.industry, Thoracic Surgery, Video-Assisted, medicine.medical_treatment, VATS lobectomy, General Medicine, medicine.disease, Surgery, Treatment Outcome, Thoracotomy, Cardiothoracic surgery, Relative risk, Propensity score matching, medicine, Risk of mortality, Humans, Morbidity, Lung cancer, business, Pneumonectomy, Retrospective Studies
Abstract

Measuring predicted post-operative diffusion capacity of the lung for carbon monoxide (ppoDLCO) is essential to determine patient operability and to stratify the risk of patients who are candidates for major lung cancer surgery. Studies that established surgical risk variables were based on open surgery series. The aim of our study was to analyze morbidity and mortality as a function of ppoDLCO and to compare its behavior in open and video-assisted thoracic surgery (VATS).We compared 90-day mortality and morbidity in patients undergoing open surgery versus VATS as a function of decline in ppoDLCO. Propensity score matching (using age, ASA, arterial vascular disease, BMI, gender, stage, ppoDLCO, and ppoFEVOf 2,530 patients with lung cancer and ppoDLCO values, a sample of 1,624 (812 per group) was obtained after score matching. The relative risk of mortality associated with thoracotomy in patients with ppoDLCO 60 is 2.66 (p 0.02) compared to VATS. The risk of thoracotomy in terms of overall and cardiac and respiratory morbidity is higher than that of VATS for almost all ppoDLCO values.Major resection by VATS shows lower morbidity and mortality in patients with the same ppoDLCO. A steady rise in the risk of mortality begins to occur at higher ppoDLCO values in thoracotomy (∼60) than in VATS (∼45).

Published
2020

6. Spanish Video-Assisted Thoracic Surgery Group: Method, Auditing, and Initial Results From a National Prospective Cohort of Patients Receiving Anatomical Lung Resections

Author

Silvana Crowley Carrasco, Eduardo Rivo, Santiago García-Barajas, Borja Aguinagalde, Alberto Cabañero Sánchez, Lucía Milla Collado, Sergi Call, Carlos Fernando Giraldo-Ospina, Nicolas Moreno-Mata, Juan José Gelbenzu-Zazpe, Florentino Hernando Trancho, David Sánchez-Lorente, Marcelo F. Jiménez, Ramón Moreno-Balsalobre, Laura Sanchez Moreno, Alberto Rodríguez-Fuster, Ana Isabel Blanco Orozco, Rafael Rojo-Marcos, María Elena Ramírez-Gil, Francisco Javier Moradiellos-Díez, Unai Jiménez, Sergio B. Moreno Merino, María Dolores García-Jiménez, Elena Fernández-Martín, Jose María García-Prim, Florencio Quero-Valenzuela, Miguel Congregado, Iñigo Royo-Crespo, Carme Obiols, Ángel Cilleruelo Ramos, Sergio Bolufer, Isabel Vazquez, Juan Carlos Trujillo-Reyes, Iker López Sanz, Jennifer D. Illana Wolf, Jose Alberto Garcia-Salcedo, Miguel Jesús Arrarás, Marc Boada, David Gómez de Antonio, Sergio Amor-Alonso, Raul Embun, José Luis Recuero Díaz, Alberto Jauregui Abularach, Ricard Ramos-Izquierdo, María Teresa Gómez Hernández, Roberto Mongil Poce, Néstor J. Martínez-Hernández, Carlos Simón, Jorge Hernández, Elisabeth Martínez-Téllez, [Embun, Raul] Hosp Univ Miguel Servet, Serv Cirugia Torac, Zaragoza, Spain, [Royo-Crespo, Inigo] Hosp Univ Miguel Servet, Serv Cirugia Torac, Zaragoza, Spain, [Recuero Diaz, Jose Luis] Hosp Univ Miguel Servet, Serv Cirugia Torac, Zaragoza, Spain, [Embun, Raul] Hosp Clin Univ Lozano Blesa, IIS Aragon, Zaragoza, Spain, [Royo-Crespo, Inigo] Hosp Clin Univ Lozano Blesa, IIS Aragon, Zaragoza, Spain, [Recuero Diaz, Jose Luis] Hosp Clin Univ Lozano Blesa, IIS Aragon, Zaragoza, Spain, [Bolufer, Sergio] Hosp Gen Univ Alicante, Serv Cirugia Torac, Alicante, Spain, [Call, Sergi] Univ Barcelona, Hosp Univ Mutua Terrasa, Serv Cirugia Torac, Barcelona, Spain, [Obiols, Carme] Univ Barcelona, Hosp Univ Mutua Terrasa, Serv Cirugia Torac, Barcelona, Spain, [Congregado, Miguel] Hosp Univ Virgen Macarena, Serv Cirugia Torac, Seville, Spain, [Moreno Merino, Sergio B.] Hosp Univ Virgen Macarena, Serv Cirugia Torac, Seville, Spain, [Gomez-de Antonio, David] Hosp Univ Puerta Hierro Majadahonda, Serv Cirugia Torac, Madrid, Spain, [Crowley Carrasco, Silvana] Hosp Univ Puerta Hierro Majadahonda, Serv Cirugia Torac, Madrid, Spain, [Jimenez, Marcelo F.] Univ Salamanca, Hosp Univ Salamanca, Serv Cirugia Torac, IBSAL, Salamanca, Spain, [Gomez Hernandez, Maria Teresa] Univ Salamanca, Hosp Univ Salamanca, Serv Cirugia Torac, IBSAL, Salamanca, Spain, [Moreno-Mata, Nicolas] Hosp Univ Ramon Y Cajal, Serv Cirugia Torac, Madrid, Spain, [Cabanero Sanchez, Alberto] Hosp Univ Ramon Y Cajal, Serv Cirugia Torac, Madrid, Spain, [Aguinagalde, Borja] Hosp Univ Donostia, Serv Cirugia Torac, San Sebastian, Spain, [Lopez Sanz, Iker] Hosp Univ Donostia, Serv Cirugia Torac, San Sebastian, Spain, [Amor-Alonso, Sergio] Hosp Univ Quironsalud Madrid, Serv Cirugia Torac, Madrid, Spain, [Javier Moradiellos-Diez, Francisco] Hosp Univ Quironsalud Madrid, Serv Cirugia Torac, Madrid, Spain, [Jesus Arraras, Miguel] Fdn Inst Valenciano Oncol, Serv Cirugia Torac, Valencia, Spain, [Blanco Orozco, Ana Isabel] Hosp Univ Virgen Rocio, Serv Cirugia Torac, Seville, Spain, [Boada, Marc] Univ Barcelona, Hosp Clin Barcelona, Inst Resp, Serv Cirugia Torac, Barcelona, Spain, [Sanchez-Lorente, David] Univ Barcelona, Hosp Clin Barcelona, Inst Resp, Serv Cirugia Torac, Barcelona, Spain, [Cal Vazquez, Isabel] Hosp Univ La Princesa, Serv Cirugia Torac, Madrid, Spain, [Moreno-Balsalobre, Ramon] Hosp Univ La Princesa, Serv Cirugia Torac, Madrid, Spain, [Cilleruelo Ramos, Angel] Hosp Clin Univ, Serv Cirugia Torac, Valladolid, Spain, [Fernandez-Martin, Elena] Hosp Clin San Carlos, Serv Cirugia Torac, Madrid, Spain, [Hernando Trancho, Florentino] Hosp Clin San Carlos, Serv Cirugia Torac, Madrid, Spain, [Garcia-Barajas, Santiago] Hosp Univ Badajoz, Serv Cirugia Torac, Badajoz, Spain, [Dolores Garcia-Jimenez, Maria] Hosp Univ Albacete, Serv Cirugia Torac, Albacete, Spain, [Maria Garcia-Prim, Jose] Hosp Univ Santiago de Compostela, Serv Cirugia Torac, Santiago De Compostela, Spain, [Rivo, Eduardo] Hosp Univ Santiago de Compostela, Serv Cirugia Torac, Santiago De Compostela, Spain, [Alberto Garcia-Salcedo, Jose] Hosp Univ 12 Octubre, Serv Cirugia Torac, Madrid, Spain, [Gelbenzu-Zazpe, Juan Jose] Complejo Hosp Navarra, Serv Cirugia Torac, Pamplona, Spain, [Elena Ramirez-Gil, Maria] Complejo Hosp Navarra, Serv Cirugia Torac, Pamplona, Spain, [Fernando Giraldo-Ospina, Carlos] Hosp Reg Univ, Serv Cirugia Torac, Malaga, Spain, [Mongil Poce, Roberto] Hosp Reg Univ, Serv Cirugia Torac, Malaga, Spain, [Hernandez, Jorge] Hosp Univ Sagrat Cor, Serv Cirugia Torac, Barcelona, Spain, [Illana Wolf, Jennifer D.] Hosp Puerta Mar, Serv Cirugia Torac, Cadiz, Spain, [Jauregui Abularach, Alberto] Hosp Univ Vall dHebron, Serv Cirugia Torac, Barcelona, Spain, [Jimenez, Unai] Hosp Univ Cruces, Serv Cirugia Torac, Bilbao, Spain, [Rojo-Marcos, Rafael] Hosp Univ Cruces, Serv Cirugia Torac, Bilbao, Spain, [Martinez-Hernandez, Nestor J.] Hosp Univ La Ribera, Serv Cirugia Torac, Valencia, Spain, [Martinez-Tellez, Elisabeth] Univ Autonoma Barcelona, Serv Cirugia Torac, Hosp Santa Creu & St Pau, Barcelona, Spain, [Carlos Trujillo-Reyes, Juan] Univ Autonoma Barcelona, Serv Cirugia Torac, Hosp Santa Creu & St Pau, Barcelona, Spain, [Milla Collado, Lucia] Hosp Arnau Vilanova, Serv Cirugia Torac, Lleida, Spain, [Quero-Valenzuela, Florencio] Hosp Virgen Nieves, Serv Cirugia Torac, Granada, Spain, [Ramos-Izquierdo, Ricard] Hosp Univ Bellvitge, Serv Cirugia Torac, Barcelona, Spain, [Rodriguez-Fuster, Alberto] Hosp Mar, Serv Cirugia Torac, Barcelona, Spain, [Rodriguez-Fuster, Alberto] IMIM Inst Invest Med Hosp Mar, Barcelona, Spain, [Sanchez Moreno, Laura] Hosp Univ Marques Valdecilla, Serv Cirugia Torac, Santader, Spain, [Simon, Carlos] Hosp Univ Gregorio Maranon, Serv Cirugia Toroc, Madrid, Spain, and Spanish Society of Thoracic Surgery as the best national research project of 2015

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung resections, media_common.quotation_subject, Video-assisted thoracic surgery, VATS, Audit, Outcomes, Multicentre study, 03 medical and health sciences, 0302 clinical medicine, Cancer surgery, European-society, medicine, Mortality, Lung cancer, Prospective cohort study, media_common, Selection bias, Auditoria, business.industry, General surgery, Thoracoscopy, Auditing, Perioperative, General Medicine, medicine.disease, Thoracic surgery, 030228 respiratory system, Cohort, Lobectomy, Càncer de pulmó, Cirurgia toràcica, business, Cohort study
Abstract

Introduction: Our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). Methods: We conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for "90-day mortality" and "Grade IIIb-V complications". Results: The series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR= 0.61 (p = 0.081), 90-day mortality OR = 0.46 (p = 0.051). Conclusions: More than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort. (C) 2020 SEPAR. Published by Elsevier Espana, S.L.U. All rights reserved.

Published
2019

7. Normothermic ex-vivo preservation with the portable Organ Care System Lung device for bilateral lung transplantation (INSPIRE): a randomised, open-label, non-inferiority, phase 3 study

Author

Anne Olland, Fiorella Calabrese, Pascal Thomas, Fabio De Robertis, Kenneth R. McCurry, Gabriel Loor, Christoph Knosalla, Andrés Varela, Pierre-Emanuel Falcoz, Steven Tsui, Joren C. Madsen, Michael A. Smith, Guy Lesèche, Federico Rea, Tobias Deuse, Kumud Dhital, Marco Schiavon, Abbas Ardehali, Gregor Warnecke, Arne Neyrinck, Axel Haverich, Marshall I. Hertz, Igor Tudorache, Bettina Wiegmann, Murat Avsar, Christian Bermudez, Jasleen Kukreja, Nichola Santelmo, Christian Kühn, I. Wang, Wiebke Sommer, Gilbert Massard, Dirk Van Raemdonck, Francisco Javier Moradiellos Díez, Andre R. Simon, and Jayan Nagendran

Subjects
Male, Survival, medicine.medical_treatment, Transplants, Intention, 030204 cardiovascular system & hematology, 030230 surgery, 0302 clinical medicine, Risk Factors, Fraction of inspired oxygen, Clinical endpoint, Prospective Studies, Coma, Prospective cohort study, Lung, education.field_of_study, Incidence, Bentazepam, Organ Preservation, Middle Aged, Tissue Donors, Cold Temperature, Treatment Outcome, Equipment and Supplies, Female, Safety, Lung Transplantation, Equipment and Supplies, Lung, Transplants, Prostaglandins D, Control Groups, Tissue Donors, Bentazepam, Intention, Cold Temperature, Safety, Survival, Primary Graft Dysfunction, Oxygen, Organ Preservation, Partial Pressure, Population, Coma, Incidence, Transplant Recipients, Lung Transplantation, Pulmonary and Respiratory Medicine, Adult, medicine.medical_specialty, Partial Pressure, Population, Organ Preservation Solutions, Cold storage, 03 medical and health sciences, Internal medicine, medicine, Lung transplantation, Humans, education, Survival analysis, Cryopreservation, Prostaglandins D, business.industry, Control Groups, Survival Analysis, Transplant Recipients, Oxygen, Transplantation, Primary Graft Dysfunction, business
Abstract

Summary Background Severe primary graft dysfunction (PGD) of grade 3 (PGD3) is a common serious complication following lung transplantation. We aimed to assess physiological donor lung preservation using the Organ Care System (OCS) Lung device compared with cold static storage. Methods In this non-inferiority, randomised, controlled, open-label, phase 3 trial (INSPIRE) recipients were aged 18 years or older and were registered as standard criteria primary double lung transplant candidates. Eligible donors were younger than 65 years old with a ratio of partial pressure of oxygen in arterial blood to the fraction of inspired oxygen of more than 300 mm Hg. Transplant recipients were randomly assigned (1:1) with permuted blocks, stratified by centre, to receive standard criteria donor lungs preserved in the OCS Lung device (OCS arm) or cold storage at 4°C (control arm). The composite primary effectiveness endpoint was absence of PGD3 within the first 72 h after transplant and 30-day survival in the per-protocol population, with a stringent 4% non-inferiority margin. Superiority was tested upon meeting non-inferiority. The primary safety endpoint was the mean number of lung graft-related serious adverse events within 30 days of transplant. We did analyses in the per-protocol and intention-to-treat populations. This trial is registered with ClinicalTrials.gov, number NCT01630434. Findings Between Nov 17, 2011, and Nov 24, 2014, we randomly assigned 370 patients, and 320 (86%) underwent transplantation (n=151 OCS and n=169 control); follow-up was completed in Nov 24, 2016. The primary endpoint was met in 112 (79·4%) of 141 patients (95% CI 71·8 to 85·8) in the OCS group compared with 116 (70·3%) of 165 patients (62·7 to 77·2) in the control group (non-inferiority point estimate −9·1%; 95% CI −∞ to −1·0; p=0·0038; and superiority test p=0·068). Patient survival at day 30 post-transplant was 135 (95·7%) of 141 patients (95% CI 91·0–98·4) in the OCS group and 165 patients (100%; 97·8–100·0) in the control group (p=0·0090) and at 12 months was 126 (89·4%) of 141 patients (83·1–93·9) for the OCS group compared with 146 (88·1%) of 165 patients (81·8–92·8) for the control group. Incidence of PGD3 within 72 h was reported in 25 (17·7%) of 141 patients in the OCS group (95% CI 11·8 to 25·1) and 49 (29·7%) of 165 patients in the control group (22·8 to 37·3; superiority test p=0·015). The primary safety endpoint was met (0·23 lung graft-related serious adverse events in the OCS group compared with 0·28 events in the control group [point estimate −0·045%; 95% CI −∞ to 0·047; non-inferiority test p=0·020]). In the intention-to-treat population, causes of death at 30 days and in hospital were lung graft failure or lung infection (n=2 for OCS vs n=7 for control), cardiac causes (n=4 vs n=1), vascular or stroke (n=3 vs n=0), metabolic coma (n=0 vs n=2), and generalised sepsis (n=0 vs n=1). Interpretation The INSPIRE trial met its primary effectiveness and safety endpoints. Although no short-term survival benefit was reported, further research is needed to see whether the reduced incidence of PGD3 within 72 h of a transplant might translate into earlier recovery and improved long-term outcomes after lung transplantation. Funding TransMedics Inc.

Published
2018

8. Successful Conservative Management in Iatrogenic Tracheobronchial Injury

Author

Eduardo de Miguel Porch, Francisco Javier Moradiellos Díez, Emilio Larrú Cabrero, Vicente Diaz-Hellin Gude, José Luis Martín De Nicolás, Abel Gómez-Caro Andrés, and Pilar Ausín Herrero

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Adolescent, Conservative management, medicine.medical_treatment, Iatrogenic Disease, Tracheotomy, Humans, Medicine, Aged, Retrospective Studies, Aged, 80 and over, Mechanical ventilation, business.industry, Mean age, Lung Injury, Middle Aged, medicine.disease, Mediastinitis, Tracheobronchial injury, Surgery, Trachea, Treatment Outcome, Mediastinal Emphysema, Wounds and Injuries, Female, medicine.symptom, Intubation, Cardiology and Cardiovascular Medicine, business, Subcutaneous emphysema
Abstract

Background The aim of this study was to describe and to assess the effectiveness of conservative treatment as the chosen treatment for managing iatrogenic tracheobronchial injuries (ITBI). Methods Between January 1993 and December 2003, 33 tracheobronchial injuries were treated in our hospital. Eighteen (54.5%) were ITBI and 15 (45.5%) were traumatic noniatrogenic injuries. Of the ITBI patients, sex distribution was 15 (83%) females and 3 (17%) males with a mean age of 57.7 ± 20.7 years (range, 17 to 88 years). Fifteen (83.3%) of the injuries were caused by orotracheal intubation and 3 (15.7%) by tracheotomy. The average diagnostic delay was 25.7 ± 22.9 hours. The mean injury size was 2.83 ± 1.02 cm (range, 1 to 4 cm). Nine (50%) injuries were located in the cervical trachea, 6 (33.3%) in the thoracic trachea, and 3 (16%) involved both trachea and main bronchi. Conservative treatment was chosen for 17 (94.4%) of the 18 cases. We performed surgical repair in only 1 case owing to progressive subcutaneous emphysema and increasing difficulty with mechanical ventilation. Results No complications arose from the use of conservative treatment. Four patients (22%) died in our hospital, 3 of these of non-ITBI-related causes. Mortality was not related to four variables: sex, diagnostic delay, location, or size of the ITBI. Fourteen of the 18 patients (77.7%) were discharged uneventfully, and the endoscopic and clinical follow-up examinations were satisfactory in all patients. Conclusions Conservative treatment for ITBI is effective regardless of production, size, or site of the injuries. Surgical treatment is advisable in specific cases: rapid progression of subcutaneous and mediastinal emphysema, mediastinitis, and difficulty with mechanical ventilation.

Published
2005

9. Spinal cord compression and epidural abscess extension of pleural empyema

Author

Vicente Díaz-Hellín Gude, Francisco Javier Moradiellos Díez, José Luis Martín de Nicolás, and Abel Gómez-Caro Andrés

Subjects
Pulmonary and Respiratory Medicine, medicine.medical_specialty, Cord, Epidural abscess, business.industry, medicine.medical_treatment, Pleural empyema, Laminectomy, Granulation tissue, bacterial infections and mycoses, medicine.disease, medicine.disease_cause, Methicillin-resistant Staphylococcus aureus, respiratory tract diseases, Surgery, medicine.anatomical_structure, Spinal cord compression, Anesthesia, medicine, Cardiology and Cardiovascular Medicine, Abscess, business
Abstract

We report a case of epidural extension of pleural empyema with cord compression and neurologic deficit. Surgical decompression was required and emergency bilateral laminectomy was performed with removal of abscess and granulation tissue. Methicillin-resistant Staphylococcus aureus grew in cultures of pleural and epidural specimens and appropriate intravenous antibiotics were started. In spite of early diagnosis and rapid management the patient suffered severe sequelae.

Published
2007

14. Mediastinal Parathyroid Gland or Adenopathy With Endocrine Cancer Infiltration?

Author

Isabel Salas Villar, Clara Salas Antón, and Francisco Javier Moradiellos Díez

Subjects
medicine.medical_specialty, Pathology, Endocrinology, medicine.anatomical_structure, business.industry, Internal medicine, medicine, Parathyroid gland, General Medicine, business, medicine.disease, Infiltration (medical), Endocrine cancer
Published
2007

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