[Resection of 8 mediastinal bronchogenic cysts by video-assisted thoracoscopy]. / Quiste broncogénico de mediastino. Resección videotoracoscópica en 8 casos.

Mediastinal bronchogenic cysts are an uncommon entity and surgical experience of their removal by video-assisted thoracoscopy is limited. We present our patient outcomes and surgical technique in the treatment of bronchogenic cysts by video-assisted thoracoscopy. The study included 8 patients (4 females and 4 males between the ages of 4 and 52 years), 7 of whom presented clinical symptoms. The mean widest diameter of the cyst was 7.6 cm. In 5 patients the cyst was in the middle mediastinum and in 3, the posterior mediastinum. The intervention was performed using 3 or 4 entry points. Initial puncture of the cyst and removal of its contents greatly facilitated cyst manipulation and subsequent dissection of the cyst sac from the structures to which it was attached. In all 8 cases resection by video-assisted thoracoscopy was carried out with no intraoperative complications. The mean postoperative hospital stay was 3.3 days. During follow-up, which ranged from 4 months to 10 years, no patients presented late-onset or recurrent complications.

[Resection of pulmonary metastases in 148 patients: analysis of prognostic factors]. / Cirugía de metástasis pulmonares en 148 pacientes. Análisis de sus factores pronósticos.

OBJECTIVE: To evaluate the prognostic factors for survival in a series of patients who underwent surgery for pulmonary metastases from primary tumors in distinct organs. PATIENTS AND METHODS: This was a retrospective study of 148 patients operated between May 2001 and May 2007. Multivariate analysis was used to evaluate overall survival. Patients scheduled for tumorectomy were included provided their primary tumor was controlled and they had no extrathoracic recurrence and adequate cardiorespiratory function. The influence of the following prognostic factors was analyzed: number and diameter of the metastases, lymph node infiltration, complete resection, and, above all, histological type. A significance level of 95% was used. RESULTS: A total of 90 men (60.81%) and 58 women (39.19%) were operated. The mean (SD) age was 56.5 (9.7) years. The actuarial survival at 6 years was 30.3% (n=45) and the median survival was 34 months. The factors that affected survival were the number of metastases (P< .05), diameter of the lesions (P< .05), lymph node infiltration (P< .05), complete resection (P< .05), and, above all, histological type (P< .05). Tumorectomy was the most commonly performed operation. CONCLUSIONS: These results suggest that, in the absence of other therapeutic options and contraindications, we should operate on patients in whom the primary tumor is controlled and in whom complete resection can be performed. Even if factors associated with poor prognosis are present, the outcomes are always better than when surgery is not performed, particularly in view of the relatively low morbidity and mortality associated with this type of surgery.

[Chest trauma]. / Traumatismos torácicos.

Chest trauma is a frequent problem arising from lesions caused by domestic and occupational activities and especially road traffic accidents. These injuries can be analyzed from distinct points of view, ranging from consideration of the most severe injuries, especially in the context of multiple trauma, to the specific characteristics of blunt and open trauma. In the present article, these injuries are discussed according to the involvement of the various thoracic structures. Rib fractures are the most frequent chest injuries and their diagnosis and treatment is straightforward, although these injuries can be severe if more than three ribs are affected and when there is major associated morbidity. Lung contusion is the most common visceral lesion. These injuries are usually found in severe chest trauma and are often associated with other thoracic and intrathoracic lesions. Treatment is based on general support measures. Pleural complications, such as hemothorax and pneumothorax, are also frequent. Their diagnosis is also straightforward and treatment is based on pleural drainage. This article also analyzes other complex situations, notably airway trauma, which is usually very severe in blunt chest trauma and less severe and even suitable for conservative treatment in iatrogenic injury due to tracheal intubation. Rupture of the diaphragm usually causes a diaphragmatic hernia. Treatment is always surgical. Myocardial contusions should be suspected in anterior chest trauma and in sternal fractures. Treatment is conservative. Other chest injuries, such as those of the great thoracic and esophageal vessels, are less frequent but are especially severe.

[Exploratory videothoracoscopy and videopericardioscopy in the definitive staging and assessment of resectability of lung cancer]. / Videotoracoscopia exploradora y videopericardioscopia en la estadificación definitiva y valoración de la resecabilidad del cáncer de pulmón.

OBJECTIVE: We present our experience in using videothoracoscopy for the staging and assessment of resectability of lung cancer. PATIENTS AND METHODS: Since 1993 we have carried out exploratory videothoracoscopy (EVT) for lung cancer staging and assessment of resectability. When intrapericardial vessel involvement is suspected, exploration by videopericardioscopy (VPC) is also useful for assessing resectability in these cT4 cases. Up to December 2007 we had studied 1381 patients with bronchogenic carcinoma. VPC was performed in 91 of these patients. In 45, the procedure was indicated because evidence of hilar and vascular invasion had been observed in the computed tomography or magnetic resonance images. In the remaining 46, it was performed as a result of EVT findings. RESULTS: We were able to perform EVT in 1277 patients. In 104 cases this procedure could not be performed because of firm pleural adhesions. The tumor was resected after thoracotomy in 61 of these patients; thoracotomy was thus only exploratory in only 43 (3.1%). In 141 cases (10.2%) tumors were considered unresectable based on EVT, due to mediastinal invasion in 81 cases, pleural carcinomatosis in 38 cases, and both findings in 6 cases. Lobectomy was ruled out because of spread across a fissure or vascular invasion in 16 patients who were unable to tolerate pneumonectomy. In 61 of the 91 patients who underwent VPC we were able to perform lung resection; in the remaining 30, intrapericardial dissection was prevented by invasion of the pulmonary artery (17 cases), of the upper pulmonary artery and vein (6 cases), of the upper pulmonary artery and superior vena cava (2 cases), or of the left atrium and pulmonary veins (5 cases, in which the invasion was extensive). CONCLUSIONS: EVT and VPC as a first step in lung cancer treatment require only a few minutes, do not contribute to morbidity, and avoid a significant proportion of exploratory thoracotomies.

[Usefulness of video-assisted thoracoscopy for correctly staging tumors as T3 because of chest wall invasion]. / Utilidad de la videotoracoscopia para una correcta estadificación de tumores T3 por invasión de pared.

BACKGROUND: Exploratory video-assisted thoracoscopy (EVT) can be used to assess the resectability of lung carcinomas. The aim of this study was to investigate the usefulness of this technique for distinguishing between tumors that invade the chest wall and should be staged as T3 and tumors that have been incorrectly staged as T3 on the basis of imaging studies. PATIENTS AND METHODS: From March 1993 through December 2007, we studied 1277 patients, of whom 150 (137 men and 13 women; age range, 28-81 years) presented tumors classified as cT3 because of chest wall invasion on the basis of imaging studies. RESULTS: After exploratory EVT, 44 pT3 tumors with chest wall invasion were confirmed intraoperatively and by histopathology. Of these, 36 had been correctly classified as cT3 by computed tomography or magnetic resonance imaging. However, tumors had been understaged as cT2 in 6 patients and overstaged as cT4 in 2 patients. The sensitivity, specificity, and positive and negative predictive values obtained were 100%. CONCLUSIONS: We believe that exploratory EVT is clearly better than computed tomography and/or magnetic resonance imaging for detecting chest wall invasion. In addition to correctly staging a tumor as T3 because of chest wall invasion, the technique can also help decide the best surgical approach in each case.