Spanish Lung Cancer Group SCAT trial: surgical audit to lymph node assessment based on IASLC recommendations.

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<0.01). Both number of lymph nodes resected and number of lymph nodes involved by tumor were significantly related to prognosis. CONCLUSIONS: IASLC recommendations for surgical resections were not followed in a high proportion of surgical procedures. Hilar and mediastinal lymph node assessment and involvement showed to impact prognosis. Surgical issues such as postoperative mortality could not be evaluated owing to trial design.

[Prognostic factors associated with resectable pulmonary metastases from colorectal cancer]. / Factores pronósticos en metástasis pulmonares resecables de carcinoma colorrectal.

OBJECTIVE: To analyze prognostic factors associated with survival in a group of patients who underwent resection of pulmonary metastases from colorectal cancer. PATIENTS AND METHODS: A retrospective review was performed for 55 consecutive patients who had undergone resection of pulmonary metastases from colorectal adenocarcinoma between January 1993 and June 2004. Univariate and multivariate analyses were performed to assess the effect of the recorded variables on overall survival. RESULTS: Median overall survival was 32.9 months and the probability of survival at 1, 3, and 5 years was 79%, 44%, and 22%, respectively. Survival was lower in patients in whom the largest metastasis was at least 4 cm (8.6 vs 34.5 months, P=.0085) and in patients with elevated levels of carcinoembryonic antigen (24.5 vs 41.4 months, P=.05). Significantly longer survival was observed in patients who received adjuvant chemotherapy after surgery (49.8 vs 30.9 months, P=.0058). Preoperative positron emission tomography (PET) and the absence of previous or synchronous liver metastases were associated with a nonsignificant trend toward increased survival. In the multivariate analysis, only size of the largest pulmonary metastasis influenced overall survival (P=.036). CONCLUSIONS: The preoperative variables that best predicted survival in our patients were size of the largest pulmonary metastasis and the level of carcinoembryonic antigen. Prospective studies are needed to determine the usefulness of PET for tumor staging prior to resection of pulmonary metastases.

Biopsy of the sentinel node in lung cancer. / Biopsia del ganglio centinela en el cáncer de pulmón.

INTRODUCTION AND OBJECTIVE: Mediastinal lymph node involvement can be understaged in cases of lung cancer (up to 20% in stage i). Sentinel node detection is a standard technique recommended in breast cancer and melanoma action guidelines, and could also be useful in cases of lung cancer. MATERIAL AND METHODS: Considering the detection of the sentinel node in non-small cell lung cancer (NSCLC) as feasible, a prospective cohort study was carried out on 48 patients with resectable NSCLC, using the intraoperative injection of colloid sulphate technetium-99. RESULTS: The radioisotope migrated in all cases. The procedure's sensitivity was 88.24%, its accuracy was 95.83%, its negative predictive value was 93.94% and the false negative rate was 11.76%. No complications were associated with this technique. CONCLUSIONS: The detection of a sentinel node in NSCLC with the intraoperative injection of the isotope is feasible and safe, and allows for detection and sensitivity rates comparable to those of other tumour types.

Benchmarking in Thoracic Surgery. Third Edition.

INTRODUCTION: Benchmarking entails continuous comparison of efficacy and quality among products and activities, with the primary objective of achieving excellence. OBJECTIVE: To analyze the results of benchmarking performed in 2013 on clinical practices undertaken in 2012 in 17 Spanish thoracic surgery units. METHODS: Study data were obtained from the basic minimum data set for hospitalization, registered in 2012. Data from hospital discharge reports were submitted by the participating groups, but staff from the corresponding departments did not intervene in data collection. Study cases all involved hospital discharges recorded in the participating sites. Episodes included were respiratory surgery (Major Diagnostic Category 04, Surgery), and those of the thoracic surgery unit. Cases were labelled using codes from the International Classification of Diseases, 9th revision, Clinical Modification. The refined diagnosis-related groups classification was used to evaluate differences in severity and complexity of cases. RESULTS: General parameters (number of cases, mean stay, complications, readmissions, mortality, and activity) varied widely among the participating groups. Specific interventions (lobectomy, pneumonectomy, atypical resections, and treatment of pneumothorax) also varied widely. CONCLUSIONS: As in previous editions, practices among participating groups varied considerably. Some areas for improvement emerge: admission processes need to be standardized to avoid urgent admissions and to improve pre-operative care; hospital discharges should be streamlined and discharge reports improved by including all procedures and complications. Some units have parameters which deviate excessively from the norm, and these sites need to review their processes in depth. Coding of diagnoses and comorbidities is another area where improvement is needed.