Diagnostic value of systematic bronchial aspirate on postoperative pneumonia after pulmonary resection surgery for lung cancer: a monocentre retrospective study.

OBJECTIVES: Intraoperative bacterial airway colonization seems to be associated with an increased risk of postoperative pneumonia (POP). It can be easily assessed by performing a bronchial aspirate (BA). The objective of this study is to assess the diagnostic performance of the BA to predict POP. METHODS: We conducted a single-centre retrospective observational study over a period of 10 years, from 1 January 2011 to 30 December 2020. The population study included patients admitted for a scheduled pulmonary resection surgery for lung cancer. Patients were classified into 2 populations depending on whether or not they developed a POP. Uni- and multivariable analyses were performed to identify risk factors for developing POP. The diagnostic performance of BA was represented by its sensitivity, specificity and positive and negative predictive values. RESULTS: A total of 1006 patients were included in the study. Uni- and multivariable analyses found that a positive BA was independently associated with a greater risk of developing POP with an odds ratio of 6.57 [4.165-10.865]; P < 0.001. Its specificity was 95%, sensitivity was 31%, positive predictive value was 66% and negative predictive value was 81%. CONCLUSIONS: A positive intraoperative BA is an independent risk factor for POP after lung cancer surgery. Further trials are required to validate the systematic implementation of BA as an early diagnostic tool for POP.

[Surgical results of type III and IV hiatal hernia with left thoracotomy]. / Resultados del tratamiento quirúrgico de las hernias hiatales tipo III y IV por vía transtorácica izquierda.

OBJECTIVE: The goal of the study is to report the short- and long-term outcome of a left approach in the management of type III and IV hiatal hernia. METHODS: We have retrospectively reviewed all the records of patients treated for type III and IV hiatal hernia with a left transthoracic approach. All the patients were evaluated before and after the surgery on clinical presentation, symptoms and functional assessment. We have specifically focused the evaluation on surgical results, mortality, morbidity and long term functional assessment. RESULTS: Sixty-five patients were included in this study. Type III hiatal hernia (86%) were majority compared to type IV(14%). Surgical techniques included Nissen fundoplication (37%), Collis Nissen elongation gastroplasty (20%) and Belsey-Mark IV (15%). Morbidity was low and there was no hospital mortality. Mean follow-up was 42 months. Long-term reassessment demonstrated a significant improvement of symptoms. Erosive esophagitis persisted in one patient (P < 0.001). Pressure at the level of lower esophageal sphincter was normal in all patients. 24-hours pH-metry was normal in 92% of patients. Anti-acid medication was reduced significantly (P < 0.001). CONCLUSION: Obesity, short esophagus, massive hiatal hernia, associated oesophageal diseases or previous failed surgery constituted the indications of choice for transthoracic approach. This procedure gives satisfactory functional and anatomical long term results with healing of mucosal damage.