[Comparative analysis of video-assisted thoracic surgery versus open resection for early-stage thymoma]. / Análisis comparativo del abordaje para el tratamiento del timoma estadio i-ii: VATS versus abordaje convencional.

BACKGROUND: Video-assisted thoracic surgery (VATS) has significantly developed over the last decade. However, a VATS approach for thymoma remains controversial. The aim of this study was to evaluate the feasibility of VATS thymectomy for the treatment of early-stage thymoma and to compare the outcomes with open resection. METHODS: A comparative study of 59 patients who underwent surgical resection for early stage thymoma (VATS: 44 and open resection: 15) between 1993 and 2011 was performed. Data of patient characteristics, morbidity, mortality, length of hospital stay, the relationship between miasthenia gravis-thymoma, recurrence, and survival were collected for statistical analysis. RESULTS: Thymomas were classified according to Masaoka staging system: 38 in stage I (VATS group: 29 and open group: 9) and 21 in stage II (VATS group: 15 and open group: 6). The mean tumor size in the open group was 7.6cm (13-4cm) and in the VATS group 6.9cm (12-2.5cm). The average length of stay was shorter in the VATS group than in the open group (P<.001). No significant differences were found in the estimated recurrence-free and overall 5-year survival rates (96% vs. 100%) between the 2 groups. CONCLUSIONS: VATS thymectomy for early-stage thymoma is technically feasible and is associated with a shorter hospital stay. The 5-year oncologic outcomes were similar in the open and VATS groups.

[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.

Siliconoma pulmonar, una etiología a tener en cuenta / Lung Siliconoma, an Etiology to Consider

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Usefulness of videothoracoscopic intrapericardial examination of pulmonary vessels to identify resectable clinical T4 lung cancer.

BACKGROUND: Discrepancies in predicting resectability by imaging techniques (computed tomography and magnetic resonance imaging) compared with actual intraoperative findings have persuaded us to perform systematic exploratory videothoracoscopy (EVT) as the first step in the surgical evaluation of patients with lung cancer. Resectability of centrally located primary tumors with intrapericardial extension (clinical T4), however, can be established only by direct examination of the pericardial sac contents. Therefore, in these instances, videopericardioscopy (VPC) has been added to our protocol. METHODS: From April 1993 to December 2000, members of our department used EVT to assess 620 patients with lung cancer. Of them, 27 patients, 25 men and 2 women, were seen with pericardial tumor extension. The mean age of the group was 62 years (range, 41 to 77 years). To be properly evaluated, these patients underwent VPC. We used three and, occasionally, four incisions to perform EVT. The same incisions were used to enter the pericardial cavity during VPC. RESULTS: In 15 of the 27 patients, hilar and vascular invasion was correctly predicted by imaging techniques. The other 12, however, were correctly staged only during EVT. The tumor was deemed unresectable by VPC in 6 patients (5 with invasion at the origin of the pulmonary artery and 1 with involvement of the left inferior pulmonary vein and left atrium), and exploratory thoracotomy was obviated. There was no morbidity or mortality in these 6 patients, and their mean length of hospital stay was 48 hours. The remaining 21 patients underwent thoracotomy and intrapericardial lung resection. Six of them had been considered to have unresectable disease on the basis of computed tomographic findings or magnetic resonance imaging studies. An average of 22 minutes (range, 16 to 33 minutes) was added to the operation when VPC was used. CONCLUSIONS: This study suggests that EVT is superior to imaging techniques (computed tomography or magnetic resonance imaging) in detecting tumor extension into the pericardium. In addition, short of an exploratory thoracotomy, VPC seems to be the most definitive study to establish resectability of centrally located tumors with pericardial invasion. Unnecessary exploratory thoracotomies can thus be avoided.

Herida traqueal por arma blanca con orificio de entrada y salida / Tracheal stab wound with entrance and exit orífices

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Análisis comparativo del abordaje para el tratamiento del timoma estadio I-II: VATS versus abordaje convencional / Comparative analysis of video-assisted thoracic surgery versus open resection for early-stage thymoma

INTRODUCCIÓN: La cirugía torácica video-asistida (VATS) es una técnica que ha evolucionado en las últimas décadas. A pesar de sus ventajas, este abordaje continúa siendo discutido para el tratamiento de los timomas. El objetivo de este estudio fue evaluar los resultados obtenidos por el abordaje convencional y la VATS para el tratamiento de timomas en estadio i-ii. MÉTODOS: Estudio comparativo en 59 pacientes a los que se les realizó una timectomía por timoma en estadio i-ii (VATS: 44 y cirugía convencional: 15) entre los años 1993 y 2011. Se analizaron las siguientes variables: características de los pacientes en ambos grupos, morbilidad, mortalidad, estancia hospitalaria, la relación miastenia gravis-timoma, recidiva y supervivencia a los 5 años. RESULTADOS: Los timomas se clasificaron según la clasificación de Masaoka: 38 en la etapa I (grupo VATS: 29 y grupo convencional: 9) y 21 en la etapa II (grupo VATS: 15 y grupo convencional: 6). El tamaño medio del tumor en el grupo convencional fue de 7,6 cm (13-4 cm) y en el grupo VATS 6,9 cm (12-2,5 cm). La duración media de la estancia hospitalaria fue más corta en el grupo VATS que en el grupo de cirugía convencional (p < 0,001). No se encontraron diferencias significativas entre los 2 grupos, en las recidivas ni en la supervivencia a los 5 años (96% vs. 100%). CONCLUSIÓN: La timectomía mediante VATS es una técnica factible y segura en el tratamiento de timomas estadio I-II. Se asocia a una menor estancia hospitalaria y a unos resultados oncológicos a los 5 años similares a los de la cirugía convencional. Los resultados oncológicos con un seguimiento de 5 años fueron similares a los obtenidos por la cirugía convencional

BACKGROUND: Video-assisted thoracic surgery (VATS) has significantly developed over the last decade. However, a VATS approach for thymoma remains controversial. The aim of this study was to evaluate the feasibility of VATS thymectomy for the treatment of early-stage thymoma and to compare the outcomes with open resection. METHODS: A comparative study of 59 patients who underwent surgical resection for early stage thymoma (VATS: 44 and open resection: 15) between 1993 and 2011 was performed. Data of patient characteristics, morbidity, mortality, length of hospital stay, the relationship between miasthenia gravis-thymoma, recurrence, and survival were collected for statistical analysis. RESULTS: Thymomas were classified according to Masaoka staging system: 38 in stage I (VATS group: 29 and open group: 9) and 21 in stage II (VATS group: 15 and open group: 6). The mean tumor size in the open group was 7.6 cm (13-4 cm) and in the VATS group 6.9 cm (12-2.5 cm). The average length of stay was shorter in the VATS group than in the open group (P<.001). No significant differences were found in the estimated recurrence-free and overall 5-year survival rates (96% vs. 100%) between the 2 groups. CONCLUSIONS: VATS thymectomy for early-stage thymoma is technically feasible and is associated with a shorter hospital stay. The 5-year oncologic outcomes were similar in the open and VATS groups

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

OBJETIVO: Evaluar los factores pronósticos de supervivenciaen una serie de pacientes intervenidos por metástasispulmonares de diferentes tumores y órganos.PACIENTES Y MÉTODOS: Se ha realizado un estudio retrospectivode 148 pacientes intervenidos entre mayo de 2001 ymayo de 2007, y se ha aplicado un análisis multivariantepara valorar la supervivencia global. Los criterios de inclusiónfueron: control del tumor primario, sin recurrencia extratorácicay función cardiorrespiratoria suficiente, siemprecon intención de tumorectomía. Se valoró qué influencia teníanen el pronóstico los siguientes factores: número de metástasis,diámetro de éstas, adenopatías invadidas, cirugíacompleta y, sobre todo, tipo histológico, para un nivel de significacióndel 95%.RESULTADOS: En total se intervino a 90 varones (60,81%)y 58 mujeres (39,19%). La edad media ± desviación estándarera de 56,5 ± 9,7 años. Se obtuvo una supervivencia actuariala 6 años del 30,3% (n = 45), con una mediana de supervivenciade 34 meses. Los factores que influyeron en elpronóstico fueron el número de metástasis (p < 0,05), el diámetrode éstas (p < 0,05), la presencia de adenopatías invadidas(p < 0,05), la cirugía completa (p < 0,05) y, sobre todo,el tipo histológico (p < 0,05). La tumorectomía fue la intervenciónmás realizada.CONCLUSIONES: Los resultados avalan que aceptemos paratratamiento quirúrgico a los pacientes sin otra posibilidadterapéutica a quienes pueda realizarse una resección completa,que tengan el tumor primario controlado y no presentenotras contraindicaciones, pues, aunque en presencia deciertos factores empeora la supervivencia, los resultados sonsiempre mejores que con la abstención quirúrgica, máximesi se tienen en cuenta las cifras relativamente bajas de morbilidady mortalidad con este tipo de cirugía

OBJECTIVE: To evaluate the prognostic factors for survivalin a series of patients who underwent surgery for pulmonarymetastases from primary tumors in distinct organs.PATIENTS AND METHODS: This was a retrospective study of148 patients operated between May 2001 and May 2007.Multivariate analysis was used to evaluate overall survival.Patients scheduled for tumorectomy were included providedtheir primary tumor was controlled and they had noextrathoracic recurrence and adequate cardiorespiratoryfunction. The influence of the following prognostic factorswas analyzed: number and diameter of the metastases, lymphnode 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) andthe median survival was 34 months. The factors that affectedsurvival were the number of metastases (P<.05), diameter ofthe lesions (P<.05), lymph node infiltration (P<.05), completeresection (P<.05), and, above all, histological type (P<.05).Tumorectomy was the most commonly performed operation.CONCLUSIONS: These results suggest that, in the absence ofother therapeutic options and contraindications, we shouldoperate on patients in whom the primary tumor is controlledand in whom complete resection can be performed. Even iffactors associated with poor prognosis are present, theoutcomes are always better than when surgery is notperformed, particularly in view of the relatively low morbidityand mortality associated with this type of surgery