Early complications in surgical treatment of lung cancer: a prospective, multicenter study. Grupo Cooperativo de Carcinoma Broncogénico de la Sociedad Española de Neumología y Cirugía Torácica.

BACKGROUND: We prospectively analyzed the postoperative morbidity, mortality rate, and risk factors in 605 patients who underwent thoracotomy for bronchogenic carcinoma. METHODS: Patients were categorized by postsurgical tumor stage: I, 287 patients (47.4%); II, 49 patients (8.1%); IIIA, 154 patients (25.5%); IIIB, 80 patients (13.2%); IV, 16 patients (2.7%); unavailable, 19 patients (3.1%). Two hundred ninety-four patients (48.6%) underwent lobectomy, 172 (28.4%) pneumonectomy, 20 (3.3%) bilobectomy, 29 (4.8%) segmentectomy, 27 (4.5%) wedge resection, and 63 (10.4%) exploratory thoracotomy. The importance of the factors that influence the morbidity and mortality rates was calculated from their relative risks. Univariate and multivariate methods for a logistic regression model were used for this analysis. RESULTS: Postoperative complications developed in 196 patients (32.4%); there were 165 (27.3%) cases of operation-related complications and 152 (25.1%) cases of respiratory and cardiovascular complications. The morbidity rate was highest in patients with preexisting vascular disease (50.9%; odds ratio [OR], 2.20) or insulin-dependent diabetes mellitus (52.4%; OR, 2.77) and in patients who underwent pneumonectomy (40.1%; OR, 1.82). Forty patients (6.6%) died postoperatively, most commonly of respiratory failure (67.5%). The mortality rate was highest in patients with postoperative morbidity (OR, 31.9) or vascular disease (15.8%; OR, 2.83) and in patients who underwent pneumonectomy (13.4%; OR, 4.9). CONCLUSIONS: Postoperative complications are more likely to develop in patients with peripheral vascular disease or insulin-dependent diabetes mellitus, or both. Postoperative mortality was found to be significantly higher in patients with vascular disease and those who underwent pneumonectomy.

[Assessment of mediastinal tumor involvement (T factor) in lung cancer with transesophageal ultrasonography]. / Evaluación de la afectación mediastínica tumoral (factor T) en el cáncer de pulmón mediante ecografía transesofágica.

UNLABELLED: Transesophageal sonography was originally used to assess esophageal-gastric neoplasm. The technique may also be useful in the evaluation of pulmonary neoplasms for possible mediastinal involvement, with regard to both T and N factors. OBJECTIVE: To consider the validity of this minimally-invasive technique for assessing possible mediastinal involvement by direct tumoral invasion (T4) and to help obtain the most accurate staging of lung cancer. PATIENTS AND METHODS: Sixteen patients with confirmed histopathological diagnoses of pulmonary neoplasm were examined by transesophageal sonography in order to evaluate possible mediastinal involvement. They had previously been classified by computed tomography as T4 (12 patients) or possible T4 (4 patients). Mediastinal involvement was also assessed by mediastinotomy or thoracotomy in 15 of the 16 patients. RESULTS: Transesophageal sonography revealed mediastinal involvement in eight of the 16 patients; the rest had no such involvement. Surgical exploration of the mediastinum confirmed involvement in seven of those who had been so classified by sonography (with the remaining patient not having been assessed surgically). Among the eight patients who were considered free of mediastinal involvement, there was in fact none, although we found previously undetected infiltration of the posterior surface of the right pulmonary artery in one patient. Sensitivity was 87.5%, specificity 100% and accuracy 93.3%. CONCLUSION: Transesophageal ultrasound is a diagnostic tool that can provide additional information to complement other diagnostic strategies.

Evaluación de la afectación mediastínica tumoral (factor T) en el cáncer de pulmón mediante ecografía transesofágica / Transesophageal ultrasound assessment of mediastinal tumor involvement (T factor) in lung cancer

La ecografía transesofágica es una técnica inicialmente empleada en la valoración de las neoplasias esofagogástricas. Su utilización en la evaluación de las neoplasias pulmonares puede ser una ayuda valiosa a la hora de considerar la posible afectación mediastínica tanto en el factor T como en el N. Objetivo: Considerar la validez de esta exploración incruenta para determinar la posible afectación mediastínica por invasión directa del tumor (T4) como medio para conseguir una más correcta estadificación del cáncer de pulmón. Pacientes y métodos: Dieciséis pacientes con neoplasia de pulmón confirmada histopatológicamente han sido explorados mediante ecografía transesofágica para evaluar una posible afectación mediastínica. Previamente habían sido etiquetados por tomografía computarizada como T4 (12) o dudosos T4 (4). En 15 de los 16 pacientes se evaluó la afectación del mediastino con mediastinotomía o toractomía. Resultados: De los 16 pacientes, ocho presentaban afectación mediastínica mediante ecografía transesofágica y en el resto no. La evaluación quirúrgica del mediastino confirmó la afectación de éste en siete de los detectados por la ecografía (uno no se evaluó quirúrgicamente). De los 8 pacientes considerados como sin afectación mediastínica en siete no existía y en uno no se detectó una infiltración de la cara posterior de la arteria pulmonar derecha. La sensibilidad fue del 87,5 por ciento, la especificidad, del 100 por ciento y la exactitud del 93,3 por ciento. Conclusión: La ecografía transesofágica es un método diagnóstico que puede aportar información adicional y complementaria a otros métodos diagnósticos. (AU)