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.

[Schwannoma of the intrathoracic vagus nerve]. / Schwannoma del nervio vago intratorácico.

Schwannomas, or neurilemomas, are tumors that originate in the sheaths covering peripheral nerve fibers. They are usually encapsulated, slow growing, and asymptomatic. Such tumors may appear in any nerve, although most are found in the extremities. Intrathoracic vagus schwannomas are very rare and only 72 cases have been reported. We present a new case in a 39-year-old man in whom chest film showed a well-defined, homogeneous mass measuring 3 cm in diameter located in the left para-aortic region. The presence of a smooth tumor on the vagus nerve and recurrent loop was confirmed by left lateral thoracotomy. After removal, the tumor was shown to be a vagal nerve schwannoma.

[Thoracopleuromyoplasty as definitive cure for chronic pleural empyemas, after preparation by open thoracostomy]. / La thoracopleuromyoplastie comme correction définitive des empyèmes pleuraux chroniques, après préparation avec thoracostomie ouverte.

Between 1979 and 1986, 30 patients with chronic pleural empyema (19 with pyothorax secondary to tuberculosis and 11 with pleural empyema following pulmonary resection) underwent two-stage treatment. The first stage consisted of open thoracostomy and was followed, 2 to 7 months later, by thoracopleuromyoplasty with latissimus dorsi, serratus anterior and pectoralis major muscles either alone or in combination. There was no operative mortality in this series of 30 operated patients. Definitive obliteraion of the pleural cavity and closure of the bronchial fistulae were obtained in 26 of the 30 patients. Partial necrosis of the muscle graft in the other 4 patients required further open drainage and an additional myoplasty. The long-term functional results in the cases of post-resection empyema were compatible with the restriction created by the pulmonary resection and, in the cases of empyema with a residual lung, with the restriction of the volume and perfusion of pulmonary parenchyma.