Surgical treatment of lung cancer with adrenal metastasis.

Surgical treatment of adrenal metastasis from non-small cell lung cancer is controversial. Classically this group of patients has been considered incurable, therefore excision of the primary cancer and the adrenal gland has been avoided. However, recent reports show good results in their surgical management. Five selected patients with non-small cell lung cancer and adrenal metastases have been surgically treated. Two of them also presented with brain metastases that were excised, too. One patient with brain and adrenal metastases died 38 months after surgery. The other four patients are alive and with no sign of recurrent disease at 8, 16, 52 and 58 months of follow-up. In highly selected patients in whom both the primary and the metastatic tumors are resectable and in the absence of tumor spread to other organs, surgical treatment seems to be a good therapeutic option.

Remediastinoscopy after induction chemotherapy in non-small cell lung cancer.

BACKGROUND: This study was undertaken to evaluate the technical feasibility and the sensitivity, specificity, and accuracy of remediastinoscopy in restaging N2 bronchogenic carcinoma treated with neoadjuvant chemotherapy. METHODS: Patients presenting mediastinal lymph node involvement at mediastinoscopy received three or four cycles of neoadjuvant chemotherapy with mitomycin, iphosphamide, and cisplatin or cisplatin and gemcitabine. If there was no disease progression, these patients underwent remediastinoscopy and, if no residual extracapsular involvement or N3 disease was found, a thoracotomy was then carried out. RESULTS: Twenty-four patients underwent remediastinoscopy. In 12 (50%) remediastinoscopy was positive. The 12 remaining patients were operated on and the tumors resected: 5 pneumonectomies and 7 lobectomies. Lymphadenectomy specimens showed residual disease in mediastinal lymph nodes in 5 patients (pN2) and hilar lymph nodes in 1 patient (pN1). The other 6 patients were free of nodal disease, and 4 of them presented no involvement at lung level either. The sensitivity, specificity, and accuracy of remediastinoscopy were 0.7, 1, and 0.8, respectively. CONCLUSIONS: Remediastinoscopy is a technically feasible staging tool with high diagnostic accuracy that is useful in the selection of patients who can be served best by complete resection after neoadjuvant chemotherapy.

[Study of the personality of patients with spontaneous pneumothorax]. / Estudio de personalidad de los pacientes con neumotórax espontáneo.

INTRODUCTION: Medical psychology has contributed to a greater understanding of many diseases that are predominantly medical and has also helped to improve prognosis. This study explores a surgical entity, namely spontaneous pneumothorax. OBJECTIVES: The aim was to compare the personality, depression, anxiety and type-A behavior pattern in a group of 34 patients with spontaneous pneumothorax to a group of 33 control patients admitted for a variety of minor surgical procedures. MATERIAL AND METHODS: The following objective assessment instruments were used: Trait Anxiety Inventory, Beck Depression Inventory, Jenkins Activity Inventory, Eysenck Personality Questionnaire. The questionnaires were administered before the intervention of the surgeon and after an informative interview. RESULTS: The rate of type-A behavior was statistically different in the two groups. No differences were seen for personality, depression or anxiety. CONCLUSION: We conclude that type-A behavior patterns should be reduced in patients who suffer spontaneous pneumothorax in order to improve outcome.

[Results of the surgical treatment of pathologic bronchogenic carcinoma N2 with negative mediastinoscopy]. / Resultados del tratamiento quirúrgico del carcinoma broncogénico N2 patológico con mediastinoscopia negativa.

OBJECTIVE: To analyze the survival of patients undergoing lung resection for N2 bronchogenic carcinoma with negative findings at mediastinoscopy. MATERIAL AND METHOD: Twenty-nine patients with N2 bronchogenic carcinoma were analyzed. The patients were taken from a series of 170 patients who underwent surgery between 1993 and 1997 and whose data were recorded by the Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S). In 26 patients, nodes were found in the upper mediastinum; in three patients nodes were paraesophageal or in the area of the pulmonary ligament. In 11 cases, extracapsular nodal disease was found. Three patients who died in the postoperative period were excluded from survival analysis. RESULTS: The five-year survival rate for the series of 170 patients was 39%. For the 26 patients with N2 carcinoma, five-year survival was 14% (median 12 months). Five-year survival for the remaining patients (excluding those with N2 carcinoma) was 46%. Although the median survival of patients with intracapsular nodal disease was more than twice (25 months) that of patients with extracapsular nodal disease (12 months), the difference was not significant. CONCLUSIONS: Lung resection in patients with N2 bronchogenic carcinoma with negative mediastinoscopy has little impact on survival. Surgical exploration of the mediastinum classifies such patients with greatest certainty, although the sensitivity of staging techniques warrants improvement to assure that thoracotomy is not used unnecessarily.

[Survival after resection of lung metastasis from colorectal cancer]. / Supervivencia tras resección de metástasis pulmonares de cáncer colorrectal.

OBJECTIVE: To analyze the results of resection of lung metastases from colorectal adenocarcinoma in selected patients, evaluating type of resection, morbidity and mortality associated with the procedure, and overall actuarial survival rates after surgery. PATIENTS AND METHODS: Between 1988 and 1996, 811 patients were treated surgically for colorectal adenocarcinoma. Recurrent chronic lung metastases were resected, presumably with the intention to cure, in 15 patients in the series. One patient underwent surgery for pelvic recurrence and another seven for liver metastases, before resection of the lung metastases. RESULTS: Twenty-seven wedge resections were performed, two being non-malignant and one patient requiring re-resection of new lung metastases. Unsuspected locations of lung metastasis were found in three patients during surgery. Perioperative mortality was zero. Mean follow-up was 50 months (range 28 to 99). Seven patients presented new occurrences of metastasis or tumor recurrence and died as a result. The actuarial survival rate was 48% at 5 years. CONCLUSIONS: In selected patients, surgical resection of lung metastasis from colorectal cancer, with the assumed intention of cure, has yielded a good survival rate and zero perioperative mortality. It appears advisable to use an approach that permits exhaustive palpation of the pulmonary parenchyma, due to the risk of finding unsuspected metastases.

[Contribution of transcervical mediastinoscopy and anterior mediastinostomy to the diagnosis of mediastinal lymphomas]. / Aportación de la mediastinoscopia transcervical y mediastinotomía anterior al diagnóstico de los linfomas mediastínicos.

UNLABELLED: The aim of this study has been to assess the profitability of mediastinal explorations (transcervical mediastinoscopy and anterior mediastinostomy) in the diagnosis of mediastinal lymphomas within a short-stay surgery programme. Out of 129 mediastinal explorations conducted within a period of six years, 63 were programmed as short-stay surgery, 24 of which were due to mediastinal lymphomas. Fourteen patients were discharged from the hospital within the first twelve hours and ten patients, after 24 hours. RESULTS: There were 11 cases of Hodgkin's lymphomas and 13 non-Hodgkin's lymphomas. No immediate complications were developed by the patients, with just two minor complications which did not delay hospital discharge. CONCLUSIONS: Mediastinal explorations (transcervical mediastinoscospy and anterior mediastinostomy) can be planned as short-stay surgery without any risks if they are conducted by groups with experience in these surgical techniques and provided with an adequate care infrastructure. This allows a more rationale usage of hospital resources without reducing the quality of care.

[Traumatic pulmonary pseudocyst]. / Seudoquiste pulmonar traumático.

Traumatic pulmonary pseudocyst is an unusual complication that appears after a closed thoracic trauma. It is produced as a consequence of outburst and shear forces released by the impact on the elastic thoracic wall. We present a 14-year-old boy who, after a motorcycle crash, presented a traumatic pulmonary pseudocyst, isolated on the right hemithorax. The patient's evolution was good. The antecedent of trauma, together with radiological examination and the tendency toward spontaneous resolution, suggested the diagnosis as well as the advisability of a conservative approach in most pediatric cases. Recognition of this unusual disorder would help to avoid unnecessary diagnostic and therapeutic procedures.

La cirugía torácica y la radiología. Recordando a Wilhelm Conrad Röntgen en el 106 aniversario del descubrimiento de los rayos X / Chest surgery and radiology

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Resultados del tratamiento quirúrgico del carcinoma broncogénico N2 patológico con mediastinoscopia negativa / Results of surgical treatment of N2 bronchogenic carcinoma with negative mediastinoscopy

Objetivo: Análisis de la supervivencia de los pacientes con carcinoma broncogénico N2 patológico y mediastinoscopia negativa sometidos a resección pulmonar. Material y método: Se analizan 29 pacientes con carcinoma broncogénico N2 patológico de una serie total de 170 pacientes intervenidos entre 1993 y 1997 y registrados en el Grupo Cooperativo de Carcinoma Broncogénico de la SEPAR (GCCB-S). Veintiséis pacientes presentaron afectación ganglionar en mediastino superior y tres en las estaciones del ligamento pulmonar o paraesofágica. Once casos presentaron afectación extracapsular. Tres pacientes que fallecieron en el postoperatorio se excluyeron del análisis de supervivencia. Resultados: La supervivencia a los 5 años de los 170 pacientes fue del 39 por ciento. La supervivencia a los 5 años de los 26 pacientes con N2 patológico incluidos en el análisis fue del 14 por ciento, con una mediana de 12 meses. La supervivencia a 5 años del resto de la serie, excluyendo los N2 patológicos, fue del 46 por ciento. Aunque la mediana de supervivencia para los pacientes con afectación intracapsular fue de más del doble (25 meses) que la de los pacientes con afectación extracapsular (12 meses), las diferencias no fueron significativas. Conclusiones: La resección pulmonar en pacientes con carcinoma broncogénico N2 patológico con mediastinoscopia negativa tiene poco impacto en la supervivencia. La exploración quirúrgica del mediastino selecciona a estos pacientes con la máxima certeza clasificadora; aunque sería de desear que la sensibilidad de estas técnicas se incrementara para evitar que estos pacientes lleguen a precisar la toracotomía. (AU)

Seudoquiste pulmonar traumático / Traumatic pulmonary pseudocyst

El seudoquiste pulmonar traumático es una complicación poco frecuente que se presenta después de un tratamiento torácico cerrado. Está producido por fuerzas de estallido o cizallamiento generadas por el impacto sobre una caja torácica elástica. Presentamos el caso de un adolescente de 14 años que, tras un accidente de motocicleta presentó un seudoquiste pulmonar traumático único localizado en hemitórax derecho con una evolución favorable. El antecedente traumático acompañado de la radiología, así como la tendencia a la resolución espontánea nos orientan hacia el diagnóstico de esta entidad y nos permite adoptar una actitud conservadora en la mayoría de los casos pediátricos. El reconocimiento de esta entidad poco frecuente, evitaría procedimientos diagnósticos y terapéuticos innecesarios (AU)

Estudio de personalidad de los pacientes con neumotórax espontáneo / Study of the personality of patients with spontaneous pneumothorax

INTRODUCCIÓN: La psicología médica ha ayudado a profundizar en el conocimiento y mejor evolución de diversas enfermedades en su mayoría médicas. En el presente trabajo se pretende profundizar en una afección quirúrgica como el neumotórax espontáneo. OBJETIVOS: El objetivo de este estudio ha sido comparar la personalidad, la patología afectiva, la ansiedad y el patrón de conducta tipo A de un grupo de 34 pacientes con neumotórax espontáneo con un grupo control de 33 pacientes hospitalizados por afecciones quirúrgicas menores. MATERIAL Y MÉTODOS: Se han aplicado a los sujetos pruebas objetivas de valoración: Trait Anxiety Inventory, Beck Depression Inventory, Jenkins Activity Inventory, Eysenck Personality Questionary. Los cuestionarios se administraron antes de la intervención quirúrgica y tras una entrevista informativa. RESULTADOS: Se han encontrado diferencias estadísticamente significativas entre los grupos en patrón de conducta tipo A, no siendo así en rasgos de personalidad, estado de ánimo y ansiedad. CONCLUSIÓN: Podemos concluir que para la mejor evolución de los pacientes con neumotórax espontáneo sería necesario reducir sus características del patrón de conducta tipo A (AU)