Clinical value of video-assisted thoracoscopy for preoperative staging of non-small cell lung cancer. A prospective study of 105 patients.

This study prospectively evaluated the usefulness of thoracoscopy for staging non-small cell lung cancer in 105 consecutive patients. A comparison was made of TNM stage grouping classification according to clinical disease, thoracoscopic data, and pathological findings. In 40 (38%) patients, thoracoscopy was unreliable for assessing extent of disease due to pleural symphysis. In 13 T1 clinical lesions, thoracoscopy was unreliable in 5, clinical and thoracoscopic staging concurred in 4, but 4 cases changed to T2. In 62 T2 clinical lesions, thoracoscopy was not feasible due to technical difficulties in 21 (34%); however, in the remaining 41 cases, 6 lesions changed to T3 and 1 to T4. In the group of 23 T3 or T doubtful clinical disease, thoracoscopy was conclusive, whereas in 12 T4 clinical lesions, thoracoscopy contributed for tailoring treatment strategies. With regard to N stage, 72 N0 clinical cases, thoracoscopy revealed false negatives in 25%. N1 clinical lesions were not evaluated due to the small number of patients. In 30 N2 clinical lesions, thoracoscopy was incomplete in 11. In another 11 cases, mediastinal node involvement at nodal groups not accessible by mediastinoscopy was confirmed by thoracoscopy. Clinical and thoracoscopic findings were not concurrent in eight cases, therefore in clinical N2 lesions, the diagnostic accuracy of thoracoscopy was 63%. Only one case of unsuspected pleural metastasis was detected. Thoracoscopy-related complications occurred in nine cases. In summary, video-assisted thoracoscopy was useful for staging T3, T4, and T doubtful clinical disease as well as N2 lesions especially for the surgical exploration of lymph nodes at the lower paratracheal level (region 4), aortopulmonary window (region 5), paraaortic (region 6), posterior subcarinal space (region 7), paraesophageal (region 8), and inferior pulmonary ligament (region 9).

Primary mediastinal leiomyoma: an angiographic study and embolisation of the feeding vessels to improve the surgical approach.

The case of a young woman suffering from superior vena caval syndrome secondary to a tumour mass of the anterosuperior mediastinum is presented. Angiography showed a highly vascularised mass. Surgical biopsy confirmed the diagnosis of leiomyoma of the mediastinum. Percutaneous embolisation before surgery was performed.

Chest wall parachordoma.

A 21-year-old woman with a painful chest wall mass was found to have a parachordoma (PC). The tumor arose from the fifth intercostal space. A wide chest wall resection including the tumor and a 2.5 cm free margin and the subsequent reconstruction with a Gore-Tex soft tissue patch covered with a latissimus dorsi rotational flap was performed. To our knowledge, chest wall parachordoma has not been previously reported in the medical literature.

Subglottic stenosis in an HIV positive patient: an exceptional form of clinical presentation in Kaposi's sarcoma.

The case of a 29-year-old HIV positive male patient suffering from a Kaposi's sarcoma exclusively located in the proximal third of the trachea and subglottic region is presented. The patient was found to have included an obstruction of the upper airway. A characteristic endoscopic appearance led to the final diagnosis. A combined treatment with Nd-YAG laser endoscopic resection and laringotracheal irradiation was performed. Pathological examination confirmed Kaposi's sarcoma.

Mediastinal metastasis of ovarian carcinoma.

Mediastinal metastasis of ovarian tumors are not rare as autopsy findings. Ovarian carcinomas usually spread by transcaelomic, lymphatic or haematogenous dissemination to peritoneum, pelvic and para-aortic lymph nodes, lung and pleura. A case of mediastinal metastasis of ovarian carcinoma is reported. A retrosternal mass was identified by CT scan and resected by VTC surgery.

[Short-stay lung resection surgery]. / Cirugía de resección pulmonar de corta estancia (CRPCE).

We report a prospective study applying a short-stay lung resection program for all patients requiring such surgery with the aim of shortening mean hospital stay in our service (9.5 days) by half. All patients who underwent surgery from November 1998 to November 1999 requiring lung resection surgery were enrolled in the short-stay study, classified in two groups. Group A met the criteria for enrollment and a stay of 5 days was predicted. Group B were those who did not meet the criteria marked by the program and for whom a 5-day stay could not be predicted. Sixty-four patients were enrolled (25 in group A [39.1%] and 39 in group B [60.9%]). After application of the program, the mean stay for all 64 patients was 6.4 days, with group A patients staying a mean 5.3 days and group B patients staying a mean 7.1 days.

[Bronchial carcinoid tumor: a retrospective analysis of 62 surgically treated cases]. / Tumor carcinoide bronquial. Análisis retrospectivo de 62 casos tratados quirúrgicamente.

OBJECTIVE: To evaluate the results of surgical treatment for lung carcinoid tumor. PATIENTS AND METHOD: The medical records of 62 patients who underwent surgical intervention for lung carcinoid tumor between May 1985 and October 2000 were reviewed. RESULTS: Fifty-two patients had typical carcinoid tumors and 10 had atypical carcinoid tumors. Hilar or mediastinal lymph node metastases were present in 9 patients. Distant metastasis occurred in 5 patients and was significantly more frequent in those with the atypical carcinoid histological subtype. The overall survival rate at 15 years was 70%, with a mean survival rate of 138 (SD 11) months, calculated with the Kaplan-Meier method. We found no statistically significant correlation between smoking and the development of carcinoid tumors. CONCLUSIONS: Although carcinoid tumors behave like low-grade malignant tumors, they should be treated in the same way as other malignant lung tumors. Curative surgical resection is the technique of choice whenever possible.

[Our experience in treating obstructive lesions of the main airway by Nd-Yag laser resection]. / Nuestra experiencia en el tratamiento de las lesiones obstructivas de la vía aérea principal mediante fotorresección con láser Yag-Nd.

We performed 164 laser resections with a neodymiumyttrium-aluminum-garnet (Nd-Yag) laser in 116 patients between January 1992 and December 1997. Seventy-eight patients had malignant neoplasms, 5 had neoplasms of intermediate malignancy and 33 had inflammatory tracheal lesions. Eighteen resections were emergency procedures. All resections were performed with the patient under general anesthesia and preferably breathing spontaneously. Immediate results varied according to the nature and location of the lesion. Treatment was palliative for tumors showing intraluminal proliferation, providing successful reopening of the airway as shown endoscopically in 70% of patients. Mean survival of the 44 patients with malignant lesions who could be followed was 29 weeks, with a median of 15.19 (range, 1-120). The tracheas of patients with inflammatory stenosis were reopened rapidly and emergency tracheostomy was avoided in all cases. One patient with malignant tracheal tumors died during the procedure due to asphyxia related to tracheal hemorrhage.

Fatal right spontaneous haemothorax in Von Recklinghausen's disease.

Spontaneous massive haemothorax is uncommon and usually occurs as a result of pulmonary infarction, arteriovenous fistula, neoplasm, ruptured aortic aneurysm, rupture of pleural adhesions or pleural endometriosis. Massive haemothorax in Von Recklinghausen's disease occurs rarely but with potentially fatal results in spite of surgery. We present a case of a spontaneous massive exsanguinating haemothorax in a patient with neurofibromatosis type 1 caused by rupture of a branch of the right subclavian artery. Bleeding was probably due to neurofibromatous invasion of the arterial wall.

Bronchial bacterial colonization in patients with resectable lung carcinoma.

The pattern and clinical implications of bronchial bacterial colonization have been widely investigated in patients with chronic lung disease, particularly chronic obstructive pulmonary disease. The main aim of this study was to determine the frequency and risk factors for bronchial colonization in lung cancer patients who have undergone surgical resection. Forty-one patients with resectable lung cancer (22 (54%) active smokers, 52+/-23 pack-yrs) with a mean forced expiratory volume in one second of 80+/-16% predicted, were studied with bilateral protected specimen brush and lung tissue biopsy during the surgical procedure. Quantitative bacterial culture, susceptibility tests and histological examination of samples were performed. Bronchial colonization with > or = 1 potential pathogenic micro-organism was found in 17 of 41 (41%) patients. The most frequent strains isolated were: Haemophilus influenzae (35%), Streptococcus pneumoniae (13%) and Pseudomonas spp. (9%). The risk factors for bronchial colonization were central location of the tumour (odds ratio (OR)=9.2, confidence interval (CI) 95%=2.1-39.6, p=1.003) and increased body mass index (OR=1.6, CI 95%=1.2-2.2, p=0.005). The frequency of postoperative infectious pulmonary complications was low (five cases (12%)) and no relationship was observed with bronchial colonization. Patients with resectable lung carcinoma had a high rate of bronchial colonization (41%), mainly with potential pathogenic microorganisms. The independent risk factors for colonization in these patients were central location of the tumour and a high body mass index.

Cirugía de resección pulmonar de corta estancia (CRPCE) / Short-stay lung resection surgery

Presentamos un estudio prospectivo consistente en la aplicación de un programa de cirugía de resección pulmonar de corta estancia (CRPCE) a los enfermos que por su enfermedad precisen este tipo de tratamiento quirúrgico, con el objetivo de reducir la estancia media hospitalaria de nuestro servicio (9,5 días) al 50 por ciento. Todos los enfermos operados desde noviembre de 1998 a noviembre de 1999, que precisaban cirugía de resección pulmonar, siguieron el programa de CRPCE, siendo catalogados en dos grupos: grupo A, que cumplen los criterios de inclusión en el programa, y de los que se esperaba que tuvieran una estancia de 5 días, y grupo B, que no cumplían los criterios marcados por el programa, y de los que no se esperaba, a priori, que tuvieran una estancia de 5 días. Se incluyeron en el estudio 64 enfermos (25 en el grupo A [39,1 por ciento] y 39 en el grupo B [60,9 por ciento]). Tras la aplicación del programa se consiguió una estancia media global de 6,4 días en el total de los 64 enfermos incluidos en el programa. Los pacientes del grupo A presentaron una estancia media de 5,3 días, mientras que los pacientes del grupo B presentaron una estancia media de 7,1 días. (AU)