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INTRODUCTION: The aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS: Data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. RESULTS: The incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. CONCLUSIONS: The risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection.
Subject(s)
Lung Neoplasms , Thoracic Surgery , Databases, Factual , Humans , Lung , Lung Neoplasms/surgery , Pneumonectomy , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND AND AIM: In Stage IIIA-N2 non-small cell lung cancer (NSCLC), the accuracy of combined positron-emission tomography/computed tomography imaging (PET-CT), together with mediastinal staging techniques, has led to a wide range of challenging clinical scenarios in terms of therapeutic management. Concurrent chemoradiotherapy followed by consolidation immunotherapy remains the standard of care. In patients with potentially-resectable disease, surgery plays an important role in multimodal therapy. The introduction of targeted therapies and immune-checkpoint inhibitors has revolutionized multimodal treatment. In the present article, we review current treatment options and future trends in stage IIIA-N2 NSCLC. RELEVANCE FOR PATIENTS: This article provides insight into the current status of multimodal treatment for NSCLC to support decision-making in routine clinical practice.
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INTRODUCTION: Our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). METHODS: We conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for "90-day mortality" and "Grade IIIb-V complications". RESULTS: The series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR = 0.61 (p = 0.081), 90-day mortality OR = 0.46 (p = 0.051). CONCLUSIONS: More than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort
INTRODUCCIÓN: Nuestro estudio buscó conocer el grado de implementación actual de la cirugía toracoscópica asistida por video (VATS, por sus siglas en inglés) para las resecciones pulmonares anatómicas en España. Presentamos nuestros resultados iniciales y describimos los sistemas de auditoría desarrollados por el grupo español de VATS (GEVATS). MÉTODOS: Realizamos un estudio de cohortes prospectivo multicéntrico que incluyó pacientes que fueron tratados con resecciones pulmonares anatómicas entre el 20/12/2016 y el 20/03/2018. Los controles de calidad principales consistieron en determinar la tasa de reclutamiento de cada centro y la precisión de los datos perioperatorios recolectados en base a seis variables clave. Se analizaron las implicaciones de una baja tasa de reclutamiento para "mortalidad a los 90 días" y "complicaciones de grado IIIb-V". RESULTADOS: La serie estaba compuesta por 3533 casos (1917 VATS; 54,3%) en 33 servicios. La mediana de la tasa de reclutamiento de los centros fue del 99% (p25-p75: 76-100%), con una tasa de reclutamiento global del 83% y una precisión de los datos del 98%. No pudimos demostrar una asociación significativa entre la tasa de reclutamiento y el riesgo de morbi-mortalidad, pero se encontró una tendencia en el análisis no ajustado para aquellos centros con tasas de reclutamiento inferiores al 80% (usando los centros con tasas de 95-100% como referencia): OR = 0,61 para el grado IIIb-V (p = 0,081), OR = 0,46 para la mortalidad a los 90 días (p = 0,051). CONCLUSIONES: Más de la mitad de las resecciones pulmonares anatómicas en España se realizan a través de VATS. Según nuestros resultados, la tasa de reclutamiento del centro y sus posibles implicaciones debido al sesgo de selección, deberían recibir más atención por parte de los principales estudios multicéntricos voluntarios de nuestra especialidad. La alta representatividad y la confiabilidad de los datos de GEVATS constituyen un punto de partida fundamental para esta cohorte nacional
Subject(s)
Humans , Male , Female , Thoracic Surgery, Video-Assisted/statistics & numerical data , Thoracic Surgery, Video-Assisted/standards , Lung Neoplasms/surgery , Prospective Studies , Spain , Statistics, Nonparametric , Time Factors , Treatment Outcome , Pulmonary Surgical Procedures/statistics & numerical data , Pulmonary Surgical Procedures/standardsABSTRACT
INTRODUCTION: Our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). METHODS: We conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for "90-day mortality" and "Grade IIIb-V complications". RESULTS: The series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR=0.61 (p=0.081), 90-day mortality OR=0.46 (p=0.051). CONCLUSIONS: More than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort.
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En este trabajo se revisan la incidencia, las causas, el diagnóstico, la prevención y el tratamiento de las siguientes complicaciones quirúrgicas que pueden ocurrir tras procedimientos de resección pulmonar: fuga aérea prolongada, enfisema subcutáneo, cámaras pleurales residuales, dehiscencia precoz del muñón bronquial, hemorragia, empiema pleural, fístula broncopleural, fístula esófago-pleural, quilotórax, hernia cardíaca, torsión lobular, síndrome posneumonectomía, lesiones nerviosas y embolización tumoral (AU)
We review incidence, etiology, diagnosis, prevention and treatment of the following complications of pulmonary resection: prolonged air leak, subcutaneous emphysema, residual pleural spaces, early bronchial stump dehiscence, bleeding, pleural empyema, bronchopleural fistula, esophagopleural fistula, chylothorax, cardiac herniation, pulmonary torsion, postpneumonectomy syndrome, nerve injuries and tumor embolism (AU)
Subject(s)
Humans , Intraoperative Complications , Pneumonectomy , Postoperative Complications , Torsion Abnormality , Anastomotic Leak , Chylothorax/diagnosis , Chylothorax/etiology , Chylothorax/therapy , Empyema, Pleural , Esophageal Fistula , Herniorrhaphy , Lung Diseases , Neoplastic Cells, Circulating , Postoperative Hemorrhage , Respiratory Tract Fistula , Subcutaneous Emphysema , Hernia , Surgical Wound DehiscenceABSTRACT
We review incidence, etiology, diagnosis, prevention and treatment of the following complications of pulmonary resection: prolonged air leak, subcutaneous emphysema, residual pleural spaces, early bronchial stump dehiscence, bleeding, pleural empyema, bronchopleural fistula, esophagopleural fistula, chylothorax, cardiac herniation, pulmonary torsion, postpneumonectomy syndrome, nerve injuries and tumor embolism.
Subject(s)
Intraoperative Complications/etiology , Pneumonectomy , Postoperative Complications/etiology , Anastomotic Leak/diagnosis , Anastomotic Leak/etiology , Anastomotic Leak/therapy , Chylothorax/diagnosis , Chylothorax/etiology , Chylothorax/therapy , Empyema, Pleural/diagnosis , Empyema, Pleural/etiology , Empyema, Pleural/therapy , Esophageal Fistula/diagnosis , Esophageal Fistula/etiology , Esophageal Fistula/therapy , Hernia/diagnosis , Hernia/etiology , Herniorrhaphy , Humans , Intraoperative Complications/diagnosis , Intraoperative Complications/therapy , Lung Diseases/diagnosis , Lung Diseases/etiology , Lung Diseases/surgery , Neoplastic Cells, Circulating , Peripheral Nerve Injuries/etiology , Peripheral Nerve Injuries/therapy , Postoperative Complications/diagnosis , Postoperative Complications/therapy , Postoperative Hemorrhage/etiology , Postoperative Hemorrhage/therapy , Respiratory Tract Fistula/diagnosis , Respiratory Tract Fistula/etiology , Respiratory Tract Fistula/therapy , Subcutaneous Emphysema/diagnosis , Subcutaneous Emphysema/etiology , Subcutaneous Emphysema/therapy , Surgical Wound Dehiscence/diagnosis , Surgical Wound Dehiscence/etiology , Surgical Wound Dehiscence/therapy , Torsion Abnormality/diagnosis , Torsion Abnormality/etiology , Torsion Abnormality/surgeryABSTRACT
Introducción El secuestro pulmonar es un parénquima pulmonar patológico aislado y con vascularización arterial propia y es infrecuente. Objetivos Estudio descriptivo-retrospectivo de pacientes del Hospital Universitario La Princesa. Material y métodos Se analizan las características de pacientes del Servicio de Cirugía Torácica del Hospital Universitario La Princesa entre 1996-2008.ResultadosSe intervino a 8 pacientes con confirmación anatomopatológica, 5 eran mujeres. La infección respiratoria apareció en 7 pacientes, con afectación del lóbulo inferior derecho en 4 de ellos. La variante intralobular se diagnosticó en 7 enfermos. La vascularización provenía de la aorta torácica en 5 casos. La vía de abordaje fue la toracotomía posterolateral y se practicaron lobectomías en 5 pacientes. No hubo morbimortalidad.Conclusión1. Es una anomalía congénita infrecuente. 2. En nuestra serie, la frecuencia es mayor en mujeres en los lóbulos inferiores y es similar en ambos hemitórax. 3. La clínica más frecuente fue la infección respiratoria de repetición. 4. El diagnóstico se realizó mediante pruebas de imagen (AU)
Introduction Lung sequestration is a pathologically isolated pulmonary parenchyma, with its own arterial vascularisation. Aims A descriptive-retrospective study of patients of the La Princesa University Hospital, Madrid. Material and Methods The characteristics of patients admitted to the La Princesa University Hospital Thoracic Surgery Unit during 19962008, were analysed. Results Of the 500 patients, 8 had histopathology confirmation, of which 5 were women. There was respiratory infection in 7 patients, with 4 in the lower right lobe. The intralobar variant was diagnosed in 7 patients. The systemic vascularisation came from the thoracic aorta in five cases. A standard posterolateral thoracotomy with lobectomy was performed in 5 patients. There was no morbidity or mortality. It was more common in women, in lower lobes and similar in both hemithorax; 3. The most common clinical symptom was the respiratory infection; 4. The diagnosis was made with imaging tests (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Aged , Bronchopulmonary Sequestration , Bronchopulmonary Sequestration/diagnosis , Bronchopulmonary Sequestration/surgery , Retrospective StudiesABSTRACT
INTRODUCTION: Lung sequestration is a pathologically isolated pulmonary parenchyma, with its own arterial vascularisation. AIMS: A descriptive-retrospective study of patients of the La Princesa University Hospital, Madrid. MATERIAL AND METHODS: The characteristics of patients admitted to the La Princesa University Hospital Thoracic Surgery Unit during 1996-2008, were analysed. RESULTS: Of the 500 patients, 8 had histopathology confirmation, of which 5 were women. There was respiratory infection in 7 patients, with 4 in the lower right lobe. The intralobar variant was diagnosed in 7 patients. The systemic vascularisation came from the thoracic aorta in five cases. A standard posterolateral thoracotomy with lobectomy was performed in 5 patients. There was no morbidity or mortality. It was more common in women, in lower lobes and similar in both hemithorax; 3. The most common clinical symptom was the respiratory infection; 4. The diagnosis was made with imaging tests.
