Resultados de la Neumonectomía en el Cáncer de Pulmón no Microcítico: Estudio Unicéntrico de Morbi-Mortalidad / Results of Pneumonectomy in Non-Small Cell Lung Cancer: Single Center Study of Morbi-Mortality

Resumen abreviado: Estudio de la morbi-mortalidad de la neumonectomía por Cáncer de pulmón en nuestro centro durante 2012-2017. La morbilidad <90días y mortalidad <90días global fue 38,4% y 17%. La morbilidad y mortalidad son mayores en lado derecho. Durante último trienio disminuyó la morbi-mortalidad y el número de neumonectomías por año (5,3%).Introducción: Presentamos este trabajo para analizar la morbi-mortalidad de la neumonectomía en nuestro centro, así como los factores que influyen en la misma, mostrando nuestros resultados en el tiempo en dos períodos: 2012-2014 y 2015-2017.Material y métodos: Se trata de un estudio analítico y observacional retrospectivo de todas las neumonectomías por Cáncer de pulmón no células pequeñas (CPNCP) intervenidas durante 2012-2017. Se ha analizado la morbi-mortalidad de toda la muestra según lateralidad, FEV1, estadio, edad y sistema de sutura. También se ha estudiado la morbi-mortalidad durante: 2012-2014 y 2015-2017. El análisis estadístico se realizó con el software SPSS versión 26.Resultados: Se realizaron 65 neumonectomías (izquierdas: 39 y derechas: 26) en pacientes con el diagnóstico de CPNCP. La morbilidad <90días fue del 38,4% (25/65). El porcentaje de complicaciones en el lado derecho y en los pacientes con FEV1 <80% fue 46%, en estadio avanzado 50%, pacientes >75años 77% y neumonectomías con sistema de sutura TA-roticulator 50%. La mortalidad <90días global fue un 17% (11/65). La mortalidad de las neumonectomías en los pacientes con FEV1 <80% fue 18%, el lado derecho 30,7%, en estadio avanzado 22,2%, pacientes >75años 22% y neumonectomías con sistema de sutura TA-roticulator 28%. El análisis por períodos reveló una morbilidad (27,5%) y mortalidad (6,8%) más baja en último trienio y menor número de neumonectomías por año (5,3%). (AU)

Resumen abreviado: Study of the morbidity and mortality of pneumonectomy for lung cancer in our center during 2012-2017. Overall morbidity <90 days and mortality <90 days were 38.4% and 17%. Morbidity and mortality are higher on the right side. During the last triennium, morbidity and mortality and the number of pneumonectomies per year decreased (5.3%).Introduction: We present this work to analyze the morbidity and mortality of pneumonectomy in our center, as well as the factors that influence it, showing our results over time in two periods: 2012-2014 and 2015-2017.Material and methods: This is a retrospective analytical and observational study of all pneumonectomies for non-small cell lung cancer (NSCLC) operated during 2012-2017. The morbi-mortality of the entire sample was analyzed according to laterality, FEV1, stage, age and suture system. Morbi-mortality has also been studied during: 2012-2014 and 2015-2017. Statistical analysis was performed with SPSS version 26 software.Results: 65 pneumonectomies were performed (left: 39 and right: 26) in patients diagnosed with NSCLC. Morbidity <90 days was 38.4% (25/65). The percentage of complications on the right side and in patients with FEV1 <80% was 46%, in advanced stage 50%, patients >75 years old 77% and pneumonectomies with TA-roticulator suture system 50%. Overall <90-day mortality was 17% (11/65). Mortality of pneumonectomies in patients with FEV1 <80% was 18%, right side 30.7%, advanced stage 22.2%, patients >75 years old 22%, and pneumonectomies with TA-roticulator suture system 28%. The analysis by periods revealed a lower morbidity (27.5%) and mortality (6.8%) in the last triennium and a lower number of pneumonectomies per year (5.3%). (AU)

Metástasis de carcinoma pulmonar pleomórfico como causa de abdomen agudo / Small Bowel Perforation Due to Metastatic Pleomorphic Lung Cancer

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Manejo de fístula broncopleural mediante colocación del dispositivo Amplatzer(R) / Bronchopleural Fistula Management with Amplatzer(TM) Insertion

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Sumario ejecutivo de las recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas / Executive summary of the SEPAR recommendations for the diagnosis and treatment of non-small cell lung cancer

La Sociedad Española de Neumología y Cirugía Torácica (SEPAR), a través de las áreas de Cirugía Torácica y de Oncología Torácica, ha promovido la realización de un manual de recomendaciones para el diagnóstico y el tratamiento del cáncer de pulmón de células no pequeñas. Las elevadas incidencia y mortalidad de esta patología hacen necesaria una constante actualización de las mejores evidencias científicas para su consulta por parte de los profesionales de la salud. Para su confección se ha contado con un amplio grupo de profesionales de distintas especialidades que han elaborado una revisión integral, que se ha concretado en 4 apartados principales. En el primero se ha estudiado la prevención y el cribado de la enfermedad, incluyendo los factores de riesgo, el papel de la deshabituación tabáquica y el diagnóstico precoz mediante programas de cribado. En un segundo apartado se ha analizado la presentación clínica, los estudios de imagen y el riesgo quirúrgico, incluyendo el cardiológico y la evaluación funcional respiratoria. Un tercero trata sobre los estudios de confirmación cito-histológica y de estadificación, con un análisis de las clasificaciones TNM e histológica, métodos no invasivos y mínimamente invasivos, así como las técnicas quirúrgicas para el diagnóstico y estadificación. En un cuarto y último capítulo se han abordado aspectos del tratamiento, como el papel de las técnicas quirúrgicas, la quimioterapia, la radioterapia, el abordaje multidisciplinar por estadios y otros tratamientos dirigidos frente a dianas específicas, terminando con recomendaciones acerca del seguimiento del cáncer de pulmón y los tratamientos paliativos quirúrgicos y endoscópicos en estadios avanzados

The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages

Executive summary of the SEPAR recommendations for the diagnosis and treatment of non-small cell lung cancer. / Sumario ejecutivo de las recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas.

The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.

Recomendaciones SEPAR de diagnostico y tratamiento del cancer de pulmón de celulas no pequeñas / Recommendations of the Spanish Society of Pneumology and Thoracic Surgery on the diagnosis and treatment of non-small-cell lung cancer

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Is video-assisted thoracoscopic diaphragmatic plication a widespread technique for diaphragmatic hernia in adults? Review of the literature and results of a national survey.

Diaphragmatic plication is the most accepted treatment for symptomatic diaphragmatic hernia in adults. The fact that this pathology is infrequent and this procedure not been widespread means that this is an exceptional technique in our field. To estimate its use in the literature, we carried out a review in English and Spanish, to which we added our series. We found only six series that contribute 59 video-assisted mini-thoractomy for diaphragmatic plications in adults, and none in Spanish. Our series will be the second largest with 18 cases. Finally, we conducted a survey in all the Spanish Thoracic Surgery units in Spain: none reported more than 10 cases operated by thoracoscopy in the last 8 years (except our series) and most continue employing thoracotomy as the main approach. We believe that many patients with symptomatic diaphragmatic hernia could benefit from the use of such techniques.

Mediastinitis / Mediastinitis

La mediastinitis se define como la inflamación aguda o crónica de las estructuras mediastínicas. Se presenta con una baja incidencia en general. La causa aguda más frecuente es la postesternotomía derivada de la cirugía cardíaca de revascularización con ambas arterias mamarias internas, con una incidencia del 0,4-5% y una mortalidad del 16,5 al 47%, siendo el vector más frecuente el Staphylococcus aureus. La perforación esofágica normalmente iatrogénica es la segunda causa de mediastinitis aguda, vehiculizada por flora orofaríngea común, con una mortalidad del 20 al 60%, dependiendo del momento del diagnóstico. La mediastinitis necrotizante descendente es la tercera causa, siendo el foco odontógeno en un 60% el origen y el Streptococcus β-hemolítico el microorganismo causante en el 71,5%. La tomografía computarizada es la herramienta diagnóstica de imagen más adecuada. El tratamiento es prácticamente siempre quirúrgico y su precocidad determina la supervivencia de estos pacientes. El choque séptico es el factor de peor pronóstico posquirúrgico (AU)

Mediastinitis is defined as acute or chronic inflammation of the mediastinal structures and generally has a low incidence. The most frequent acute cause is sternotomy following cardiac revascularization surgery with both internal mammary arteries, with an incidence of 0.4% to 5% and a mortality of 16.5% to 47 %. The most frequent vector is Staphylococcus aureus. Esophageal perforation, usually iatrogenic, is the second most frequent cause of acute mediastinitis, produced by common oropharyngeal flora, with a mortality rate of 20% to 60%, depending on the time of diagnosis. The third most frequent cause is descending necrotizing mediastinitis, the origin being an odontogenous focus in 60% and beta-hemolytic streptococcus the causative agent in 71.5 % of cases. The most accurate diagnostic imaging technique is computed tomography. Treatment is almost always surgical and survival depends on its early performance. The worst postsurgical prognostic factor is septic shock (AU)

[Mediastinitis]. / Mediastinitis.

Mediastinitis is defined as acute or chronic inflammation of the mediastinal structures and generally has a low incidence. The most frequent acute cause is sternotomy following cardiac revascularization surgery with both internal mammary arteries, with an incidence of 0.4% to 5% and a mortality of 16.5% to 47%. The most frequent vector is Staphylococcus aureus. Esophageal perforation, usually iatrogenic, is the second most frequent cause of acute mediastinitis, produced by common oropharyngeal flora, with a mortality rate of 20% to 60%, depending on the time of diagnosis. The third most frequent cause is descending necrotizing mediastinitis, the origin being an odontogenous focus in 60% and beta-hemolytic streptococcus the causative agent in 71.5% of cases. The most accurate diagnostic imaging technique is computed tomography. Treatment is almost always surgical and survival depends on its early performance. The worst postsurgical prognostic factor is septic shock.

Video-assisted thoracic surgery lobectomy: results in lung cancer.

BACKGROUND: The application of video-assisted thoracic surgery (VATS) in major pulmonary resections is still far from routine in most hospitals, even though the safety and technical feasibility of the procedure have by now been amply demonstrated. This paper reports on the surgical technique used by the authors for VATS lobectomy, on their experience of the procedure and on the results obtained. METHODS: A retrospective study was performed of all patients undergoing VATS lobectomy at the our Thoracic Surgery Department ,between 1993 and 2009.The clinical records of all patients were reviewed, and the following variables were noted for purposes of analysis: patient age and sex; clinical diagnosis; staging; date of surgery; type of surgery; conversion to conventional surgery and grounds for conversion; duration of surgery; intraoperative, postoperative and long-term complications; postoperative stay, final diagnosis and staging; and death rates. RESULTS: A total of 349 VATS lobectomies were performed over the study period (292 men, 57 women; mean age 59.7) The aetiology was non-small-cell lung carcinoma (NSCLC) in 313 patients and benign processes in 26;four patients had carcinoid tumours, and a further six required lobectomy due to metastases. The overall conversion rate was 9.4%. Mean duration of lobectomy was 148 minutes, and median duration 92 minutes. Mean postoperative was 3.9 days. The morbidity rate was 12.89 %, mostly involving minor complications. Perioperative mortality was 1.43%. There were no intraoperative deaths. The overall five-year survival rate for patients with NSCLC was 80.1%. CONCLUSIONS: VATS lobectomy is a safe and technically-viable procedure that meets oncological criteria for lung-cancer surgery. Major pulmonary resection using VATS should be considered the procedure of choice for a number of benign processes and for early-stage bronchogenic carcinoma (T1-T2 N0 M0).

Videotoracoscopia exploradora y videopericardioscopia en la estadificación definitiva y valoración de la resecabilidad del cáncer de pulmón / Exploratory Videothoracoscopy and Videopericardioscopy in the Definitive Staging and Assessment of Resectability of Lung Cancer

Introducción: El objetivo del artículo es presentar nuestra experiencia en videotoracoscopia para laestadificación y valoración de la resecabilidad del cáncer de pulmón.Pacientes y métodos: Desde 1993 realizamos videotoracoscopia exploradora (VTE) para la estadificación y valoración de la resecabilidad del cáncer de pulmón. Cuando se sospecha que hay afectación vascularintrapericárdica, la exploración intrapericárdica de los vasos mediante videopericardioscopia (VPC) sirvepara valorar la resecabilidad en estos supuestos cT4. Hasta diciembre de 2007 intervenimos a 1.381pacientes con carcinoma broncogénico. En este grupo de pacientes se realizaron 91 VPC, 45 de ellas por sospecha previa de invasión hiliar y vascular en la tomografía computarizada o resonancia magnética; en los 46 restantes se indicó durante la VTE.Resultados: En 1.277 pacientes pudo llevarse a cabo la VTE, que no fue posible en 104 casos por adherenciaspleurales firmes —61 pudieron resecarse trastoracotomía y sólo 43(3,1%) fueron toracotomíasexploradoras—. En 141 casos (10,2%)se hallaron en la VTE causas de irresecabilidad: en 81 invasiónmediastínica, en 38 carcinomatosis pleural, en 6 concurrieron ambas causas y en 16 había invasióntranscisural y/o vascular que impedía la lobectomía en pacientes que no toleraban la neumonectomía. En 61 de los 91 pacientes a quienes se realizó VPC pudo llevarse a cabo la exéresis pulmonar; en los 30restantes había invasión intrapericárdica que impedía su disección: de la arteria pulmonar en 17 casos; de la arteria y vena pulmonar es superiores en 6; de la arteria pulmonar y vena cava superiores en 2, y ampliainvasión de la aurícula izquierda y venas pulmonares en 5.Conclusiones: La VTE y la VPC como primer paso de la intervención por cáncer de pulmón requiere pocosminutos, no añade morbilidad y evita una significativa proporción de toracotomías exploradoras(AU)

Objective: We present our experience in using videothoracoscopy for the staging and assessment of resectability of lung cancer.Patients and Methods: Since 1993 we have carried out exploratory videothoracoscopy (EVT) for lung cancerstaging and assessment of resectability. When intrapericardial vessel involvemen tissu spected, explorationby videopericardioscopy (VPC)is also useful for assessing resectability in the se cT4 cases. Up to December2007 we had studied 1381 patients with bronchogenic carcinoma. VPC was performed in 91 of these patients. In 45, the procedure was indicated because evidence of hilar and vascular invasion had been observed in the computed tomography or magnetic resonance images. In there maining 46, it wasperformed as a result of EVT findings.Results: We were able to perform EVT in 1277 patients. In 104 cases this procedure could not be performed because of firm pleural adhesions. The tumor was resected after thoracotomy in 61 of these patients;thoracotomy was thus only exploratory in only 43 (3.1%). In 141 cases(10.2%) tumors were consideredunresectable based on EVT, due to mediastinal invasion in 81 cases, pleural carcinoma tos is in 38 cases, and both findings in 6 cases. Lobectomy was ruled out because of spread across a fissure or vascular invasion in16 patients who were unable to tolerate pneumonectomy.In 61 of the 91 patients who underwent VPC we were able to perform lung resection; in the remaining 30, intrapericardial dissection was prevented by invasion of the pulmonary artery (17cases), of the upper pulmonary artery and vein(6cases), of the upper pulmonary artery and superior vena cava (2cases), or ofthe left a trium and pulmonary veins(5cases, in which the invasion was extensive).Conclusions: EVT and VPC as a first stepin lung cancer treatment require only a few minutes, do not contribute to morbidity, and avoid a significant proportion of exploratory thoracotomies(AU)

Utilidad de la videotoracoscopia para una correcta estadificación de tumores T3 por invasión de pared / Usefulness of Video-assisted Thoracoscopy for Correctly Staging Tumors as T3 Because of Chest Wall Invasion

IntroducciónLa videotoracoscopia exploradora (VTE) es una técnica que permite valorar la resecabilidad del carcinoma de pulmón. El objetivo de este trabajo ha sido comprobar su utilidad para diferenciar los verdaderos tumores T3 por invasión parietal de aquellos que se estadificaron de forma incorrecta por las pruebas de imagen.Pacientes y métodosDesde marzo de 1993 hasta diciembre de 2007 se estudió a 1.277 pacientes, de los que 150 (137 varones y 13 mujeres; rango de edad: 28 81 años) presentaron tumores estadificados como cT3 por invasión parietal en las pruebas de imagen.ResultadosTras la realización de la VTE, los tumores pT3 por invasión parietal confirmados intraoperatoriamente y mediante estudio anatomopatológico fueron 44. De ellos, 36 se habían clasificado correctamente como cT3 por tomografía computarizada o resonancia magnética. Se observó además que 6 casos habían sido infravalorados como cT2, y otros 2 supravalorados como cT4. La sensibilidad, especificidad y valor predictivo tanto positivo como negativo obtenidos en nuestra serie han sido del 100%.ConclusionesEn nuestra opinión, la VTE es una técnica claramente superior a la tomografía computarizada y/o resonancia magnética para detectar infiltración de pared, por lo que, además de estadificar correctamente la situación tumoral T3 por invasión parietal, permite decidir la vía de abordaje adecuada para cada caso(AU)

BackgroundExploratory video-assisted thoracoscopy (EVT) can be used to assess the resectability of lung carcinomas. The aim of this study was to investigate the usefulness of this technique for distinguishing between tumors that invade the chest wall and should be staged as T3 and tumors that have been incorrectly staged as T3 on the basis of imaging studies.Patients and MethodsFrom March 1993 through December 2007, we studied 1277 patients, of whom 150 (137 men and 13 women; age range, 28 81 years) presented tumors classified as cT3 because of chest wall invasion on the basis of imaging studies.ResultsAfter exploratory EVT, 44 pT3 tumors with chest wall invasion were confirmed intraoperatively and by histopathology. Of these, 36 had been correctly classified as cT3 by computed tomography or magnetic resonance imaging. However, tumors had been understaged as cT2 in 6patients and overstaged as cT4 in 2 patients. The sensitivity, specificity, and positive and negative predictive values obtained were 100%.ConclusionsWe believe that exploratory EVT is clearly better than computed tomography and/or magnetic resonance imaging for detecting chest wall invasion. In addition to correctly staging a tumor as T3 because of chest wall invasion, the technique can also help decide the best surgical approach in each case(AU)

[Exploratory videothoracoscopy and videopericardioscopy in the definitive staging and assessment of resectability of lung cancer]. / Videotoracoscopia exploradora y videopericardioscopia en la estadificación definitiva y valoración de la resecabilidad del cáncer de pulmón.

OBJECTIVE: We present our experience in using videothoracoscopy for the staging and assessment of resectability of lung cancer. PATIENTS AND METHODS: Since 1993 we have carried out exploratory videothoracoscopy (EVT) for lung cancer staging and assessment of resectability. When intrapericardial vessel involvement is suspected, exploration by videopericardioscopy (VPC) is also useful for assessing resectability in these cT4 cases. Up to December 2007 we had studied 1381 patients with bronchogenic carcinoma. VPC was performed in 91 of these patients. In 45, the procedure was indicated because evidence of hilar and vascular invasion had been observed in the computed tomography or magnetic resonance images. In the remaining 46, it was performed as a result of EVT findings. RESULTS: We were able to perform EVT in 1277 patients. In 104 cases this procedure could not be performed because of firm pleural adhesions. The tumor was resected after thoracotomy in 61 of these patients; thoracotomy was thus only exploratory in only 43 (3.1%). In 141 cases (10.2%) tumors were considered unresectable based on EVT, due to mediastinal invasion in 81 cases, pleural carcinomatosis in 38 cases, and both findings in 6 cases. Lobectomy was ruled out because of spread across a fissure or vascular invasion in 16 patients who were unable to tolerate pneumonectomy. In 61 of the 91 patients who underwent VPC we were able to perform lung resection; in the remaining 30, intrapericardial dissection was prevented by invasion of the pulmonary artery (17 cases), of the upper pulmonary artery and vein (6 cases), of the upper pulmonary artery and superior vena cava (2 cases), or of the left atrium and pulmonary veins (5 cases, in which the invasion was extensive). CONCLUSIONS: EVT and VPC as a first step in lung cancer treatment require only a few minutes, do not contribute to morbidity, and avoid a significant proportion of exploratory thoracotomies.

[Usefulness of video-assisted thoracoscopy for correctly staging tumors as T3 because of chest wall invasion]. / Utilidad de la videotoracoscopia para una correcta estadificación de tumores T3 por invasión de pared.

BACKGROUND: Exploratory video-assisted thoracoscopy (EVT) can be used to assess the resectability of lung carcinomas. The aim of this study was to investigate the usefulness of this technique for distinguishing between tumors that invade the chest wall and should be staged as T3 and tumors that have been incorrectly staged as T3 on the basis of imaging studies. PATIENTS AND METHODS: From March 1993 through December 2007, we studied 1277 patients, of whom 150 (137 men and 13 women; age range, 28-81 years) presented tumors classified as cT3 because of chest wall invasion on the basis of imaging studies. RESULTS: After exploratory EVT, 44 pT3 tumors with chest wall invasion were confirmed intraoperatively and by histopathology. Of these, 36 had been correctly classified as cT3 by computed tomography or magnetic resonance imaging. However, tumors had been understaged as cT2 in 6 patients and overstaged as cT4 in 2 patients. The sensitivity, specificity, and positive and negative predictive values obtained were 100%. CONCLUSIONS: We believe that exploratory EVT is clearly better than computed tomography and/or magnetic resonance imaging for detecting chest wall invasion. In addition to correctly staging a tumor as T3 because of chest wall invasion, the technique can also help decide the best surgical approach in each case.

[Resection of pulmonary metastases in 148 patients: analysis of prognostic factors]. / Cirugía de metástasis pulmonares en 148 pacientes. Análisis de sus factores pronósticos.

OBJECTIVE: To evaluate the prognostic factors for survival in a series of patients who underwent surgery for pulmonary metastases from primary tumors in distinct organs. PATIENTS AND METHODS: This was a retrospective study of 148 patients operated between May 2001 and May 2007. Multivariate analysis was used to evaluate overall survival. Patients scheduled for tumorectomy were included provided their primary tumor was controlled and they had no extrathoracic recurrence and adequate cardiorespiratory function. The influence of the following prognostic factors was analyzed: number and diameter of the metastases, lymph node infiltration, complete resection, and, above all, histological type. A significance level of 95% was used. RESULTS: A total of 90 men (60.81%) and 58 women (39.19%) were operated. The mean (SD) age was 56.5 (9.7) years. The actuarial survival at 6 years was 30.3% (n=45) and the median survival was 34 months. The factors that affected survival were the number of metastases (P< .05), diameter of the lesions (P< .05), lymph node infiltration (P< .05), complete resection (P< .05), and, above all, histological type (P< .05). Tumorectomy was the most commonly performed operation. CONCLUSIONS: These results suggest that, in the absence of other therapeutic options and contraindications, we should operate on patients in whom the primary tumor is controlled and in whom complete resection can be performed. Even if factors associated with poor prognosis are present, the outcomes are always better than when surgery is not performed, particularly in view of the relatively low morbidity and mortality associated with this type of surgery.

Cirugía de metástasis pulmonares en 148 pacientes. Análisis de sus factores pronósticos / Resection of pulmonary metastases in 148 Patients: analysis of prognostic factors

OBJETIVO: Evaluar los factores pronósticos de supervivenciaen una serie de pacientes intervenidos por metástasispulmonares de diferentes tumores y órganos.PACIENTES Y MÉTODOS: Se ha realizado un estudio retrospectivode 148 pacientes intervenidos entre mayo de 2001 ymayo de 2007, y se ha aplicado un análisis multivariantepara valorar la supervivencia global. Los criterios de inclusiónfueron: control del tumor primario, sin recurrencia extratorácicay función cardiorrespiratoria suficiente, siemprecon intención de tumorectomía. Se valoró qué influencia teníanen el pronóstico los siguientes factores: número de metástasis,diámetro de éstas, adenopatías invadidas, cirugíacompleta y, sobre todo, tipo histológico, para un nivel de significacióndel 95%.RESULTADOS: En total se intervino a 90 varones (60,81%)y 58 mujeres (39,19%). La edad media ± desviación estándarera de 56,5 ± 9,7 años. Se obtuvo una supervivencia actuariala 6 años del 30,3% (n = 45), con una mediana de supervivenciade 34 meses. Los factores que influyeron en elpronóstico fueron el número de metástasis (p < 0,05), el diámetrode éstas (p < 0,05), la presencia de adenopatías invadidas(p < 0,05), la cirugía completa (p < 0,05) y, sobre todo,el tipo histológico (p < 0,05). La tumorectomía fue la intervenciónmás realizada.CONCLUSIONES: Los resultados avalan que aceptemos paratratamiento quirúrgico a los pacientes sin otra posibilidadterapéutica a quienes pueda realizarse una resección completa,que tengan el tumor primario controlado y no presentenotras contraindicaciones, pues, aunque en presencia deciertos factores empeora la supervivencia, los resultados sonsiempre mejores que con la abstención quirúrgica, máximesi se tienen en cuenta las cifras relativamente bajas de morbilidady mortalidad con este tipo de cirugía

OBJECTIVE: To evaluate the prognostic factors for survivalin a series of patients who underwent surgery for pulmonarymetastases from primary tumors in distinct organs.PATIENTS AND METHODS: This was a retrospective study of148 patients operated between May 2001 and May 2007.Multivariate analysis was used to evaluate overall survival.Patients scheduled for tumorectomy were included providedtheir primary tumor was controlled and they had noextrathoracic recurrence and adequate cardiorespiratoryfunction. The influence of the following prognostic factorswas analyzed: number and diameter of the metastases, lymphnode infiltration, complete resection, and, above all,histological type. A significance level of 95% was used.RESULTS: A total of 90 men (60.81%) and 58 women(39.19%) were operated. The mean (SD) age was 56.5 (9.7)years. The actuarial survival at 6 years was 30.3% (n=45) andthe median survival was 34 months. The factors that affectedsurvival were the number of metastases (P<.05), diameter ofthe lesions (P<.05), lymph node infiltration (P<.05), completeresection (P<.05), and, above all, histological type (P<.05).Tumorectomy was the most commonly performed operation.CONCLUSIONS: These results suggest that, in the absence ofother therapeutic options and contraindications, we shouldoperate on patients in whom the primary tumor is controlledand in whom complete resection can be performed. Even iffactors associated with poor prognosis are present, theoutcomes are always better than when surgery is notperformed, particularly in view of the relatively low morbidityand mortality associated with this type of surgery