Pneumonectomy for non-small cell lung cancer. A National Cancer Database analysis of geographic and temporal trends, outcomes, and associated factors.

BACKGROUND: The circumstances under which pneumonectomy should be performed are controversial. This study aims to investigate national trends in pneumonectomy use to determine which patients, in what geographic areas, and under what clinical circumstances pneumonectomy is performed in the United States. METHODS: We queried the National Cancer Database and included all patients undergoing anatomic surgical resection for non-small cell lung cancer (2015-2020). The association between demographic and clinical factors and the use of pneumonectomy were investigated. RESULTS: Who: A total of 128,421 patients were identified, of whom 738 (0.6%) underwent pneumonectomy. Those patients were younger (median 65 vs 68 years, P < .001), more often male (59.9% vs 44.9%, P < .001), more likely to be below median income level (44.2% vs 38.6%, P = .002), and more likely to have lower education indicators (53% vs 48.6%, P = .02) than those who underwent other anatomic resections. Notably, there was a decreasing trend in pneumonectomy use during the study period (0.9% down to 0.4%, P < .001). Where: Patients undergoing pneumonectomy were less likely to live in metropolitan areas (77.9% vs 81.7%, P = .008) and to live closer (<12 miles) to their treating facility (45% vs 49%, P = .02). Regional geographic differences also were identified (P < .001). Why: Patients who underwent pneumonectomy were more likely to have received neoadjuvant therapy (20.6% vs 5.3%, P < .001), to be clinically N (+) (39.3% vs 12.3%, P < .001), and to have more advanced tumors (cT3-4: 46.3% vs 11.3%, P < .001). CONCLUSION: Although primarily driven by advanced oncologic features, socioeconomic and geographic factors also were associated independently with the use of pneumonectomy. Standardizing pneumonectomy indications nationwide is crucial to prevent widening outcome gaps for patients with lung cancer.

Association of Food Desert Residence and 5-Year Mortality in Lung Cancer Patients Undergoing Resection.

INTRODUCTION: Food desert (FD) residence has emerged as a risk factor for poor outcomes in breast, colon and esophageal cancers. The purpose of this retrospective study was to examine FD residence as an associated risk factor in nonsmall cell lung cancer (NSCLC) patients treated with anatomic lung resection (ALR). METHODS: All consecutive ALRs for stage I-III NSCLC from January 2015 to December 2017 at a single institution were reviewed. The primary exposure of interest was FD residence as defined by the United States Department of Agriculture. The primary outcome was 5-y overall mortality. Secondary outcomes were 30-d complications and 1- and 3-y mortality. Cox proportional hazard analysis was used to model factors associated with each outcome, adjusted for covariates. RESULTS: A total of 348 ALRs were included, with 101 (29%) patients residing in an FD. In the unadjusted Cox model, those residing in FD had an associated lower 5-year mortality risk compared to those not residing in an FD (hazard ratio = 0.56, 95% confidence interval (0.33-0.97); P = 0.04). That association was not statistically significant once adjusted for covariates (hazard ratio = 0.59, 95% confidence interval (0.34-1.04); P = 0.07). CONCLUSIONS: In this study, FD residence was not associated with an increase in the risk of 5-y mortality. Selection bias of patients deemed healthy enough to undergo surgery may have mitigated the negative association of FD residence demonstrated in other cancers. Future work will evaluate all NSCLC patients undergoing treatments at our institution to further evaluate FDs as a risk factor for worse outcomes.

Video-Assisted vs Robotic-Assisted Lung Lobectomies for Operating Room Resource Utilization and Patient Outcomes.

Importance: With increased use of robots, there is an inadequate understanding of minimally invasive modalities' time costs. This study evaluates the operative durations of robotic-assisted vs video-assisted lung lobectomies. Objective: To compare resource utilization, specifically operative time, between video-assisted and robotic-assisted thoracoscopic lung lobectomies. Design, Setting, and Participants: This retrospective cohort study evaluated patients aged 18 to 90 years who underwent minimally invasive (robotic-assisted or video-assisted) lung lobectomy from January 1, 2020, to December 31, 2022, with 90 days' follow-up after surgery. The study included multicenter electronic health record data from 21 hospitals within an integrated health care system in Northern California. Thoracic surgery was regionalized to 4 centers with 14 board-certified general thoracic surgeons. Exposures: Robotic-assisted or video-assisted lung lobectomy. Main Outcomes and Measures: The primary outcome was operative duration (cut to close) in minutes. Secondary outcomes were length of stay, 30-day readmission, and 90-day mortality. Comparisons between video-assisted and robotic-assisted lobectomies were generated using the Wilcoxon rank sum test for continuous variables and the χ2 test for categorical variables. The average treatment effects were estimated with augmented inverse probability treatment weighting (AIPTW). Patient and surgeon covariates were adjusted for and included patient demographics, comorbidities, and case complexity (age, sex, race and ethnicity, neighborhood deprivation index, body mass index, Charlson Comorbidity Index score, nonelective hospitalizations, emergency department visits, a validated laboratory derangement score, a validated institutional comorbidity score, a surgeon-designated complexity indicator, and a procedural code count), and a primary surgeon-specific indicator. Results: The study included 1088 patients (median age, 70.1 years [IQR, 63.3-75.8 years]; 704 [64.7%] female), of whom 446 (41.0%) underwent robotic-assisted and 642 (59.0%) underwent video-assisted lobectomy. The median unadjusted operative duration was 172.0 minutes (IQR, 128.0-226.0 minutes). After AIPTW, there was less than a 10% difference in all covariates between groups, and operative duration was a median 20.6 minutes (95% CI, 12.9-28.2 minutes; P < .001) longer for robotic-assisted compared with video-assisted lobectomies. There was no difference in adjusted secondary patient outcomes, specifically for length of stay (0.3 days; 95% CI, -0.3 to 0.8 days; P = .11) or risk of 30-day readmission (adjusted odds ratio, 1.29; 95% CI, 0.84-1.98; P = .13). The unadjusted 90-day mortality rate (1.3% [n = 14]) was too low for the AIPTW modeling process. Conclusions and Relevance: In this cohort study, there was no difference in patient outcomes between modalities, but operative duration was longer in robotic-assisted compared with video-assisted lung lobectomy. Given that this elevated operative duration is additive when applied systematically, increased consideration of appropriate patient selection for robotic-assisted lung lobectomy is needed to improve resource utilization.

Profiles, diagnostic process, and patterns of care of patients with stage III non-small cell lung cancer: A French national study.

BACKGROUND: The management of stage III non-small-cell lung cancer (NSCLC) remains heterogeneous and complex, even after the approval of immune checkpoint inhibitors post-chemoradiotherapy (CRT). This observational study from France evaluated real-world practices in managing stage III NSCLC. METHODS: Between 2020 and 2022, we conducted a physician practice survey in 41 medical centers across France, and retrospectively analyzed aggregated information from 417 consecutive charts of patients with stage III NSCLC. We collected information on diagnostic and staging procedures, biomarker testing, surgical and non-surgical treatments, and follow-up. RESULTS: According to the physician survey, diagnostic workup of stage III NSCLC primarily relied on positron emission tomography/computed tomography and brain magnetic resonance imaging, performed for the majority of patients in 100 % and 78 % of centers, respectively. Of 417 patient charts, 414 were evaluable with 53 % of patients having stage IIIA disease, 37 % IIIB, and 10 % IIIC. The most common node involvement was N2 (59 %). Programmed death-ligand 1 testing was conducted for 98 % of patients. Invasive staging (mediastinoscopy or endobronchial ultrasound) was performed in 41 % of patients, of whom 83 % had N2 or N3 nodal involvement. Surgical resection was offered to 120 patients (29 %), with 85 % achieving R0 resection. In 292 charts of patients with unresectable stage III NSCLC, 190 patients (65 %) were offered CRT followed by consolidation immunotherapy. Within these patients, concurrent CRT was more frequently employed (52 %) than sequential CRT (13 %). CONCLUSIONS: Diagnostic procedures and treatment modalities in French medical centers generally align with clinical guidelines for stage III NSCLC, except for invasive staging that was less commonly performed than expected.

The impact of undergoing elective pediatric lung resection during respiratory syncytial virus peak season on patient outcomes: A nationwide retrospective analysis.

OBJECTIVES: Observational data to support delaying elective pediatric thoracic surgery during peak respiratory viral illness season is lacking. This study evaluated whether lung surgery during peak viral season is associated with differences in postoperative outcomes and resource utilization. METHODS: A retrospective observational cohort study was performed using the Pediatric Health Information System (PHIS). Patients with a congenital lung malformation (CLM) who underwent elective lung resection between 1 January 2016 and 29 February 2020 were included. Respiratory syncytial virus (RSV) incidence was used as a proxy for respiratory viral illness circulation. Monthly hospital-specific RSV incidence was calculated from PHIS data, and peak RSV season was defined by Centers for Disease Control data. Multivariable regression models were built to identify predictors of postoperative mechanical ventilation, which was the main outcome measure, as well as secondary outcomes including 30-day readmission after lung resection, postoperative length of stay (LOS) and hospital billing charges. RESULTS: Of 1542 CLM patients identified, 344 (22.3%) underwent lung resection during peak RSV season. 38% fewer operations were performed per month during peak RSV season than during off-peak months (p < .001). Children who underwent surgery during peak RSV season did not differ from the off-peak group in terms of age at operation, race, or comorbid conditions (i.e., congenital heart disease, newborn respiratory distress, and preoperative pneumonia). There was no association between hospital-specific RSV incidence at the time of surgery and postoperative mechanical ventilation, postoperative LOS, 30-day readmission rate or hospital billing charges. DISCUSSION: Performing elective lung surgery in children with CLMs during peak viral season is not associated with adverse surgical outcomes or increased utilization of healthcare resources.

Disparities and Underutilization of Surgery for Early Stage Small Cell Lung Cancer.

BACKGROUND: The National Comprehensive Cancer Network recommends surgical resection for stage I small cell lung cancer (SCLC). Despite these recommendations and the curative potential of such surgery, many continue to underutilize surgery. Our aim is to investigate factors that contribute to underutilization of surgery for stage I SCLC. METHODS: The National Cancer Database was queried to identify patients with SCLC stage I-IV from 2004 to 2018. Staging was defined by the American Joint Committee on Cancer guidelines. Cochran-Armitage analysis was performed to analyze trends in surgical treatment for patients diagnosed with stage I SCLC. Multivariable logistic regression assessed relationships between patient factors and surgical treatment. RESULTS: A total of 296,583 patients were diagnosed with SCLC. Of the stage I patients (n = 13,003), only 29.4.% (n = 3823) underwent surgery. Trend analysis demonstrated increased frequency of surgical treatment for stage I SCLC over years 2004 to 2017, from 14.9% to 39.6% (P < .0001). Factors that were associated with underutilization of surgery for stage I SCLC include African American race, lower median income, nonprivate insurance or Medicare, community facility, and geographic regions other than the Northeast. CONCLUSIONS: Surgical treatment for stage I SCLC remains underutilized and our study identifies notable associated factors. The recognition of these factors may help patients overcome barriers to receiving recommended treatments, improve guideline adherence, and overall quality of care for stage I SCLC patients.

Estudio comparativo de la supervivencia tras procedimientos videotoracoscópicos para la lobectomía del cáncer de pulmón: abordaje por puerto único frente a múltiple / Comparative study of survival following videothoracoscopic lobectomy procedures for lung cancer: single-versus multiple-port approaches

Introducción: La cirugía toracoscópica videoasistida se ha convertido en la técnica de elección para las intervenciones de cáncer de pulmón en estadio inicial en muchos centros, a pesar de que no se ha probado que la supervivencia a largo plazo sea la misma con todos los abordajes quirúrgicos. Método: Efectuamos una revisión retrospectiva de 276 lobectomías practicadas en nuestro servicio mediante cirugía videoasistida, y analizamos la edad, sexo, comorbilidades, tabaquismo, FEV1 y FCV, abordaje quirúrgico, estadios TNM y patológico, tipo histológico, quimioterapia neoadyuvante o coadyuvante y tiempo hasta la recidiva o la detección de metástasis con el objetivo de evaluar la tasa de supervivencia y la duración del periodo sin enfermedad en relación con el abordaje quirúrgico, dos/tres puertos o puerto único, de los pacientes. Resultados: Las tasas de supervivencia global al cabo de uno y cuatro años fueron del 88,1 y 67,6%, respectivamente. En el análisis bivariante se observó que las variables que se asociaban con la supervivencia eran las comorbilidades, el tipo histológico, el estadio, el abordaje quirúrgico y la necesidad de quimioterapia. Al analizar el abordaje quirúrgico de forma independiente, se observó que la tasa de supervivencia era inferior en el grupo en el que se utilizó la técnica monoportal frente al grupo en el que se utilizaron dos o tres puertos (VATS). Al estratificar a los pacientes según el estadio tumoral (estadio I) y el tamaño del tumor (T2), la supervivencia fue significativamente inferior en los pacientes tratados con el abordaje monoportal, en comparación con la VATS. En el análisis multivariante, el riesgo de muerte fue mayor con la técnica monoportal (HR = 1,78). En el análisis del tiempo transcurrido sin enfermedad se observó una tendencia hacia una mayor supervivencia favorable a la VATS con dos/tres puertos, tanto para la recidiva local (p = 0,093) como para el desarrollo de metástasis (p = 0,091). Conclusiones: Estos resultados cuestionan el uso de la técnica uniportal en las neoplasias malignas de pulmón, lo que sugiere la necesidad de efectuar ensayos clínicos que permitan identificar el papel de esta técnica en la cirugía del cáncer de pulmón

Introduction: Video-assisted thoracoscopic surgery has become the technique of choice in the early stages of lung cancer in many centers although there is no evidence that all of the surgical approaches achieve the same long-term survival. Method: We carried out a retrospective review of 276 VATS lobectomies performed in our department, analyzing age, sex, comorbidities, current smoker, FEV1 and FCV, surgical approach, TNM and pathological stage, histologic type, neoadjuvant or coadjuvant chemotherapy, relapse and metastasis time, with the main aim of evaluating the survival rate and disease-free time, especially with regard to the two/three versus single port approach. Result: The one/four year global survival rate was 88.1 and 67.6% respectively. Bivariate analysis found that the variables associated with survival are comorbidity, histological type, stage, surgical approach and need for chemotherapy. When we independently analyzed the surgical approach, we found a lower survival rate in the single-port group vs. the two/three-port group (VATS). Stratifying by tumoral stage (stage I) and by tumor size (T2) survival was significantly lower for patients with single-port group in comparison to VATS approach. In the multivariate analysis, single-port group is associated with a higher risk of death (HR = 1.78). In analyzing disease-free survival, differences were found in both cases in favor of two/three port VATS: p = .093 for local relapses and p = .091 for the development of metastasis. Conclusions: These results challenge the use of the single port technique in malignant lung pathologies, suggesting the need for clinical trials in order to identify the role this technique may have in lung cancer surgery

Anatomic pulmonary resection via video-assisted thoracic surgery: analysis of 117 cases at a referral center in Brazil / Ressecções pulmonares anatômicas por cirurgia torácica videoassistida: experiência de 117 casos em um centro de referência no Brasil

ABSTRACT Objective: To describe our experience with video-assisted thoracic surgery (VATS) for anatomic pulmonary resection at a referral center for thoracic surgery in Brazil. Methods: All patients who underwent anatomic pulmonary resection by VATS between 2010 and 2015 were included. Clinical and pathological data, as well as postoperative complications, were analyzed. Results: A total of 117 pulmonary resections by VATS were performed, of which 98 were lobectomies and 19 were anatomic segmentectomies. The mean age of the patients was 63.6 years (range, 15-86 years). Females predominated (n = 69; 59%). The mean time to chest tube removal was 2.47 days, and the mean length of ICU stay was 1.88 days. The mean length of hospital stay was 4.48 days. Bleeding ≥ 400 mL occurred in 15 patients. Conversion to thoracotomy was required in 4 patients. Conclusions: Our results are similar to those published in major international studies, indicating that VATS is an important strategy for pulmonary resection. They also show that VATS can be safely performed with adequate training. This technique should be used more often for the treatment of lung diseases in Brazil.

RESUMO Objetivo: Relatar a experiência com cirurgia torácica videoassistida (CTVA) para ressecções pulmonares anatômicas em um centro nacional de referência de cirurgia torácica no Brasil. Métodos: Foram incluídos todos os pacientes tratados com ressecções pulmonares anatômicas por CTVA entre 2010 e 2015 e analisados dados clínicos e patológicos, assim como complicações pós-operatórias. Resultados: Foram realizadas 117 ressecções pulmonares por CTVA, sendo 98 lobectomias e 19 segmentectomias anatômicas. A média de idade foi de 63,6 anos (variação, 15-86 anos), sendo a maioria mulheres (n = 69; 59%). A média de tempo de permanência com dreno foi de 2,47 dias e a de estada em UTI foi de 1,88 dias. A média de tempo de internação foi de 4,48 dias. Sangramento ≥ 400 ml ocorreu em 15 pacientes. Houve conversão para toracotomia em 4 pacientes. Conclusões: Nossos resultados vão ao encontro de publicações em grandes séries internacionais, corroborando que a CTVA é uma importante via de execução de ressecções pulmonares e que pode ser realizada com segurança quando há treinamento adequado, devendo ser mais utilizada no Brasil para o tratamento das doenças pulmonares.

Análisis descriptivo del tratamiento quirúrgico del cáncer de pulmón en los centros del sistema sanitario público de Andalucía. Proyecto vara II / Descriptive analysis of the surgical treatment of lung cancer at Public Health Hospitals in Andalusia: VARA Project II

Introducción: El cáncer de pulmón es el responsable de unas 3000 muertes cada año en Andalucía y, aunque la cirugía es el tratamiento de elección en estadios iniciales, menos del 20-25% son intervenidos. La Dirección del Plan Integral de Oncología de Andalucía (PIOA) realizó un estudio (Proyecto VARA I) sobre variabilidad y accesibilidad al tratamiento de radioterapia en 2003, observando una infrautilización manifiesta de este recurso en cáncer de pulmón. Esto motivó la puesta en marcha de un 2º estudio (VARA II) para evaluar el tratamiento locorregional, radioterapia y cirugía, del cáncer de pulmón en esta Comunidad. Material y métodos: Se evaluaron retrospectivamente las historias clínicas de los pacientes intervenidos en 2007 por cáncer de pulmón en los Hospitales Públicos de Andalucía. Se realizaron análisis descriptivos y de variabilidad entre los distintos equipos quirúrgicos. Resultados: Se evaluaron 418 pacientes, de los que 303 ofrecieron datos suficientes para el análisis. La edad media fue de 64 años (94% varones) con la siguiente distribución por estadios: I (60%), II (13%), III (21%), IV (6%). Se practicó tomografía de emisión de positrones (PET) en el 75% y mediastinoscopia en el 5%. La tasa de cirugía fue del 17% del total de casos esperados de cáncer de pulmón no células pequeñas. En el 97% de los casos se practicó linfadenectomía, la mayoría de ellas (72%) con un número de (..) (AU)

Introduction: Lung cancer is responsible of 3000 deaths every year in Andalusia. Although surgery is the elective treatment in early stages, less than 20-25% are operated on. The Direction of the Comprehensive Cancer Plan of Andalusia (PIOA) performed a study (VARA I Project) about variability and accessibility to radiation therapy in Andalusia in 2003, finding a clear infra utilisation in lung cancer. This motivated a second study (VARA II) to evaluate the locoregional treatment, both radiotherapy and surgery, of lung cancer in this region. Material and methods: Medical Records of patients operated in 2007 for lung cancer in Andalusian Public Hospitals were retrospectively evaluated. Descriptive analysis and studies of variability between surgical teams were performed. Results: Medical records of 418 patients were evaluated, 303 of them showing sufficient data for the analysis. Mean age was 64 (94% males), with the following stage distribution: I (60%), II (13%), III (21%), IV (6%). A PET was realized in 75% and mediastinoscopy in 5%. Surgery rate was 17% of the total expected cases of non small cell lung cancer. A lymphadenectomy was performed in 97%, the majority of them (72%) with less than 10 nodes resected. A good clinical and pathological concordance was demonstrated and low values of perioperative mortality (6%). Inter-hospitals variability study showed significant differences on histology, PET use, number of mediastinal nodes resected and reintervention rate. Discussion: The estimated surgical rate is similar to the published by other authors, although with a larger percentage of advanced stages III-IV. An important variability in patterns of care is demonstrated. Last, a low use of diagnostic mediastinoscopy is highlighted, while the use of PET for preoperative mediastinal evaluation is increasing, especially when the hospital owns the technique (AU)

Neumonectomía en niños / Pneumonectomy in children

Objetivo. La neumonectomía es raramente necesaria en niños y sus efectos a largo plazo son mal conocidos. El objetivo de este estudio es evaluar a los pacientes neumonectomizados en nuestro centro. Material y métodos. Revisamos retrospectivamente los pacientes neumonectomizados entre 1969 y 2008, recogiendo datos sobre la indicación, edad, supervivencia, función respiratoria y escoliosis. Resultados. Encontramos 10 pacientes (varón: mujer 1,5:1) con edad media de 102 ± 66 meses. Las indicaciones más frecuentes fueron las bronquiectasias (4, 1 con fibrosis quística), los tumores (1 carcinoide bronquial, 1 pseudotumor inflamatorio, 1 metástasis de osteosarcoma, 1 PNET pulmonar) y las malformaciones (1 secuestro pulmonar, 1enfisema lobar congénito). La supervivencia global fue del 90% a los (..) (AU)

Background/aim. Pneumonectomy is seldom indicated in children and its long-term effects are not well known. The aim of the present study was to examine retrospectively the indications and the long-termsequelae in a relatively large cohort of patients treated at our institution .Material and methods: We reviewed the charts of children undergoing pneumonectomy between 1969 and 2009 with particular attention to indications, techniques, complications, survival, pulmonary function and spine deformities Results: Ten patients (M:F=6/4) aged 102 ± 66 months underwent pneumonectomy for bronchiectasis (4, one with cystic fibrosis), tumors (..) (AU)

Tratamento cirúrgico das malformações pulmonares congênitas em pacientes pediátricos / Surgical treatment of congenital lung malformations in pediatric patients

OBJETIVO: Determinar as principais malformações congênitas pulmonares e os principais métodos diagnósticos utilizados, assim como as indicações de tratamento cirúrgico e os seus resultados em um serviço de referência de cirurgia torácica pediátrica. MÉTODOS: Foram revisados 52 prontuários de pacientes com diagnóstico anatomopatológico de malformações congênitas pulmonares e que foram submetidos à ressecção pulmonar entre janeiro de 1997 e dezembro de 2006. Os critérios de exclusão foram idade > 12 anos e dados clínicos incompletos. A amostra final foi composta de 35 pacientes. RESULTADOS: Nesta amostra, a média de idade foi de 31 meses, com predominância do sexo masculino (n = 21). Os achados anatomopatológicos foram malformação adenomatoide cística (n = 14), enfisema lobar congênito (n = 13), sequestro pulmonar (n = 8), e malformação arteriovenosa (n = 1). A ressecção mais comum foi a lobectomia inferior esquerda (25,71 por cento), seguida por diferentes tipos de segmentectomia (22,85 por cento), lobectomia superior esquerda (22,85 por cento), lobectomia superior direita (14,28 por cento), lobectomia inferior direita (8,57 por cento) e lobectomia média (5,71 por cento). Dos 35 pacientes, 34 (97,14 por cento) foram submetidos à drenagem pleural fechada, com tempo médio de permanência do dreno torácico de 3,9 dias. Dez pacientes (28,5 por cento) apresentaram complicações pós-operatórias. Não houve óbitos nesta série. CONCLUSÕES: A ressecção pulmonar para o tratamento das malformações pulmonares é um procedimento seguro, apresentando baixa morbidade e nenhuma mortalidade em um serviço de referência para doenças pulmonares.

OBJECTIVE: To determine the main congenital lung malformations treated and the principal diagnostic methods employed, as well as the indications for surgical treatment and the results obtained, at a referral facility for pediatric thoracic surgery. METHODS: We reviewed the medical charts of 52 patients anatomopathologically diagnosed with congenital lung malformations and who had been submitted to pulmonary resection between January of 1997 and December of 2006. Exclusion criteria were age > 12 years and incomplete clinical data. The final sample comprised 35 patients. RESULTS: In this sample, the mean age was 31 months, and there was a predominance of males (n = 21). The anatomopathological findings were cystic adenomatoid malformation (n = 14), congenital lobar emphysema (n = 13), pulmonary sequestration (n = 8) and arteriovenous malformation (n = 1). The most common type of lung resection was left lower lobectomy (in 25.71 percent) followed by different types of segmentectomy (in 22.85 percent), left upper lobectomy (in 22.85 percent), right upper lobectomy (in 14.28 percent), right lower lobectomy (in 8.57 percent) and middle lobectomy (in 5.71 percent). Of the 35 patients, 34 (97.14 percent) were submitted to closed pleural drainage, with a mean duration of thoracic drainage of 3.9 days. Ten patients (28.5 percent) presented with postoperative complications. There were no deaths in our sample. CONCLUSIONS: Pulmonary resection for the treatment of congenital lung malformations is a safe procedure, presenting low morbidity and no mortality at a referral facility for pediatric thoracic surgery.

Lobulectomía pulmonar toracoscópica: resultados iniciales en pediatría / Thoracoscopic lung lobectomy: preliminary results in pediatric patients

El objetivo del presente estudio consistió en revisar nuestra experienciainicial con el uso de la toracoscopia para la realización de resecciones pulmonares y sus complicaciones. Para ello se llevó a cabo un estudio retrospectivo de las historias clínicas y videos de lobulectomías pulmonares toracoscópicas de pacientes intervenidosquirúrgicamente en la Fundación Hospitalaria-Hospital Privado de Niños y en el Hospital Universitario CEMIC durante el período 04/2005 - 10/2008. Se incluyeron 11 pacientes delsexo femenino y 9 del sexo masculino. Las medianas del tiempo quirúrgico, del tiempo de permanencia del tubo de drenaje y de la estadía hospitalaria fueron de 150 minutos (intervalo:60-270 minutos), 3 días (intervalo: 2-10 días) y 15 días (intervalo: 3-29 días), respectivamente. Se concluyó finalmente que la lobulectomía pulmonar toracoscópica es una técnica factible yaplicable a todas las edades pediátricas, que debiera considerarse como alternativa de abordaje para grupos entrenados.(AU)

Resultados funcionales del tratamiento quirúrgico de las bronquiectasias en un país en vías de desarrollo / Functional results of surgical treatment of bronchiectasis in a developing country

Objetivo: La prevalencia de las bronquiectasias ha disminuido significativamente durante los últimos decenios en los países desarrollados. Sin embargo, la resección quirúrgica de las bronquiectasias desempeña todavía un papel importante en la práctica de la cirugía torácica en los países en vías de desarrollo como Turquía. El presente estudio se ha diseñado para evaluar los resultados obtenidos con el tratamiento quirúrgico de las bronquiectasias, especialmente en lo que se refiere a sus efectos sobre el bienestar funcional de los pacientes. Pacientes y método: Entre enero de 1995 y diciembre de 2003 recibieron tratamiento quirúrgico debido a bronquiectasias 81 pacientes. Se evaluaron las características demográficas, el tipo de resección quirúrgica y la morbilidad y mortalidad operatorias. Los resultados relativos al nivel funcional global "social" o extrapulmonar se clasificaron y compararon con una escala creada para determinar el grado de bienestar de los pacientes antes de la intervención y a los 6 meses. Resultados: La edad media de los pacientes era de 24,4 años y 47 (58%) eran de sexo masculino. El tratamiento quirúrgico consistió en lobectomía en 37 (45%), neumonectomía en 10 (12%), segmentectomía en 13 (16%) y la combinación de lobectomía y segmentectomía en 22 (27%) de las intervenciones quirúrgicas. La resección completa se llevó a cabo en 69 pacientes (85%). No se produjo ningún fallecimiento a consecuencia de la cirugía. La tasa de morbilidad fue del 18,3%. Se observó mejoría hasta un estado funcional excelente en el 81,7% de los pacientes, así como mejoría hasta un estado funcional bueno en el 12,7%; en el 5,6% no se observaron cambios. Los resultados obtenidos con la resección completa fueron significativamente mejores que los conseguidos con la resección incompleta (p = 0,0015). Conclusión: Los resultados funcionales del tratamiento quirúrgico de las bronquiectasias obtenidos en esta serie de pacientes son favorables y prometedores, especialmente en pacientes seleccionados con una reserva pulmonar suficiente y con un proceso patológico localizado en quienes es posible la resección completa

Background: The prevalence of bronchiectasis has decreased significantly over recent decades in developed countries. However, resection for bronchiectasis still plays an important part in thoracic surgery practice in developing countries such as Turkey. This study was designed to evaluate the outcomes of surgical treatment for bronchiectasis, particularly in aspects related to the effects on functional well-being. Patients and method: From January 1995 through December 2003, operations for bronchiectasis were performed in 81 patients. Demographic features, type of resection, and operative morbidity and mortality were evaluated. The outcomes related to overall "social" or nonpulmonary functional status were classified and compared according to a scale constructed to assess patients' well-being preoperatively and at the 6th postoperative month. Results: The mean age was 24.4 years and 47 patients (58%) were male. Surgical treatment was lobectomy in 37 (45%), pneumonectomy in 10 (12%), segmentectomy in 13 (16%), and lobectomy plus segmentectomy in 22 (27%) of the operations. Complete resection of disease was achieved in 69 patients (85%). There was no operative mortality. The rate of morbidity was 18.3%. Improvement to a functional status of excellent was observed in 81.7% and improvement to a status of good was seen in 12.7% of patients; 5.6% experienced no change. The results of complete resection were significantly better than those of incomplete resection (P=.0015). Conclusion: Functional results of surgical treatment for bronchiectasis in this series suggest that the outcomes are favorable and promising, particularly in selected patients with sufficient pulmonary reserves and localized disease who are suitable for complete resection

Tratamiento quirúrgico del cáncer de pulmón estadio III-A / Surgical treatment of lung cancer III-A stage

Se analiza la experiencia de 60 pacientes con tratamiento quirúrgico del cáncer de pulmón Estadío III-a. Se compararon dos grupos entre sí: Grupo I (T3 NO-1) y Grupo II (T3 N2) y se obtuvo una supervivencia actuarial a los 5 años del 34 por ciento y 23 por ciento respectivamente y una supervivencia para toda la población de 29 por ciento. Se analizaron distintos factores pronóstico: Tipo histológico, tamaño tumoral, tipo, número y localización de las adenopatías, etc. Se concluye que dentro del mismo Estadío III-a confluyen factores favorables y desfavorables y que el análisis de dichos factores permitirá seleccionar la mejor terapéutica, obteniendo índices de supervivencia satisfactorios con el tratamiento quirúrgico (AU)

Dehiscencia del muñón bronquial después de neumonectomías / Bronchial stump dehiscence after pneumonectomy

Entre los años 1983 y 1993 se trataron 14 pacientes con dehiscencias del muñón bronquial después de neumonectomías, divididos en dos grupos de acuerdo con el momento de aparición: dehiscencias tempranas (7 casos) y dehiscencias tardías (7 casos). Se describen posibles factores causales: técnicos en el primer grupo e infecciosos en el segundo. La conducta terapéutica, adaptada a cada caso en particular, estuvo orientada al manejo de la insuficiencia respiratoria, el control de la sepsis, el cierre del orificio fistuloso y la reparación de la cavidad residual. Se establecen normas orientadoras para el tratamiento (AU)

Tratamiento quirúrgico del cáncer de pulmón estadio III-A / Surgical treatment of lung cancer III-A stage

Se analiza la experiencia de 60 pacientes con tratamiento quirúrgico del cáncer de pulmón Estadío III-a. Se compararon dos grupos entre sí: Grupo I (T3 NO-1) y Grupo II (T3 N2) y se obtuvo una supervivencia actuarial a los 5 años del 34 por ciento y 23 por ciento respectivamente y una supervivencia para toda la población de 29 por ciento. Se analizaron distintos factores pronóstico: Tipo histológico, tamaño tumoral, tipo, número y localización de las adenopatías, etc. Se concluye que dentro del mismo Estadío III-a confluyen factores favorables y desfavorables y que el análisis de dichos factores permitirá seleccionar la mejor terapéutica, obteniendo índices de supervivencia satisfactorios con el tratamiento quirúrgico

Dehiscencia del muñón bronquial después de neumonectomías / Bronchial stump dehiscence after pneumonectomy

Entre los años 1983 y 1993 se trataron 14 pacientes con dehiscencias del muñón bronquial después de neumonectomías, divididos en dos grupos de acuerdo con el momento de aparición: dehiscencias tempranas (7 casos) y dehiscencias tardías (7 casos). Se describen posibles factores causales: técnicos en el primer grupo e infecciosos en el segundo. La conducta terapéutica, adaptada a cada caso en particular, estuvo orientada al manejo de la insuficiencia respiratoria, el control de la sepsis, el cierre del orificio fistuloso y la reparación de la cavidad residual. Se establecen normas orientadoras para el tratamiento

Transfusión autóloga y hemodilución aguda en cirugía torácica: variación de parámetros fisiológicos / Autologous blood infusion combined with normovolemic haemodilution with poligeline colloid

En 20 pacientes (1 HIV+) que iban a ser operados por cirugía torácica se efectuó transfusión autóloga en agudo asociada a hemodilución normovolémica con coloide de poligelina al 3,5 por ciento . Antes y después de la exanguinación y la infusión del coloide se midió la presión arterial media, la frecuencia cardiaca y el hemocrito al comienzo y fin del procesamiento. El tiempo promedio de extracción y reinfusión fue de 28 y 22 minutos respectivamente. La caída media del hematocrito fue de 4,3 puntos (p<0,01) mientras que la presión arterial media bajó 10 por ciento y la frecuencia cardíaca se elevó 12 por ciento . Luego de la infusión del coloide los parámetros encontraron casi los niveles iniciales, lo que permitió iniciar la anestesia prácticamente en las condiciones basales. Las variaciones tensionales entre los tres momentos no alcanzaron significación estadística, mientras que las del pulso fueron significativas (p<0,05). Se concluye que el método de complejidad mínima y escasa o nula repercusión hemodinámica, es de utilidad en las operaciones torácicas al permitir hacer una reserva extra de sangre

Transfusión autóloga y hemodilución aguda en cirugía torácica: variación de parámetros fisiológicos / Autologous blood infusion combined with normovolemic haemodilution with poligeline colloid

En 20 pacientes (1 HIV+) que iban a ser operados por cirugía torácica se efectuó transfusión autóloga en agudo asociada a hemodilución normovolémica con coloide de poligelina al 3,5 por ciento . Antes y después de la exanguinación y la infusión del coloide se midió la presión arterial media, la frecuencia cardiaca y el hemocrito al comienzo y fin del procesamiento. El tiempo promedio de extracción y reinfusión fue de 28 y 22 minutos respectivamente. La caída media del hematocrito fue de 4,3 puntos (p<0,01) mientras que la presión arterial media bajó 10 por ciento y la frecuencia cardíaca se elevó 12 por ciento . Luego de la infusión del coloide los parámetros encontraron casi los niveles iniciales, lo que permitió iniciar la anestesia prácticamente en las condiciones basales. Las variaciones tensionales entre los tres momentos no alcanzaron significación estadística, mientras que las del pulso fueron significativas (p<0,05). Se concluye que el método de complejidad mínima y escasa o nula repercusión hemodinámica, es de utilidad en las operaciones torácicas al permitir hacer una reserva extra de sangre(AU)

Resecciones pulmonares: estudio de morbimortalidad / Lung resection: study of morbimortality

Se estudiaron 56 casos de resecciones pulmonares realizadas en el Hospital Nacional Edgardo Rebagliati Martins en 5 años. La edad promedio fue de 46 años, con predominio del sexo masculino 4.3. El diagnóstico más frecuente fue cáncer pulmonar: 21 por ciento, luego bronquiectasia: 16 por ciento, caverna tuberculosa: 5 por ciento, quiste hidatídico: 4 por ciento. La resección pulmonar más frecuente fue la lobectomía: 84 por ciento. La suturas más empleadas para el cierre del muñón bronquial fueron: poliglactine y poliester. La complicación postoperatoria predominante fue la fístula pleurocutánea: 9 por ciento, luego empiema: 4 por ciento, infección de herida operatoria: 4 por ciento. La mortalidad fue de 8.9 por ciento, siendo mayor en las neumonectomías. No se determinó una causa de muerte de mayor incidencia.