Recomendaciones de actuación en cirugía torácica electiva y urgente en contexto de pandemia por SARS-CoV-2 de la Sociedad Española de Cirugía Torácica (SECT) / Recommendations for acting in elective and urgent thoracic surgery during SARS-CoV-2 pandemic. Spanish Society of Thoracic Surgery

La expansión de la pandemia producida por el nuevo coronavirus SARS-CoV-2 ha obligado a focalizar casi toda la asistencia sanitaria en pacientes con enfermedad COVID-19, obligando a suspender la mayoría de intervenciones quirúrgicas electivas programadas. La cirugía torácica es eminentemente oncológica, por lo que resulta obligada una adecuada priorización de los pacientes para ser intervenidos lo antes posible y en condiciones de máxima seguridad. Por otra parte, la afectación pulmonar grave COVID-19 presenta complicaciones que con frecuencia requieren procedimientos quirúrgicos torácicos urgentes en un contexto nuevo. La Sociedad Española de Cirugía Torácica (SECT) ha desarrollado este documento para establecer unas recomendaciones básicas para mantener la actividad quirúrgica electiva imprescindible y para orientar a los cirujanos que deban afrontar urgencias torácicas en este nuevo y desconocido entorno

Expansion of the pandemic produced by new coronavirus SATS-CoV-2 has made healthcare focused on patients with COVID-19 disease, leading to discontinue most of elective surgical procedures. Being thoracic surgery eminently oncological, an optimal triage of patients amenable to be safely operated on is mandatory. Moreover, severe pulmonary involvement by COVID-19 causes complications frequently needing urgent thoracic surgical procedures under a new context. The Spanish Society of Thoracic Surgery (SECT) has developed this document to establish basic recommendations to keep up essential elective surgical activity and to guide surgeons facing thoracic urgencies in this new and unknown environment

Recommendations for acting in elective and urgent thoracic surgery during SARS-CoV-2 pandemic. Spanish Society of Thoracic Surgery. / Recomendaciones de actuación en cirugía torácica electiva y urgente en contexto de pandemia por SARS-CoV-2 de la Sociedad Española de Cirugía Torácica (SECT).

Expansion of the pandemic produced by new coronavirus SATS-CoV-2 has made healthcare focused on patients with COVID-19 disease, leading to discontinue most of elective surgical procedures. Being thoracic surgery eminently oncological, an optimal triage of patients amenable to be safely operated on is mandatory. Moreover, severe pulmonary involvement by COVID-19 causes complications frequently needing urgent thoracic surgical procedures under a new context. The Spanish Society of Thoracic Surgery (SECT) has developed this document to establish basic recommendations to keep up essential elective surgical activity and to guide surgeons facing thoracic urgencies in this new and unknown environment.

Individual data meta-analysis for the study of survival after pulmonary metastasectomy in colorectal cancer patients: A history of resected liver metastases worsens the prognosis.

OBJECTIVES: To assess the impact of a history of liver metastases on survival in patients undergoing surgery for lung metastases from colorectal carcinoma. METHODS: We reviewed recent studies identified by searching MEDLINE and EMBASE using the Ovid interface, with the following search terms: lung metastasectomy, pulmonary metastasectomy, lung metastases and lung metastasis, supplemented by manual searching. Inclusion criteria were that the research concerned patients with lung metastases from colorectal cancer undergoing surgery with curative intent, and had been published between 2007 and 2014. Exclusion criteria were that the paper was a review, concerned surgical techniques themselves (without follow-up), and included patients treated non-surgically. Using Stata 14, we performed aggregate data and individual data meta-analysis using random-effect and Cox multilevel models respectively. RESULTS: We collected data on 3501 patients from 17 studies. The overall median survival was 43 months. In aggregate data meta-analysis, the hazard ratio for patients with previous liver metastases was 1.19 (95% CI 0.90-1.47), with low heterogeneity (I2 4.3%). In individual data meta-analysis, the hazard ratio for these patients was 1.37 (95% CI 1.14-1.64; p < 0.001). Multivariate analysis identified the following factors significantly affecting survival: tumour-infiltrated pulmonary lymph nodes (p < 0.001), type of resection (p = 0.005), margins (p < 0.001), carcinoembryonic antigen levels (p < 0.001), and number and size of lung metastases (both p < 0.001). CONCLUSIONS: A history of liver metastases is a negative prognostic factor for survival in patients with lung metastases from colorectal cancer. We registered the meta-analysis protocol in PROSPERO (CRD42015017838).

Combined Hepatic and Pulmonary Metastasectomies From Colorectal Carcinoma. Data From the Prospective Spanish Registry 2008-2010 / Metastasectomías hepáticas y pulmonares combinadas de carcinoma colorrectal. Datos del registro prospectivo español 2008-2010

Introduction: Resection of both liver and lung metastases from colorectal carcinoma (CRC) is a standard of care in selected patients with oligometastatic disease. We present here the analysis of the subgroup of patients undergoing combined surgery from the Spanish Group of Surgery of Pulmonary Metastases (PM) from Colorectal Carcinoma (GECMP-CCR-SEPAR). Methods: We analyze characteristics, survival and prognostic factors of patients undergoing combined resection from March-2008 to February-2010 and followed-up during at least 3 years, from the prospective multicenter Spanish Registry. Results: A total of 138 patients from a whole series of 543 cases from 32 thoracic surgery units underwent both procedures. Seventy-seven (43.8%) resected liver metastases were synchronic with colorectal tumor. Median disease specific survival (DSS) from first pulmonary metastasectomy was 48.9 months, being three and 5-year DSS 65.1% and 41.7%, respectively. From CRC-surgery median DSS was 97.2 months, with 3 and 5-year DSS rates of 96.7% and 77%, respectively. Five-year DSS from pulmonary metastasectomy was 41.7% for patients with combined resection and 52.4% for those without hepatic involvement (P = .04). Differences disappeared when considering DSS from colorectal surgery. Carcinoembrionary antigen (CEA) before lung surgery over 10 mg/dl and bilateral PM were independent prognostic factors for survival (hazard ratio 2.4 and 2.5, respectively). Conclusions: Patients with resection of PM of CRC with history of resected hepatic metastases presented significantly lower disease specific survival rates than those undergoing pulmonary metastasectomy alone. CEA before lung surgery and bilateral PM associated worse prognosis

Introducción: La resección de metástasis hepáticas y pulmonares del carcinoma colorrectal (CCR) es un tratamiento estándar para determinados pacientes con enfermedad oligometastásica. Presentamos el análisis del subgrupo de pacientes sometidos a cirugía combinada del Grupo Español de Cirugía de Metástasis Pulmonares (MP) de Carcinoma Colorrectal (GECMP-CCR-SEPAR). Métodos: Analizamos las características, la supervivencia y los factores pronósticos de los pacientes sometidos a resección combinada desde marzo de 2008 a febrero de 2010, con seguimiento durante al menos 3 años en el Registro Español, prospectivo y multicéntrico. Resultados: Se sometieron a ambos procedimientos 138 pacientes de una serie completa de 543 casos, procedentes de 32 unidades de cirugía torácica. Setenta y siete (43,8%) de las metástasis hepáticas resecadas eran sincrónicas al tumor colorrectal. La mediana de la supervivencia específica para la enfermedad (SEE) desde la primera metastasectomía pulmonar fue de 48,9 meses; las SEE a 3 y 5 años fueron del 65,1 y 41,7%, respectivamente. La mediana de la SEE desde la cirugía del CCR fue de 97,2 meses, con tasas de la SEE a 3 y 5 años del 96,7 y 77%, respectivamente. Las SEE a 5 años de la metastasectomía pulmonar fueron del 41,7% para los pacientes con resección combinada y del 52,4% para aquellos sin afectación hepática (p = 0,04). Las diferencias desaparecieron cuando se tenía en cuenta la SEE desde la cirugía colorrectal. Tener un nivel de antígeno carcinoembrionario (ACE) por encima de 10mg/dl antes de la cirugía pulmonar y la presencia bilateral de MP fueron factores pronósticos independientes para la supervivencia (odds ratio: 2,4 y 2,5, respectivamente). Conclusiones: Los pacientes con resección de MP de CCR con antecedentes de metástasis hepáticas resecadas presentaron tasas de SEE significativamente más bajas que aquellos sometidos a metastasectomía pulmonar sola. El ACE antes de la cirugía pulmonar y la presencia de MP bilaterales se asociaron a peor pronóstico

Combined Hepatic and Pulmonary Metastasectomies From Colorectal Carcinoma. Data From the Prospective Spanish Registry 2008-2010.

INTRODUCTION: Resection of both liver and lung metastases from colorectal carcinoma (CRC) is a standard of care in selected patients with oligometastatic disease. We present here the analysis of the subgroup of patients undergoing combined surgery from the Spanish Group of Surgery of Pulmonary Metastases (PM) from Colorectal Carcinoma (GECMP-CCR-SEPAR). METHODS: We analyze characteristics, survival and prognostic factors of patients undergoing combined resection from March-2008 to February-2010 and followed-up during at least 3 years, from the prospective multicenter Spanish Registry. RESULTS: A total of 138 patients from a whole series of 543 cases from 32 thoracic surgery units underwent both procedures. Seventy-seven (43.8%) resected liver metastases were synchronic with colorectal tumor. Median disease specific survival (DSS) from first pulmonary metastasectomy was 48.9 months, being three and 5-year DSS 65.1% and 41.7%, respectively. From CRC-surgery median DSS was 97.2 months, with 3 and 5-year DSS rates of 96.7% and 77%, respectively. Five-year DSS from pulmonary metastasectomy was 41.7% for patients with combined resection and 52.4% for those without hepatic involvement (P=.04). Differences disappeared when considering DSS from colorectal surgery. Carcinoembrionary antigen (CEA) before lung surgery over 10mg/dl and bilateral PM were independent prognostic factors for survival (hazard ratio 2.4 and 2.5, respectively). CONCLUSIONS: Patients with resection of PM of CRC with history of resected hepatic metastases presented significantly lower disease specific survival rates than those undergoing pulmonary metastasectomy alone. CEA before lung surgery and bilateral PM associated worse prognosis.

Causal Model of Survival After Pulmonary Metastasectomy of Colorectal Cancer: A Nationwide Prospective Registry.

BACKGROUND: Although numerous existing studies have analyzed the prognostic factors of patients who have had surgical intervention for lung metastases of colorectal carcinoma (CRC), many of the results obtained until now have been contradictory. As a consequence, there is no established consensus about which group of prognostic factors could have a greater value when considered together. METHODS: This was a multicenter prospective cohort study that included all patients who underwent a first pulmonary metastasectomy of CRC, with radical intent, during a 2-year period (March 2008 to February 2010). The follow-up continued until March 2013, and an analysis of disease-specific survival (DSS), determined from the first pulmonary metastasectomy, was implemented. The selection of the best submodel was taken based on their coefficient of determination (R(2)) and how parsimonious they were depending on the number of variables included. RESULTS: The series, consisting of 522 patients, presented the following survival rates: median, 54.9 months; 3-year DSS, 69.4% (95% confidence interval [CI], 65% to 73.8%); and 5-year DSS, 46.1% (95% CI, 38.5% to 53.7%). The resulting survival model consisted of disease-free interval of 12 months or less (hazard ratio [HR], 1.76; 95% CI, 1.21 to 2.54; p = 0.003), carcinoembryonic antigen level exceeding 5 ng/mL (HR, 1.50; 95% CI, 1.04 to 2.17; p = 0.028), bilateral lung disease (HR, 1.81; 95% CI, 1.20 to 2.75; p = 0.005), and thoracic lymph node involvement (HR, 2.71; 95% CI, 1.44 to 5.12; p = 0.002). CONCLUSIONS: According to these results from the Spanish Group of Lung Metastases of Colo-Rectal Cancer, the combination of these four variables-disease-free interval, carcinoembryonic antigen level, laterality, and thoracic lymph node involvement-constitutes the first-choice survival causal model based on the clinical and pathologic factors most frequently referenced in literature.

More than one pulmonary resections or combined lung-liver resection in 79 patients with metastatic colorectal carcinoma.

BACKGROUND: The way to select patients who will benefit from surgical resection of pulmonary metastases of colorectal carcinoma (CRC) remains unclear. METHODS: We analyze overall survival and potential prognostic factors in 101 pulmonary resections of CRC metastases in 79 patients, focusing on cases with repeated pulmonary resection or with hepatic metastasectomy. RESULTS: Number of pathological pulmonary metastases was higher than that of preoperatively suspected pulmonary nodules in 18% of the resections. Morbidity rate was 16.5%. There was no mortality. Five-year survival rates from the resection of the CRC and from the first pulmonary metastasectomy were 74.6% and 53.3%, respectively. Prognosis did not decrease in patients with history of hepatic metastasectomy or in those in which repeated pulmonary resection was performed. Age ≥70, preoperative carcinoembrionary antigen (CEA) ≥5 ng/dl and mediastinal lymph node involvement entailed worse prognosis. Pathological lymph node involvement and age were shown as independent prognostic factors in the multivariate analysis. CONCLUSIONS: Resection of pulmonary metastases of CRC is a safe procedure, with 5-year survival rates over 50%. History of resected hepatic metastases or needs for more than one pulmonary resection do not seem to decrease survival rates. Only lymph node involvement and age seem to be clearly associated to worse prognosis.