[Prognostic value of the carcinoembryonic antigen found in pleural lavage fluid from patients with lung carcinoma]. / Valor pronóstico del antígeno carcinoembrionario hallado en lavados pleurales de pacientes con carcinoma pulmonar.

OBJECTIVE: To detect the tumor marker carcinoembryonic antigen (CEA) in pleural lavage fluid taken during surgery from patients with pulmonary carcinoma without associated pleural effusion and assess its possible prognostic implications. PATIENTS AND METHODS: A prospective, observational study was undertaken to include consecutive patients who underwent surgical treatment for lung carcinoma in which pleural lavage was performed prior to closure of the thoracic cavity (study group). The same techniques and measurements were used in patients undergoing thoracotomy for benign disease (control group). The preoperative blood level of CEA was also quantified. RESULTS: In the study group, the median CEA levels in blood and pleural lavage fluid were 2.90 ng/mL and 0.40 ng/mL respectively; these figures are higher than those corresponding to the control group. A CEA level of 0.30 ng/mL in pleural lavage fluid was established as a cutoff point, based on the corresponding receiver operating characteristic curve, with a sensitivity of 68.4% and a specificity of 35.7%. A graph of survival in relation to this cutoff point revealed a statistically significant effect (P<.05). CONCLUSIONS: It is possible to detect CEA in pleural lavage fluid from the thoracic cavity of patients with lung carcinoma. The values obtained are higher than those found in fluid from patients without neoplastic disease, and this parameter functions as an independent predictor of disease course.

Valor pronóstico del antígeno carcinoembrionario hallado en lavados pleurales de pacientes con carcinoma pulmonar / Prognostic value of the carcinoembryonic antigen found in pleural lavage fluid from patients with lung carcinoma

OBJETIVO: Detectar el marcador tumoral antígeno carcino-embrionario (CEA) en lavados pleurales de pacientes con carcinoma pulmonar sin derrame pleural asociado, en el momento de la cirugía, a fin de estudiar sus posibles implicaciones pronósticas. PACIENTES Y MÉTODOS: Se trata de un estudio observacional prospectivo que recoge de forma consecutiva a los pacientes intervenidos de carcinoma pulmonar a los que se realizó lavado pleural de la cavidad torácica al finalizar su apertura (grupo de estudio). Se practicaron la misma técnica y medición en pacientes toracotomizados por enfermedades benignas (grupo control). También se cuantificó el valor del CEA sanguíneo preoperatorio. RESULTADOS: El CEA (mediana) sanguíneo en el grupo de estudio fue de 2,90 ng/ml y en el lavado pleural de 0,40 ng/ml, cifras superiores a las correspondientes del grupo control. Se estableció como punto de corte del CEA en el lavado pleural el valor de 0,30 ng/ml, establecido según la curva de eficacia diagnóstica correspondiente, con una sensibilidad del 68,4% y una especificidad del 35,7%. La gráfica de supervivencia en función de este punto de corte mostró significación estadística (p < 0,05). CONCLUSIONES: Es posible detectar CEA en lavados pleurales de la cavidad torácica en pacientes con carcinoma pulmonar, con valores superiores a los encontrados en pacientes sin enfermedad neoplásica. La medición de dicho valor es un factor pronóstico independiente en la evolución de la enfermedad

OBJECTIVE: To detect the tumor marker carcinoembryonic antigen (CEA) in pleural lavage fluid taken during surgery from patients with pulmonary carcinoma with out associated pleural effusion and assess its possible prognostic implications. PATIENTS AND METHODS: A prospective, observational study was undertaken to include consecutive patients who underwent surgical treatment for lung carcinoma in which pleural lavage was performed prior to closure of the thoracic cavity (study group). The same techniques and measurements were used in patients undergoing thoracotomy for benign disease (control group). The preoperative blood level of CEA was also quantified. RESULTS: In the study group, the median CEA levels in blood and pleural lavage fluid were 2.90 ng/mL and 0.40 ng/mL respectively; these figures are higher than those corresponding to the control group. A CEA level of 0.30 ng/mL in pleural lavage fluid was established as a cutoff point, based on the corresponding receiver operating characteristic curve, with a sensitivity of 68.4% and a specificity of 35.7%. A graph of survival in relation to this cutoff point revealed a statistically significant effect (P<.05). CONCLUSIONS: It is possible to detect CEA in pleural lavage fluid from the thoracic cavity of patients with lung carcinoma. The values obtained are higher than those found in fluid from patients without neoplastic disease, and this parameter functions as an independent predictor of disease course. A substantial number of patients died of causes unrelated to the NSCLC for which they had been treated

[Localized fibrous tumors of the pleura: clinical and surgical evaluation]. / Tumores fibrosos de localización pleural: valoración clinicoquirúrgica.

Solitary fibrous tumors of the pleura are uncommon and mainly arise in the pleura itself. Such tumors are generally asymptomatic and slow-growing. We report a series of 10 cases (8 men and 2 women with a mean age of 58.6 years) treated over a period of 54 months. The tumors were classified histologically as benign or malignant according to the criteria used by England. The treatment of choice was complete resection of the tumor. Six posterolateral thoracotomies and 4 video-assisted resections were performed. Histology showed a mixture of fibroblast-like cells and collagenous stroma. Sarcomatous degeneration was observed in the excised tumor of 1 patient. The patients were followed for a mean of 23.9 months. We conclude that although fibrous tumors of the pleura are considered benign histologically, complete resection and follow up for all patients are recommended.

[Intraparenchymal pulmonary inflammatory pseudotumors]. / Seudotumor inflamatorio pulmonar de localización intraparenquimatosa.

Inflammatory pseudotumors are rare entities which occasionally affect the pulmonary parenchyma. Their clinical diagnosis arises in a variety of ways and half the time they are detected by chance. Deciding on a therapeutic approach is difficult because a firm diagnosis is established only after studying the excised tissue. We describe our experience with the diagnosis, surgical treatment, and follow up of 4 cases of inflammatory pseudotumor located in the pulmonary parenchyma and treated by surgical resection (by thoracotomy or video assisted thoracoscopic surgery) with good outcomes following complete resection.

Seudotumor inflamatorio pulmonar de localizaciónintraparenquimatosa / Intraparenchymal Pulmonary Inflammatory Pseudotumors

Los tumores seudoinflamatorios son una rara entidad que en ocasiones afecta al parénquima pulmonar. Su diagnóstico clínico es variado, siendo un hallazgo casual en casi la mitad de los casos. Entraña una difícil decisión en cuanto a la mejor opción terapéutica, ya que el diagnóstico de certeza se establece tras el estudio de la pieza quirúrgica. Presentamos nuestra experiencia con el diagnóstico, tratamiento quirúrgico y seguimiento de 4 casos de tumores seudoinflamatorios de localización intraparenquimatosa tratados mediante resección quirúrgica (por toracotomía o cirugía videotoracoscópica) con buenos resultados tras la resección completa (AU)

[Video-assisted thoracoscopic surgery in the treatment of pneumothorax: 107 consecutive procedures]. / Cirugía videotoracoscópica en el tratamiento de los neumotórax: consideraciones sobre 107 procedimientos consecutivos.

The aim of this prospective study was to evaluate video-assisted thoracoscopic surgery (VATS) in primary and secondary spontaneous pneumothoraces. Over a 37-month period, 107 videothoracoscopic interventions were performed to treat spontaneous pneumothorax in 105 patients, 78 men and 27 women, whose average age was 28 years.Indications for surgery included recurrent ipsilateral pneumothorax (47 cases), persistent air leak (23 cases), hypertensive pneumothorax (14 cases), history of contralateral pneumothorax (13 cases), and elective surgery (10 cases). All of these patients were treated by endoscopic resection of the bullae (or apical zone in cases where the suspected abnormalities, or bullae, could not be visualized) plus physical pleurodesis. There were no perioperative deaths. Complications occurred in 6% of the cases of primary spontaneous pneumothorax and in 45% of the cases of secondary spontaneous pneumothorax. The complications among the secondary pneumothorax patients ranged widely from postoperative subcutaneous emphysema (resolved through simple, unassisted observation) to the need for an accessory minithoracotomy. Two patients (1.8%) suffered a recurrence of pneumothorax 4 and 8 months, respectively, after VATS treatment.

Cirugía videotoracoscópica en el tratamientode los neumotórax: consideraciones sobre107 procedimientos consecutivos / Video-assisted thoracoscopic surgery in the treatment of pneumothorax: 107 consecutive procedures

El objetivo del trabajo es valorar la cirugía videotoracoscópica en los neumotórax primarios y secundarios. Para ello se ha realizado un estudio prospectivo a lo largo de 37 meses, durante los cuales se practicaron 107 intervenciones videotoracoscópicas para el tratamiento de los neumotórax espontáneos en un total de 105 pacientes. Se incluyó a 78 varones y 27 mujeres con una edad media de 28 años. Las indicaciones quirúrgicas fueron: neumotórax recurrente ipsolateral en 47 casos; fuga aérea persistente en 23 casos; neumotórax hipertensivo en 14 ocasiones; cuadro de neumotórax contralateral antiguo en 13 casos, y cirugía electiva en 10 casos. Todos los pacientes fueron tratados con resección endoscópica de zona bullosa (o zona apical en caso de no visualizar la zona sospechosa) más pleurodesis física. No hubo mortalidad perioperatoria. Las complicaciones fueron del 6 por ciento en los casos de neumotórax espontáneos primarios y del 45 por ciento en los casos de neumotórax espontáneos secundarios, incluyendo éstas una amplia gama, desde el enfisema subcutáneo posquirúrgico resuelto con simple observación hasta la necesidad de minitoracotomía accesoria. Dos pacientes (1,8 por ciento) sufrieron recidiva del neumotórax a los 4 y 8 meses de la videocirugía, respectivamente (AU)

[Spontaneous pneumothorax as the first sign of pulmonary carcinoma]. / Neumotórax espontáneo como primera manifestación de un carcinoma pulmonar.

We report five cases of spontaneous pneumothorax as the first sign of pulmonary carcinoma. Initial tests did not detect neoplasms. Diagnosis took place during surgery for four patients and the fifth was diagnosed by preoperative computed tomography to assess pulmonary bullous emphysema. All five patients had persistent air leaks in spite of correct placement and functioning of drains, the reason for which surgery was scheduled. Three segmentectomies, one lobectomy and one exploratory thoracotomy for pleural metastasis were performed. Histopathologic diagnoses were 3 giant cell tumors, 1 adenocarcinoma and 1 non-mucinous bronchoalveolar carcinoma. We think that when risk factors are present, the existence of unresolved pneumothorax after correct placement of a drain should lead to a suspicion of associated pulmonary carcinoma.

Neumotórax espontáneo como primera manifestación de un carcinoma pulmonar / Spontaneous pneumothorax as the first sign of pulmonary carcinoma

Presentamos 5 casos de pacientes con un neumotórax espontáneo como primera manifestación de un carcinoma pulmonar. Las exploraciones complementarias iniciales no descubrieron la neoplasia. En 4 casos el diagnóstico fue intraoperatorio y en el quinto al realizar una tomografía computarizada preoperatoria para valorar un enfisema bulloso pulmonar. Todos los pacientes sufrieron fugas aéreas mantenidas pese a la correcta colocación y funcionamiento del drenaje, por lo que se indicó la cirugía. Se llevaron a cabo tres segmentectomías, una lobectomía y una toracotomía exploradora por metástasis pleurales. El examen histopatológico diagnosticó tres tumores de células grandes, un adenocarcinoma y un carcinoma bronquioloalveolar no mucinoso. Creemos que en presencia de factores de riesgo, la existencia de un neumotórax no resuelto tras correcta colocación de drenaje torácico debe poner ante la sospecha clínica de un carcinoma pulmonar asociado. (AU)

[Bronchoplasty in bronchopulmonary tumors. Review of 50 cases]. / Broncoplastias en tumores broncopulmonares. Revisión de cincuenta casos.

Bronchoplasty in oncological surgery is performed to remove a tumor while preserving most of the pulmonary parenchyma. Survival in selected patients is similar to survival after lung removal. We report a series of 50 bronchoplastic procedures performed in 37 patients with bronchopulmonary cancer. Twelve had carcinoid tumors and 1 had single lung metastasis from adenocarcinoma of the colon. Twenty-seven operations were performed on the right side and 23 on the left. The pulmonary parenchyma was not resected in 2 patients. The pulmonary artery was also repaired in 5 patients. Mortality at 30 days was 2% (1 patient) and survival at 5 years was 47% calculated according to the method of Kaplan-Meier. Survival was 37 months in only 1 of the 8 patients with mediastinal adenopathy, for whom complementary radiation therapy was provided. Survival among the patients with carcinoid tumors is 91.6% to date, as all but 1 are alive at present. The single death was due to intestinal diverticulosis. The patient with metastasis is alive 12 years after surgery. Spirometric function tests were performed in 17 patients 1 year after surgery and ventilation perfusion was studied in 13. A slight loss of forced vital capacity and maximum expiratory volume in 1 second, while ventilation perfusion corresponding to the parenchyma preserved was normal. Bronchoplasty is the treatment of choice for endobronchial tumors with low degrees of malignancy. Bronchoplasty is an effective surgical treatment for a select group of carcinomas.