Detección intraoperatoria radioguiada de tumor carcinoide productor de hormona adrenocorticotropa ectópica / Radioguided intraoperative detection of ectopic adrenocorticotropic hormone-producing carcinoid tumor

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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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Tratamiento de la eventración diafragmática en adultos mediante plicatura diafragmática asistida por videotoracoscopia. ¿Es una técnica difundida en nuestro medio? Revisión de la literatura, resultados de una encuesta nacional / Is video-assisted thoracoscopic diaphragmatic plication a widespread technique for diaphragmatic hernia in adults?: Review of the literature and results of a national survey

La plicatura diafragmática es el tratamiento más aceptado para la eventración diafragmática sintomática en adultos. La infrecuencia de esta dolencia y la escasa difusión de este procedimiento hacen que esta técnica sea excepcional en nuestro medio. Para estimar la difusión en la literatura, realizamos una revisión estructurada en lenguas inglesa y castellana a la que sumamos nuestra casuística: encontramos solo 6 series que aportan un total de 59 plicaturas diafragmáticas en adultos asistidas por toracoscopia. Ninguna en castellano. Nuestra serie sería la segunda mayor: 18 casos, con resultados satisfactorios similares a los publicados. Finalmente efectuamos una encuesta a todos los servicios españoles de cirugía torácica: ninguno tiene más de 10 casos operados por toracoscopia en los últimos 8 años (a excepción del nuestro) y la mayoría continúa utilizando la toracotomía como abordaje. En nuestra opinión muchos pacientes con eventración diafragmática sintomática podrían beneficiarse con la difusión de estas técnicas

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 6 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

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.

El neumomediastino espontáneo: ¿indica «gravedad» o esta depende del proceso respiratorio subyacente? / Spontaneous Pneumomediastinum: Is It a Sign of Severity, or Does It Depend on the Underlying Respiratory Process?

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Aspectos técnicos del abordaje anterior transmanubrial en la cirugía de los tumores del estrecho torácico / Technical Aspects of the Anterior Transmanubrial Approach in Thoracic Inlet Tumor Surgery

El tratamiento quirúrgico de los tumores del estrecho torácico superior supone un reto para el cirujano por su localización y por los elementos anatómicos que contiene dicha región. Se han propuesto varias vías de abordaje y cada una de ellas presenta ventajas e inconvenientes. En nuestra opinión, el abordaje anterior transmanubrial descrito en 1997 es uno de los más adecuados. Realizamos la descripción y comentarios sobre algunos detalles técnicos como ayuda al cirujano que pretenda realizar este abordaje, mostramos nuestros resultados sobre 5 pacientes y comentamos asimismo otros diferentes abordajes para esta patología(AU)

Surgical treatment of thoracic inlet tumors represents a challenge to the surgeon due to its location and anatomical elements contained in that region. Several surgical approaches have been proposed, each of them showing some advantages but drawbacks as well. In our opinion, the anterior transmanubrial approach described in 1997 is one of the most convenient. The objective of this paper is to describe and comment on some technical aspects of the procedure in order to aid surgeons who intend to perform this surgical approach. Moreover, we show our results in five patients and also comment on other approaches in this pathology(AU)

Technical aspects of the anterior transmanubrial approach in thoracic inlet tumor surgery.

Surgical treatment of thoracic inlet tumors represents a challenge to the surgeon due to its location and anatomical elements contained in that region. Several surgical approaches have been proposed, each of them showing some advantages but drawbacks as well. In our opinion, the anterior transmanubrial approach described in 1997 is one of the most convenient. The objective of this paper is to describe and comment on some technical aspects of the procedure in order to aid surgeons who intend to perform this surgical approach. Moreover, we show our results in five patients and also comment on other approaches in this pathology.

Síndrome posneumonectomía izquierda. Tratamiento endoscópico precoz / Left Postpneumonectomy Syndrome: Early Endoscopic Treatment

Se entiende por síndrome posneumonectomía la obstrucción bronquial postoperatoria, causada por un desplazamiento exagerado del mediastino. Este síndrome está bien documentado en la literatura médica como complicación tardía de una neumonectomía derecha, pero su producción tras una resección del pulmón izquierdo es excepcional, pues apenas se ha publicado una decena de casos. La fisiopatología, las manifestaciones clínicas, el pronóstico y el tratamiento son similares para ambos lados.Presentamos el caso de un paciente adulto a quien se practicó una neumonectomía izquierda y que desarrolló un síndrome posneumonectomía a los 15 meses del postoperatorio. La estenosis del bronquio intermediario se produjo entre el cuerpo vertebral y la arteria pulmonar derecha. Se efectuó eficazmente tratamiento endoscópico con una prótesis metálica autoexpandible, con lo cual se observó la remisión completa de los síntomas durante los 6 meses de seguimiento(AU)

Postpneumonectomy syndrome is characterized by postoperative bronchial obstruction caused by mediastinal shift. The syndrome is well documented in the medical literature as a late complication of right pneumonectomy; however, it rarely occurs following resection of the left lung, and only 10 cases have been published. The pathophysiology, clinical manifestations, prognosis, and treatment are similar for both sides of the lung.We present the case of an adult patient who underwent left pneumonectomy and developed postpneumonectomy syndrome 15 months later. Stenosis of the intermediate bronchus occurred between the vertebral body and the right pulmonary artery. Endoscopic treatment with a self-expanding metal stent was successful, and complete remission was observed over the 6 months of follow-up(AU)

[Left postpneumonectomy syndrome: early endoscopic treatment]. / Síndrome posneumonectomía izquierda. Tratamiento endoscópico precoz.

Postpneumonectomy syndrome is characterized by postoperative bronchial obstruction caused by mediastinal shift. The syndrome is well documented in the medical literature as a late complication of right pneumonectomy; however, it rarely occurs following resection of the left lung, and only 10 cases have been published. The pathophysiology, clinical manifestations, prognosis, and treatment are similar for both sides of the lung. We present the case of an adult patient who underwent left pneumonectomy and developed postpneumonectomy syndrome 15 months later. Stenosis of the intermediate bronchus occurred between the vertebral body and the right pulmonary artery. Endoscopic treatment with a self-expanding metal stent was successful, and complete remission was observed over the 6 months of follow-up.

Síndrome de Claude Bernard-Horner como complicación poco frecuente del drenaje postoperatorio / Claude Bernard-Horner syndrome as a rare complication of postoperative pleural drainage

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