Factores pronósticos en el trasplante cardiopulmonar: experiencia a 30 años en un centro de referencia / Prognosis factors in heart–lung transplantation: Thirty years experience in a reference center

Introducción: El trasplante cardiopulmonar (TCP) ha presentado una disminución progresiva en el número de procedimientos. En nuestro país existe poca información al respecto, siendo el objetivo de este estudio analizar la experiencia de un hospital de referencia. Métodos: Estudio observacional unicéntrico de una cohorte histórica en el periodo entre 1990 y 2021. Las asociaciones entre categorías se evaluaron mediante la prueba de X2 o la f de Fisher. La supervivencia se analizó a través del método de Kaplan-Meier. Las diferencias se evaluaron con el estudio de log-rank y el análisis multivariante con el método de Cox. Resultados: Se observó una reducción del número de procedimientos realizados en el último decenio (2000-2009: 19 [44,2%]; 2010-2021: 15 [34,8%]). La mortalidad posoperatoria precoz fue de 23,3%, reduciéndose a 13,3% a partir del 2010. La intrahospitalaria fue de 41%, disminuyendo a 33% en 2010. Los factores asociados a la mortalidad fueron cirugía torácica previa, corticoterapia, circulación extracorpórea (CEC) mayor a 200 min, tiempo de isquemia mayor a 300 min y dehiscencia traqueal (p < 0,005). La supervivencia global a uno, cinco y 10 años fue de 58, 44,7 y 36,1%, respectivamente. Los factores asociados a menores tasas de supervivencia fueron cirugía torácica previa, donante masculino, CEC mayor 200 min, tiempo de isquemia mayor a 300 min, dehiscencia traqueal y diferencia de pesos (p < 0,005). Conclusiones: Existe una disminución en el número de procedimientos, siendo más evidente en la última década, pero evidenciando una mejora tanto de la mortalidad posoperatoria y supervivencia.(AU)

Introduction: Heart–lung transplantation has shown a progressive decrease in the number of procedures. There is a lack of information about this field in Spain. The main goal of this study is to analyze the experience of a national reference hospital. Methods: We performed a retrospective study of a historical cohort of heart–lung transplanted patients in a single center, during a 30 years period (from 1990 to 2021). The associations between variables were evaluated using the χ2 test or Fisher's exact test. Survival was analyzed using the Kaplan–Meier method. Differences were evaluated using the log-rank test and multivariate analysis with the Cox method. Results: A decrease in the number of procedures performed in the last decade was observed [2000–2009: 19 procedures (44.2%); 2010–2021: 15 procedures (34.8%)]. Early postoperative mortality was 23.3%, falling to 13.3% from 2010. In-hospital mortality was 41%, falling to 33% from 2010. Main factors related to higher mortality: previous thoracic surgery, corticosteroid therapy, extracorporeal circulation (ECLS) greater than 200 min, ischemia time greater than 300 min, and tracheal dehiscence (p < 0.005). Overall survival at one, five, and ten years was 58%, 44.7%, and 36.1%, respectively. Factors associated with lower survival rates: previous thoracic surgery, male donor, extracorporeal circulation greater than 200 min, ischemia time greater than 300 min, tracheal dehiscence and weight difference (p < 0.005). Conclusions: There has been a progressive decrease in the number of heart–lung transplantations, being more evident in the last decade, but showing an improvement in both mortality and survival.(AU)

Impact of Pleural Lavage Cytology Positivity on Early Recurrence After Surgery for Non-Small Cell Lung Cancer.

OBJECTIVE: The aim of this study was to elucidate the impact of pleural lavage cytology positivity on early recurrence in patients operated on non-small cell lung cancer (NSCLC). METHODS: This is a multicentre prospective cohort study of 684 patients undergoing an anatomical lung resection for NSCLC between October 2015 and October 2017 at 12 national centres. A pleural lavage was performed before and after lung resection. The association between the different predictors of early recurrence and PLC positivity was performed using univariate and multivariate logistic regression models. A propensity score analysis was performed by inverse probability weighting (IPSW) using average treatment effect (ATE) estimation to analyse the impact of PLC positivity on early recurrence. RESULTS: Overall PLC positivity was observed in 15 patients (2.2%). After two years, 193 patients (28.2%) relapsed, 182 (27.2%) with a negative PLC and 11 (73.3%) with a positive PLC (p<0.001). Factors associated to early recurrence were adenocarcinoma histology (OR=1.59, 95%CI 1.06-2.38, p=0.025), visceral pleural invasion (OR=1.59, 95%CI 1.04-2.4, p=0.03), lymph node involvement (OR=1.84, 95%CI 1.14-2.96, p=0.013), advanced pathological stage (OR=2.12, 95%CI 1.27-3.54, p=0.004) and PLC positivity (OR=4.14, 95%CI 1.25-16.36, p=0.028). After IPSW, PLC positivity was associated with an increased risk of early recurrence (OR=3.46, 95%CI 2.25-5.36, p<0.001). CONCLUSIONS: Positive pleural lavage cytology was found to be the strongest predictor of early recurrence.

Impacto de la pandemia por COVID-19 en la formación de los cirujanos torácicos en España / Impact of the COVID-19 pandemic on thoracic surgery training in Spain

Tras más de dos años desde su aparición, la pandemia por SARS-CoV-2 ha generado importantes cambios en la sanidad y su organización. El presente trabajo trata de dilucidar las implicaciones de estos en la formación especializada de la cirugía torácica y sus repercusiones en los profesionales. Para ello, desde la Sociedad Española de Cirugía Torácica (SECT) se distribuye una encuesta entre los residentes en activo y aquellos que han terminado su formación en los últimos tres años. Esta consta de 24 preguntas cerradas de respuesta múltiple sobre el impacto de la pandemia en sus servicios, su formación y su vivencia. La tasa de respuesta (TR) de la encuesta fue de 42% (52 de una población objetivo de 120). El efecto de la pandemia en el funcionamiento de los servicios de cirugía torácica fue considerado alto o extremo según 78,8% de los participantes. Las actividades académicas fueron completamente suspendidas en 42,3% de los casos, mientras que 57,7% de los participantes tuvieron que prestar atención asistencial a pacientes ingresados por COVID, de los cuales 25% fue a tiempo parcial y 32,7% a tiempo completo. De los encuestados, 80% consideró que los cambios sufridos durante la pandemia afectaron su formación como residente y 36,5% opinó que debería ofrecerse una prolongación del periodo de formación para quienes se hayan visto afectados. Así pues, observamos cómo la pandemia ha afectado profundamente de forma negativa la formación especializada en cirugía torácica en España. (AU)

In the more than 2 years since its emergence, the SARS-CoV-2 pandemic has prompted important changes in healthcare systems and their organization. The aim of this study is to determine the implications in specialized thoracic surgery training as well as the repercussions on thoracic surgery residents. With this objective, the Spanish Society of Thoracic Surgery has conducted a survey among all its trainees and those who had finished their residency during the last 3 years. It consisted of 24 multiple-answer closed questions about the impact of the pandemic on their services, their training, and their personal experience. The response rate was 42% (52 out of a target population of 120). The effect of the pandemic on thoracic surgery services was high or extreme according to 78.8% of the participants. Academic activities were completely cancelled in 42.3% of the cases, and 57.7% of the respondents were required to treat hospitalized COVID patients (25% part-time, and 32.7% full-time). More than 80% of the survey participants believed that changes during the pandemic negatively affected their training, and 36.5% would prefer to extend their training period. In sum, we observe how the pandemic has had deep negative effects on specialized training in thoracic surgery in Spain. (AU)

Impact of COVID-19 pandemic in thoracic surgery training in Spain.

In the more than 2 years since its emergence, the SARS-CoV-2 pandemic has prompted important changes in healthcare systems and their organization. The aim of this study is to determine the implications in specialized thoracic surgery training as well as the repercussions on thoracic surgery residents. With this objective, the Spanish Society of Thoracic Surgery has conducted a survey among all its trainees and those who had finished their residency during the last 3 years. It consisted of 24 multiple-answer closed questions about the impact of the pandemic on their services, their training, and their personal experience. The response rate was 42% (52 out of a target population of 120). The effect of the pandemic on thoracic surgery services was high or extreme according to 78.8% of the participants. Academic activities were completely cancelled in 42.3% of the cases, and 57.7% of the respondents were required to treat hospitalized COVID patients (25% part-time, and 32.7% full-time). More than 80% of the survey participants believed that changes during the pandemic negatively affected their training, and 36.5% would prefer to extend their training period. In sum, we observe how the pandemic has had deep negative effects on specialized training in thoracic surgery in Spain.

[Impact of the COVID-19 pandemic on thoracic surgery training in Spain]. / Impacto de la pandemia por COVID-19 en la formación de los cirujanos torácicos en España.

In the more than 2 years since its emergence, the SARS-CoV-2 pandemic has prompted important changes in healthcare systems and their organization. The aim of this study is to determine the implications in specialized thoracic surgery training as well as the repercussions on thoracic surgery residents. With this objective, the Spanish Society of Thoracic Surgery has conducted a survey among all its trainees and those who had finished their residency during the last 3 years. It consisted of 24 multiple-answer closed questions about the impact of the pandemic on their services, their training, and their personal experience. The response rate was 42% (52 out of a target population of 120). The effect of the pandemic on thoracic surgery services was high or extreme according to 78.8% of the participants. Academic activities were completely cancelled in 42.3% of the cases, and 57.7% of the respondents were required to treat hospitalized COVID patients (25% part-time, and 32.7% full-time). More than 80% of the survey participants believed that changes during the pandemic negatively affected their training, and 36.5% would prefer to extend their training period. In sum, we observe how the pandemic has had deep negative effects on specialized training in thoracic surgery in Spain.

A Standardised Approach to the Biomechanical Evaluation of Tracheal Grafts.

The ideal tracheal substitute must have biomechanical properties comparable to the native trachea, but currently there is no standardised approach to evaluating these properties. Here we propose a novel method for evaluating and comparing the properties of tracheal substitutes, thus systematising both measurement and data curation. This system was tested by comparing native rabbit tracheas to frozen and decellularised specimens and determining the histological characteristics of those specimens. We performed radial compression tests on the anteroposterior tracheal axis and longitudinal axial tensile tests with the specimens anastomosed to the jaw connected to a measuring system. All calculations and results were adjusted according to tracheal size, always using variables relative to the tracheal dimensions, thus permitting comparison of different sized organs. The biomechanical properties of the decellularised specimens were only slightly reduced compared to controls and significant in regard to the maximum stress withstood in the longitudinal axis (-0.246 MPa CI [-0.248, -0.145] MPa) and the energy stored per volume unit (-0.124 mJ·mm-3 CI [-0.195, -0.055] mJ·mm-3). The proposed method is suitable for the systematic characterisation of the biomechanical properties of different tracheal substitutes, regardless of the size or nature of the substitute, thus allowing for direct comparisons.

Retrasplante pulmonar. Experiencia de un centro de referencia / Lung retransplant. Experience of a referral centre

ANTECEDENTES Y OBJETIVOS: El retrasplante pulmonar (RTP) es un tratamiento válido en pacientes con disfunción pulmonar, pero con una elevada morbimortalidad. Nuestro objetivo es analizar nuestra experiencia en RTP en supervivencia y función pulmonar. PACIENTES Y MÉTODOS: Estudio retrospectivo de pacientes con RTP (1990-2019). VARIABLES: receptores y procedimiento, mortalidad precoz, supervivencia y función pulmonar en pacientes CLAD. Variables cuantitativas (media±DE); cualitativas (%). Se utilizó el test t de Student o χ2. La supervivencia se estimó mediante Kaplan-Meier, comparándose con Log Rank. Se estableció como significativa p < 0,05. RESULTADOS: De 784 pacientes trasplantados, 25 pacientes (edad media 38,41 ± 16,3 años, 12 hombres y 13 mujeres) fueron RTP; CLAD (n = 19), infarto pulmonar (n = 2), complicaciones de vía aérea (n = 2), disfunción del injerto (n = 1), rechazo hiperagudo (n = 1). Tiempo medio hasta el retrasplante: 5,41 ± 3,87 años en CLAD y 21,2 ± 21,4 días en no CLAD. La mortalidad a 90 días fue del 52% y 36,8% en el segundo periodo (p = 0,007), siendo mayor en pacientes que precisaron ECMO preoperatorio (80 vs. 20%, p = 0,04). La supervivencia a 1 y 5 años fue del 53,9% y 37,7%, respectivamente (p = 0,016). La supervivencia del grupo CLAD fue mayor (p = 0,08). El ECMO pre RTP disminuyó la supervivencia (p = 0,032). FEV1 mejoró una media de 0,98 ± 0,13L (25,6 ± 18,8%) (p = 0,001). CONCLUSIONES: El RTP es un procedimiento de elevada mortalidad que obliga a una cuidadosa selección de los pacientes, con mejores resultados en aquellos con CLAD. La función pulmonar de los pacientes con CLAD mejoró significativamente

BACKGROUND: Lung retransplantation (LR) is a valid choice with a significant risk of perioperative morbidity and mortality in selected patients with graft dysfunction after lung transplantation. Our goal is to analyse our experience in LR in terms of survival and lung function. METHODS: Retrospective study of patients undergoing LR (1990-2019). VARIABLES: recipients and procedure, early mortality, survival and lung function in patients with CLAD. Quantitative variables (mean±SD); qualitative (%). Student's t test or χ2 was used. Survival was estimated using Kaplan-Meier, compared with Log Rank. A p < 0.05 was established as significant. RESULTS: Of 784 transplanted patients, 25 patients (mean age 38.41-16.3 years, 12 men and 13 women) were LR; (CLAD (n = 19), pulmonary infarction (n = 2), airway complications (n = 2), graft dysfunction (n = 1), hyperacute rejection (n = 1), mean time to retransplantation: 5.41 ± 3.87 years in CLAD and 21.2 ± 21.4 days in non-CLAD. The 90-day mortality was 52% and 36.8% in the second period (p = 0.007), being higher in patients who required preoperative ECMO (80 vs. 20%, p = 0.04). The 1- and 5-year survival was 53.9% and 37.7%, respectively (p = 0.016). Survival of the CLAD group was greater (p = 0.08). Pre LR ECMO decreased survival (p = 0.032). After LR, FEV1 improved an average of 0.98 ± 0.13L (25.6 ± 18.8%) (p = 0.001). CONCLUSIONS: LR is a high mortality procedure that requires careful selection of patients with better results in patients with CLAD. The lung function of patients with CLAD improved significantly

Lung retransplant. Experience of a referral centre. / Retrasplante pulmonar. Experiencia de un centro de referencia.

BACKGROUND: Lung retransplantation (LR) is a valid choice with a significant risk of perioperative morbidity and mortality in selected patients with graft dysfunction after lung transplantation. Our goal is to analyse our experience in LR in terms of survival and lung function. METHODS: Retrospective study of patients undergoing LR (1990-2019). VARIABLES: recipients and procedure, early mortality, survival and lung function in patients with CLAD. Quantitative variables (mean±SD); qualitative (%). Student's t test or χ2 was used. Survival was estimated using Kaplan-Meier, compared with Log Rank. A p < 0.05 was established as significant. RESULTS: Of 784 transplanted patients, 25 patients (mean age 38.41-16.3 years, 12 men and 13 women) were LR; (CLAD (n = 19), pulmonary infarction (n = 2), airway complications (n = 2), graft dysfunction (n = 1), hyperacute rejection (n = 1), mean time to retransplantation: 5.41 ± 3.87 years in CLAD and 21.2 ± 21.4 days in non-CLAD. The 90-day mortality was 52% and 36.8% in the second period (p = 0.007), being higher in patients who required preoperative ECMO (80 vs. 20%, p = 0.04). The 1- and 5-year survival was 53.9% and 37.7%, respectively (p = 0.016). Survival of the CLAD group was greater (p = 0.08). Pre LR ECMO decreased survival (p = 0.032). After LR, FEV1 improved an average of 0.98 ± 0.13L (25.6 ± 18.8%) (p = 0.001). CONCLUSIONS: LR is a high mortality procedure that requires careful selection of patients with better results in patients with CLAD. The lung function of patients with CLAD improved significantly.

Quilotórax secundario a trombosis venosa en portador de trasplante bipulmonar / Chylothorax due to Venous Thrombosis in a Double-Lung Transplant Patien

No disponible

Extracción quirúrgica urgente de cuerpo extraño en la vía aérea / Surgical management of foreign body on airway. Case report and review

No disponible

Mortalidad perioperatoria del trasplante pulmonar en la enfermedad pulmonar obstructiva crónica / Perioperative mortality of lung transplantation in chronic obstructive pulmonary disease

Introducción: El trasplante pulmonar (TP) es una alternativa terapéutica en pacientes con EPOC en fase terminal. Nuestro objetivo es analizar la mortalidad perioperatoria (30 días) (MP) y los factores de riesgo que la condicionan en pacientes con EPOC sometidos a TP. Pacientes y método: Cohorte retrospectiva de 107 pacientes con EPOC trasplantados en el Hospital Universitario La Fe (1991-2008). Los datos demográficos, el grado de disnea, el diagnóstico, el índice BODE, el tipo de trasplante, la circulación extracorpórea, la edad del donante, la dependencia de glucocorticoides, la presencia de bronquiectasias, la reperfusión retrógrada, la transfusión de hemoderivados y la relación PaO2/FiO2 fueron analizadas. Las variables continuas se expresaron como media ± DE y las categóricas, con frecuencias absolutas y porcentajes. El análisis multivariante se realizó mediante el modelo de regresión de Cox. Resultados: Se trasplantaron 94 hombres y 13 mujeres con una edad media de 52,58 ± 8,05 años. El 75% de los pacientes tuvieron un BODE ≥ 7. Se realizaron 76 procedimientos bipulmonares. La MP fue del 14%. Las causas de muerte fueron las infecciones (53,3%) y las complicaciones quirúrgicas (33,3%). La presencia de bronquiectasias, el uso de glucocorticoides, la diferencia de talla entre receptor/donante y la presencia de émbolos grasos en la reperfusión retrógrada fueron factores de riesgo para la MP. La relación de PaO2/FiO2 a las 6 h fue un factor protector para la MP. Conclusiones: El TP es un procedimiento con una elevada tasa de MP. El uso previo de glucocorticoides, la presencia de bronquiectasias y de émbolos grasos en la reperfusión retrógrada, así como la PaO2/FiO2condicionaron la MP (AU)

Introduction: Lung transplantation (LT) has been considered an alternative therapeutic approach in terminal patients. However, this process in COPD is not controversy-free. This paper aimed to analyze 30-day mortality (PM) patterns and their risk factors in COPD patients undergoing LT. Patients and method: A retrospective cohort with 107 COPD patients, transplanted at the University La Fe Valencia, Spain, treated from January 1991 to December 2008. Demographics values, degree of dyspnoea, diagnosis, BODE index, single versus bilateral LT, cardio-pulmonary bypass, donor age, steroid dependence, presence of bronchiectasis, retrograde perfusion, transfusion of blood products, and PaO2/FiO2 were analyzed. Continuous variables were expressed as mean ± SD and categorical variables as absolute frequency and percentage. A Cox regression model was used for multivariate analysis. Results: Ninety-four men and 13 women of a mean age of 52.58 ± 8.05 years were transplanted. Of all patients, 75% obtained a BODE score above 7. There were 76 bilateral LT. PM was established at 14%. Main causes of death were infection (53.3%) and surgical complications (33.3%). Presence of bronchiectasis and chronic use of corticosteroids, donor/recipient difference in size and presence of fat in retrograde perfusion fluid were important risk factors for PM. Moreover, PaO2/FiO2 ratio at 6 h was a protective factor for the event, thus a higher ratio value, lowered the risk of PM. Conclusions: LT is a procedure with a high PM rate. Use of corticosteroids, the presence of bronchiectasis and fat emboli in the retrograde reperfusion, and PaO2/FiO2 significantly determine PM (AU)

[Perioperative mortality of lung transplantation in chronic obstructive pulmonary disease]. / Mortalidad perioperatoria del trasplante pulmonar en la enfermedad pulmonar obstructiva crónica.

INTRODUCTION: Lung transplantation (LT) has been considered an alternative therapeutic approach in terminal patients. However, this process in COPD is not controversy-free. This paper aimed to analyze 30-day mortality (PM) patterns and their risk factors in COPD patients undergoing LT. PATIENTS AND METHOD: A retrospective cohort with 107 COPD patients, transplanted at the University La Fe Valencia, Spain, treated from January 1991 to December 2008. Demographics values, degree of dyspnoea, diagnosis, BODE index, single versus bilateral LT, cardio-pulmonary bypass, donor age, steroid dependence, presence of bronchiectasis, retrograde perfusion, transfusion of blood products, and PaO2/FiO2 were analyzed. Continuous variables were expressed as mean±SD and categorical variables as absolute frequency and percentage. A Cox regression model was used for multivariate analysis. RESULTS: Ninety-four men and 13 women of a mean age of 52.58±8.05 years were transplanted. Of all patients, 75% obtained a BODE score above 7. There were 76 bilateral LT. PM was established at 14%. Main causes of death were infection (53.3%) and surgical complications (33.3%). Presence of bronchiectasis and chronic use of corticosteroids, donor/recipient difference in size and presence of fat in retrograde perfusion fluid were important risk factors for PM. Moreover, PaO2/FiO2 ratio at 6h was a protective factor for the event, thus a higher ratio value, lowered the risk of PM. CONCLUSIONS: LT is a procedure with a high PM rate. Use of corticosteroids, the presence of bronchiectasis and fat emboli in the retrograde reperfusion, and PaO2/FiO2 significantly determine PM.

Factores pronóstico en el carcinoma bronquial no microcítico menor de 3 centímetros (análisis actuarial, incidencia acumulativa y grupos de riesgo) / Prognostic factors in non-small cell lung cancer less than 3 centimeters: actuarial analysis, accumulative incidence and risk groups

Introducción: En la clasificación TNM, los factores determinantes del factor T en el carcinoma pulmonar no microcítico apenas han variado con el tiempo y todavía se basan únicamente en características anatómicas. Nuestro objetivo fue estudiar la influencia en la supervivencia de estos y otros factores de tipo morfopatológico. Métodos: Se incluyeron 263 pacientes sometidos a resección pulmonar por carcinoma pulmonar no microcítico en estadio I patológico y diámetro ≤ 3 cm. Se realizó un estudio de supervivencia y de estimación del riesgo competitivo observando variables clínicas, quirúrgicas y patológicas, siguiendo los métodos de análisis actuarial y de incidencia acumulativa, respectivamente. Posteriormente, se creó un modelo de riesgo de acuerdo con los resultados. Resultados: La supervivencia fue de 79,8 y 74,3% a los 5 y 10 años, respectivamente. Los factores con mejor pronóstico, estadísticamente significativo según el método actuarial fueron: presencia de síntomas, hábito tabáquico, FEV1 > 60%, número de ganglios resecados > 7, tipo histológico escamoso, ausencia de invasión vascular, ausencia de invasión pleural visceral y presencia de invasión bronquial lobar proximal. La edad < 50 años rozó la significación estadística. En el análisis multivariante entraron en regresión la invasión pleural visceral y la invasión vascular. El estudio de riesgo competitivo mostró una probabilidad de muerte por cáncer de 14,3 y 35,1% en 5 y 10 años, respectivamente. Las variables significativas en los análisis univariante y multivariante fueron similares excepto el FEV1 > 60%. Conclusiones: La presencia de invasión pleural visceral y la invasión vascular determina la supervivencia o el riesgo de muerte por carcinoma pulmonar no microcítico ≤ 3 cm y permiten elaborar un modelo predictivo de riesgo

Introduction: In TNM classification, factors determining the tumor (T) component in non-small cell lung cancer have scarcely changed over time and are still based solely on anatomical features. Our objective was to study the influence of these and other morphopathological factors on survival. Methods: A total of 263 patients undergoing lung resection due to stage I non-small cell lung cancer ≤ 3 cm in diameter were studied. A survival analysis and competing-risk estimate study was made on the basis of clinical, surgical and pathological variables using actuarial analysis and accumulative incidence methods, respectively. A risk model was then generated from the results Results: Survival at 5 and 10 years was 79.8 and 74.3%, respectively. The best prognostic factors were presence of symptoms, smoking habit and FEV1 > 60%, number of resected nodes > 7, squamous histology, absence of vascular invasion, absence of visceral pleural invasion and presence of invasion more proximal than the lobar bronchus. All these were statistically significant according to the actuarial method. The factor 'age < 50 years' was close to the margin of statistical significance. Pleural invasion and vascular invasion were entered in the multivariate analysis. The competing-risk analysis showed a probability of death due to cancer of 14.3 and 35.1% at 5 and 10 years, respectively. Significant variables in the univariate and multivariate analyses were similar, with the exception of FEV1 > 60%. Conclusions: Pleural invasion and vascular invasion determine survival or risk of death due to non-small cell lung cancer ≤ 3 cm and can be used for generating a predictive risk model

Resultados funcionales del trasplante pulmonar en la enfermedad pulmonar obstructiva crónica / Functional Outcomes After Lung Transplant in Chronic Obstructive Pulmonary Disease

Introducción: El trasplante pulmonar (TP) es una opción terapéutica con resultados controvertidos en la enfermedad pulmonar obstructiva crónica (EPOC). Nuestro objetivo es analizar los resultados del trasplante en términos de función pulmonar, así como identificar los factores pronósticos. Método: Se realizó un análisis retrospectivo de 107 pacientes con EPOC trasplantados en el Hospital Universitario La Fe entre 1991 y 2008. Se analizaron variables preoperatorias, estudio funcional pre y post-TP, variables del procedimiento quirúrgico y del seguimiento a largo plazo, expresadas en media o porcentaje según el caso, comparándose los resultados espirométricos antes y después del TP. Para el análisis multivariante se utilizó regresión lineal o logística según la variable. Resultados: Fueron trasplantados 94 hombres (87,9%) y 13 mujeres (12,1%), con una edad media ± desviación estándar de 52,58 ± 8,05 años; el 71% de TP fueron bipulmonares. Los valores espirométricos mejoraron tras el TP: FVC: +1,22 l (+34,9%), FEV1: +1,66 l (+56,7%) y FEF25-75: +1,85 l (+50,8%); p = 0,001, manteniéndose esta mejoría funcional tras 5 años solo en el grupo con puntuación BODE > 7 (p = 0,001). La talla del receptor, el tipo de TP, la utilización de circulación extracorpórea durante el procedimiento quirúrgico, la presencia de síndrome de bronquiolitis obliterante junto con la edad y la causa de muerte del donante influyeron significativamente en la función pulmonar a largo plazo. Conclusiones: El TP mejora la función pulmonar de los pacientes con EPOC. Esta mejoría se mantiene a los 5 años solo en los pacientes con BODE mayor de 7. El trasplante bipulmonar proporciona mejores resultados funcionales que el unipulmonar

Introduction: Lung transplantation (LT) is a therapeutic option with controversial results in chronic obstructive pulmonary disease (COPD). We aimed to analyze the outcomes of transplantation in terms of lung function and to identify prognostic factors. Method: A retrospective analysis of 107 patients with COPD receiving lung transplants in the La Fe Hospital between 1991 and 2008 was performed. Preoperative variables, pulmonary function tests before and after LT, surgical procedure variables and long-term monitoring, expressed as mean or percentage, as applicable, were analyzed. Spirometric results before and after LT were analyzed. Linear or logistic regression were used for multivariate analysis depending on the variable. Results: Ninety-four men (87.9%) and 13 women (12.1%) were transplanted, with a mean age ± standard deviation of 52.58 ± 8.05 years; 71% of LTs were double-lung transplantations. Spirometric values improved after LT: FVC: +1.22 L (+34.9%), FEV1: +1.66 L (+56.7%) and FEF25-75: +1.85 L (+50.8%); P = .001. This functional improvement was maintained after 5 years only in the group with BODE score > 7 (P = .001). Recipient height, type of LT, use of extracorporeal circulation during the surgical procedure, presence of bronchiolitis obliterans syndrome and the age and cause of death of the donor significantly influenced lung function over time. Conclusions: LT improves lung function in COPD patients. This improvement was maintained at 5 years only in patients with BODE > 7. Double lung transplantation provides better functional results than single-lung transplantation

Prognostic Factors in Non-Small Cell Lung Cancer Less Than 3 Centimeters: Actuarial Analysis, Accumulative Incidence and Risk Groups.

INTRODUCTION: In TNM classification, factors determining the tumor (T) component in non-small cell lung cancer have scarcely changed over time and are still based solely on anatomical features. Our objective was to study the influence of these and other morphopathological factors on survival. METHODS: A total of 263 patients undergoing lung resection due to stage I non-small cell lung cancer ≤3cm in diameter were studied. A survival analysis and competing-risk estimate study was made on the basis of clinical, surgical and pathological variables using actuarial analysis and accumulative incidence methods, respectively. A risk model was then generated from the results. RESULTS: Survival at 5 and 10 years was 79.8 and 74.3%, respectively. The best prognostic factors were presence of symptoms, smoking habit and FEV1>60%, number of resected nodes>7, squamous histology, absence of vascular invasion, absence of visceral pleural invasion and presence of invasion more proximal than the lobar bronchus. All these were statistically significant according to the actuarial method. The factor "age<50 years" was close to the margin of statistical significance. Pleural invasion and vascular invasion were entered in the multivariate analysis. The competing-risk analysis showed a probability of death due to cancer of 14.3 and 35.1% at 5 and 10 years, respectively. Significant variables in the univariate and multivariate analyses were similar, with the exception of FEV1>60%. CONCLUSIONS: Pleural invasion and vascular invasion determine survival or risk of death due to non-small cell lung cancer ≤3cm and can be used for generating a predictive risk model.

Functional outcomes after lung transplant in chronic obstructive pulmonary disease.

INTRODUCTION: Lung transplantation (LT) is a therapeutic option with controversial results in chronic obstructive pulmonary disease (COPD). We aimed to analyze the outcomes of transplantation in terms of lung function and to identify prognostic factors. METHOD: A retrospective analysis of 107 patients with COPD receiving lung transplants in the La Fe Hospital between 1991 and 2008 was performed. Preoperative variables, pulmonary function tests before and after LT, surgical procedure variables and long-term monitoring, expressed as mean or percentage, as applicable, were analyzed. Spirometric results before and after LT were analyzed. Linear or logistic regression were used for multivariate analysis depending on the variable. RESULTS: Ninety-four men (87.9%) and 13 women (12.1%) were transplanted, with a mean age±standard deviation of 52.58±8.05 years; 71% of LTs were double-lung transplantations. Spirometric values improved after LT: FVC: +1.22L (+34.9%), FEV1: +1.66L (+56.7%) and FEF25-75: +1.85L (+50.8%); P=.001. This functional improvement was maintained after 5 years only in the group with BODE score >7 (P=.001). Recipient height, type of LT, use of extracorporeal circulation during the surgical procedure, presence of bronchiolitis obliterans syndrome and the age and cause of death of the donor significantly influenced lung function over time. CONCLUSIONS: LT improves lung function in COPD patients. This improvement was maintained at 5years only in patients with BODE>7. Double lung transplantation provides better functional results than single-lung transplantation.