Study protocol for an observational cohort evaluating incidence and clinical relevance of perioperative elevation of high-sensitivity troponin I and N-terminal pro-brain natriuretic peptide in patients undergoing lung resection.

INTRODUCTION: Myocardial injury after non-cardiac surgery has been defined as myocardial injury due to ischaemia, with or without additional symptoms or ECG changes occurring during or within 30 days after non-cardiac surgery and mainly diagnosed based on elevated postoperative cardiac troponin (cTn) values. In patients undergoing thoracic surgery for lung resection, only postoperative cTn elevations are seemingly not enough as an independent predictor of cardiovascular complications. After lung resection, troponin elevations may be regulated by mechanisms other than myocardial ischaemia. The combination of perioperative natriuretic peptide measurement together with high-sensitivity cTns may help to identify changes in ventricular function during thoracic surgery. Integrating both cardiac biomarkers may improve the predictive value for cardiovascular complications after lung resection. We designed our cohort study to evaluate perioperative elevation of both high-sensitivity troponin I (hs-TnI) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients undergoing lung resection and to establish a risk score for major cardiovascular postoperative complications. METHODS AND ANALYSIS: We will conduct a prospective, multicentre, observational cohort study, including 345 patients undergoing elective thoracic surgery for lung resection. Cardiac biomarkers such as hs-TnI and NT-proBNP will be measured preoperatively and at postoperatively on days 1 and 2. We will calculate a risk score for major cardiovascular postoperative complications based on both biomarkers' perioperative changes. All patients will be followed up for 30 days after surgery. ETHICS AND DISSEMINATION: All participating centres were approved by the Ethics Research Committee. Written informed consent is required for all patients before inclusion. Results will be disseminated through publication in peer-reviewed journals and presentations at national or international conference meetings. TRIAL REGISTRATION NUMBER: NCT04749212.

Advances and controversies in the management of early stage non-small cell lung cancer.

Complete resection continues to be the gold standard for the treatment of early-stage lung cancer. The landmark Lung Cancer Study Group trial in 1995 established lobectomy as the minimum intervention necessary for the management of early-stage non-small cell lung cancer, as it was associated with lower recurrence and metastasis rates than sublobar resection and lower postoperative morbidity and mortality than pneumonectomy. There is a growing tendency to perform sublobar resection in selected cases, as, depending on factors such as tumor size, histologic subtype, lymph node involvement, and resection margins, it can produce similar oncological results to lobectomy. Alternative treatments such as stereotactic body radiotherapy and radiofrequency ablation can also produce good outcomes in inoperable patients or patients who refuse surgery.

Traqueotomía en pacientes COVID-19: un procedimiento necesario de alto riesgo. Experiencia de dos centros / Tracheotomy in patients COVID-19: A necessary high risk procedure. Two center experience

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Complicaciones quirúrgicas de la resección pulmonar / Surgical complications of pulmonary resection

En este trabajo se revisan la incidencia, las causas, el diagnóstico, la prevención y el tratamiento de las siguientes complicaciones quirúrgicas que pueden ocurrir tras procedimientos de resección pulmonar: fuga aérea prolongada, enfisema subcutáneo, cámaras pleurales residuales, dehiscencia precoz del muñón bronquial, hemorragia, empiema pleural, fístula broncopleural, fístula esófago-pleural, quilotórax, hernia cardíaca, torsión lobular, síndrome posneumonectomía, lesiones nerviosas y embolización tumoral (AU)

We review incidence, etiology, diagnosis, prevention and treatment of the following complications of pulmonary resection: prolonged air leak, subcutaneous emphysema, residual pleural spaces, early bronchial stump dehiscence, bleeding, pleural empyema, bronchopleural fistula, esophagopleural fistula, chylothorax, cardiac herniation, pulmonary torsion, postpneumonectomy syndrome, nerve injuries and tumor embolism (AU)

[Surgical complications of pulmonary resection]. / Complicaciones quirúrgicas de la resección pulmonar.

We review incidence, etiology, diagnosis, prevention and treatment of the following complications of pulmonary resection: prolonged air leak, subcutaneous emphysema, residual pleural spaces, early bronchial stump dehiscence, bleeding, pleural empyema, bronchopleural fistula, esophagopleural fistula, chylothorax, cardiac herniation, pulmonary torsion, postpneumonectomy syndrome, nerve injuries and tumor embolism.

Una alternativa médica al tratamiento de la hiperhidrosis localizada / No disponible

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