Surgical Risk Following Anatomic Lung Resection in Thoracic Surgery: A Prediction Model Derived from a Spanish Multicenter Database. / Riesgo quirúrgico tras resección pulmonar anatómica en cirugía torácica. Modelo predictivo a partir de una base de datos nacional multicéntrica.

INTRODUCTION: The aim of this study was to develop a surgical risk prediction model in patients undergoing anatomic lung resections from the registry of the Spanish Video-Assisted Thoracic Surgery Group (GEVATS). METHODS: Data were collected from 3,533 patients undergoing anatomic lung resection for any diagnosis between December 20, 2016 and March 20, 2018. We defined a combined outcome variable: death or Clavien Dindo grade IV complication at 90 days after surgery. Univariate and multivariate analyses were performed by logistic regression. Internal validation of the model was performed using resampling techniques. RESULTS: The incidence of the outcome variable was 4.29% (95% CI 3.6-4.9). The variables remaining in the final logistic model were: age, sex, previous lung cancer resection, dyspnea (mMRC), right pneumonectomy, and ppo DLCO. The performance parameters of the model adjusted by resampling were: C-statistic 0.712 (95% CI 0.648-0.750), Brier score 0.042 and bootstrap shrinkage 0.854. CONCLUSIONS: The risk prediction model obtained from the GEVATS database is a simple, valid, and reliable model that is a useful tool for establishing the risk of a patient undergoing anatomic lung resection.

Spanish Video-Assisted Thoracic Surgery Group: Method, Auditing, and Initial Results From a National Prospective Cohort of Patients Receiving Anatomical Lung Resections / Grupo Español de Cirugía Torácica Videoasistida: Método, Auditoría y Resultados Iniciales de una Cohorte Nacional Prospectiva de Pacientes Tratados con Resección Pulmonar Anatómica

INTRODUCTION: Our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). METHODS: We conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for "90-day mortality" and "Grade IIIb-V complications". RESULTS: The series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR = 0.61 (p = 0.081), 90-day mortality OR = 0.46 (p = 0.051). CONCLUSIONS: More than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort

INTRODUCCIÓN: Nuestro estudio buscó conocer el grado de implementación actual de la cirugía toracoscópica asistida por video (VATS, por sus siglas en inglés) para las resecciones pulmonares anatómicas en España. Presentamos nuestros resultados iniciales y describimos los sistemas de auditoría desarrollados por el grupo español de VATS (GEVATS). MÉTODOS: Realizamos un estudio de cohortes prospectivo multicéntrico que incluyó pacientes que fueron tratados con resecciones pulmonares anatómicas entre el 20/12/2016 y el 20/03/2018. Los controles de calidad principales consistieron en determinar la tasa de reclutamiento de cada centro y la precisión de los datos perioperatorios recolectados en base a seis variables clave. Se analizaron las implicaciones de una baja tasa de reclutamiento para "mortalidad a los 90 días" y "complicaciones de grado IIIb-V". RESULTADOS: La serie estaba compuesta por 3533 casos (1917 VATS; 54,3%) en 33 servicios. La mediana de la tasa de reclutamiento de los centros fue del 99% (p25-p75: 76-100%), con una tasa de reclutamiento global del 83% y una precisión de los datos del 98%. No pudimos demostrar una asociación significativa entre la tasa de reclutamiento y el riesgo de morbi-mortalidad, pero se encontró una tendencia en el análisis no ajustado para aquellos centros con tasas de reclutamiento inferiores al 80% (usando los centros con tasas de 95-100% como referencia): OR = 0,61 para el grado IIIb-V (p = 0,081), OR = 0,46 para la mortalidad a los 90 días (p = 0,051). CONCLUSIONES: Más de la mitad de las resecciones pulmonares anatómicas en España se realizan a través de VATS. Según nuestros resultados, la tasa de reclutamiento del centro y sus posibles implicaciones debido al sesgo de selección, deberían recibir más atención por parte de los principales estudios multicéntricos voluntarios de nuestra especialidad. La alta representatividad y la confiabilidad de los datos de GEVATS constituyen un punto de partida fundamental para esta cohorte nacional

Spanish Video-Assisted Thoracic Surgery Group: Method, Auditing, and Initial Results From a National Prospective Cohort of Patients Receiving Anatomical Lung Resections.

INTRODUCTION: Our study sought to know the current implementation of video-assisted thoracoscopic surgery (VATS) for anatomical lung resections in Spain. We present our initial results and describe the auditing systems developed by the Spanish VATS Group (GEVATS). METHODS: We conducted a prospective multicentre cohort study that included patients receiving anatomical lung resections between 12/20/2016 and 03/20/2018. The main quality controls consisted of determining the recruitment rate of each centre and the accuracy of the perioperative data collected based on six key variables. The implications of a low recruitment rate were analysed for "90-day mortality" and "Grade IIIb-V complications". RESULTS: The series was composed of 3533 cases (1917 VATS; 54.3%) across 33 departments. The centres' median recruitment rate was 99% (25-75th:76-100%), with an overall recruitment rate of 83% and a data accuracy of 98%. We were unable to demonstrate a significant association between the recruitment rate and the risk of morbidity/mortality, but a trend was found in the unadjusted analysis for those centres with recruitment rates lower than 80% (centres with 95-100% rates as reference): grade IIIb-V OR=0.61 (p=0.081), 90-day mortality OR=0.46 (p=0.051). CONCLUSIONS: More than half of the anatomical lung resections in Spain are performed via VATS. According to our results, the centre's recruitment rate and its potential implications due to selection bias, should deserve further attention by the main voluntary multicentre studies of our speciality. The high representativeness as well as the reliability of the GEVATS data constitute a fundamental point of departure for this nationwide cohort.

Bronchoscopic sclerosis of post-resectional bronchial fistulas.

BACKGROUND: Pulmonary resection is, by far, the primary cause of bronchial fistula. This is a severe complication because of its morbidity and mortality and the related consumption of resources. Definitive closure continues to be a challenge with several therapeutic options, but none are optimal. We describe our experience in bronchoscopic application of ethanolamine and lauromacrogol 400 for the treatment of post-resection bronchial fistulas. METHODS: Clinical records of 8 patients treated using this technique were collected prospectively. The diagnosis of a fistula was confirmed by flexible bronchoscopy. Sclerosis was indicated in the context of multimodal treatment. Sclerosant injection was performed under general anesthesia with a Wang 22G needle through a flexible bronchoscope. The procedure was repeated at 2-week intervals until definitive closure of the fistula was confirmed. RESULTS: Fistula closure was achieved in 7 (87.5%) of the 8 patients, with persistence of the fistula in one patient who could not complete the treatment because of recurrence of his neoplastic pathology. No recurrence or complications related to the technique were registered. CONCLUSIONS: Bronchoscopic sclerosis by means of submucosal injection of lauromacrogol 400 or ethanolamine should be part of the multimodal treatment of bronchopleural fistula after lung resection, pending further studies that contribute to the accurate establishment of optimal indications for this procedure.

Torsión lobar superior izquierda tras una lobectomía inferior videoasistida / Left upper lobar torsion after video-assisted thoracoscopic lower lobectomy

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Symptoms and reason for a medical visit in lung cancer patients.

BACKGROUND: Patients with lung cancer usually present with symptoms at the time of diagnosis, but it is common that neither the doctor nor the patient initially associate them with the possibility of a malignant tumour. OBJECTIVES: The aim of our study is to analyse the symptoms of patients with lung cancer and the relationship with the personal characteristics or the oncological disease. MATERIAL AND METHODS: A retrospective study was conducted on all patients diagnosed with lung cancer in the Pontevedra Health Area over a period of three years. The symptoms presented by the patient, the reason for the consultation and the agreement between both or any factors associated with either of the two are analysed. RESULTS: A total of 358 patients, with a mean age of 68.7 years, and of whom 87% males, were included in the study. The most common initial symptoms were, constitutional in 30.4% of the cases, cough in 20.9% of cases, and in third place was chest pain, which was referred to by 12% of the patients. The most frequent reason for the consultation was dyspnea in 22.1% of patients, an incidental finding in 15.4%, and haemoptysis in 12.8%. There was a moderate association (correlation coefficient = 0.495) between the initial symptoms and the consulting symptom. CONCLUSIONS: A high percentage of patients with lung cancer had symptoms associated with the tumour at the time of diagnosis, even in early stage disease.

Contexto: A Os doentes com o diagnóstico de cancro do pulmão estão habitualmente sintomáticos no momento do diagnóstico, sendo comum que o médico ou o doente não associem essa sintomatologia com a eventualidade de um tumor maligno. Objectivos: Este estudo teve como objectivo a análise dos sintomas de doentes com cancro do pulmão e sua relação com as características pessoais ou com a doença oncológica. Material e Métodos: Foi levado a cabo um estudo retrospectivo englobando todos os doentes com o diagnóstico de cancro do pulmão na Região de Saúde de Pontevedra (Espanha) ao longo de um período de três anos. São analisados os sintomas de apresentação do doente, o motivo de consulta e a concordância entre ambos ou com quaisquer factores correlacionados. Resultados: Foram incluídos no estudo 358 doentes, com uma média etária de 68,7 anos, sendo 87% dos doentes do sexo masculino. Os sintomas iniciais mais comuns foram sintomas constitucionais em 30,4% dos casos, tosse em 20,9% e dor torácica, descrita por 12% dos doentes. O motivo de consulta mais frequente foi dispneia em 22,1% dos doentes, um achado acidental em 15,4% dos doentes e hemoptise em 12,8%. Observou-se uma associação moderada (coeficiente de correlação = 0,495) entre os sintomas iniciais e o motivo de consulta. Conclusões: Uma elevada percentagem de doentes com um diagnóstico de cancro do pulmão apresentou sintomas associados com o tumor no momento do diagnóstico, mesmo num estadio inicial da doença.

Effect of delays on survival in patients with lung cancer.

BACKGROUND: The effect on survival of delays in the consultation, diagnostic and treatment processes of lung cancer (LC) is still under debate. The objective of our study was to analyse these time delays and their possible effect on survival. METHODS: A retrospective study has been performed on all patients in our health area diagnosed with LC (confirmed by cytohistology) over 3 years. The delay in specialist consultation (time between start of symptoms and the first consultation with a specialist), hospital delay (time between first consultation and start of treatment) and overall delay (the sum of the previous two delays) were analysed. The influence of each of these delays was calculated using Cox regression, adjusted for other factors. RESULTS: A total of 415 patients were included. Of these, 92.5% were male and 75.4% were in stages III-B or IV. The overall delay gave a mean of 123.6 days, the delay in consulting a specialist 82.1 days and the delay in hospitalisation was 41.4 days. A greater overall delay or greater hospital delay was associated with longer survival. No relationship was observed between the specialist consultation delay and survival. CONCLUSIONS: Globally analysing all the cases and all the stages with LC, it is seen that longer delays are associated with longer survival. This probably reflects the fact that patients with more symptoms are treated more rapidly.

Platelet count: association with prognosis in lung cancer.

Lung cancer (LC) is now the leading cause of cancer mortality in the world, therefore it would be useful to identify prognostic factors to determine patient outcome. The objective of this study is to evaluate the usefulness of platelet counts at the time of diagnosis as a prognostic factor. A retrospective study of patients with histological diagnostic evidence of LC was carried in our catchment area over a 3-year period. Survival adjusted for other factors was assessed according to the platelet count at the time of diagnosis. Patients with platelet levels within the reference range (RR) (135000-381000/microl) were divided into two groups, between 135000-258000/microl and 258000-381000/microl. A third group was made up of patients with platelet counts over 381000/microl. Adjusted survival was analysed using Cox regression models. Patients with high platelets have a 37% worse survival than those with a platelet level within the RR, but lower than 258000/microl. When tumour stage is included in the covariates, platelet levels are no longer an independent survival factor. In conclusion, platelet levels at the time of diagnosis could be a useful prognostic factor in LC.

[Impact of hemoglobin level on lung cancer survival]. / Efecto del valor de la hemoglobina en la supervivencia del cáncer de pulmón.

BACKGROUND AND OBJECTIVE: Anemia is commonly observed in lung cancer (LC). Hemoglobin levels at the time of diagnosis could be considered a prognostic indicator in patients with LC. The aim of this trial was to analyze hemoglobin levels at the time of diagnosis as a prognostic factor in patients with LC. PATIENTS AND METHOD: We retrospectively examined all patients with LC (cytologically or histologically confirmed) diagnosed in our health area for a period of 3 years. Correlation between hemoglobin levels and survival was assessed. All patients were divided into 2 groups: patients with low hemoglobin levels (lower than percentile 25 of the distribution), and patients who exceeded that figure. By means of Cox's regression, the influence of hemoglobin levels in survival was calculated and adjusted to other factors. RESULTS: 421 patients were included, 52.2% of them presented anemia at the time of diagnosis. Mean age was 65.8 years and 92.7% were male. The group of patients with hemoglobin levels lower than percentile 25 had a survival rate that was 41% inferior. CONCLUSIONS: Low hemoglobin levels are associated with decreased survival in patients with LC. The evaluation of this parameter could be used for a more accurate prognosis in LC and a better adequacy of therapeutic indications.

Efecto del valor de la hemoglobina en la supervivencia del cáncer de pulmón / Impact of hemoglobin level on lung cancer survival

FUNDAMENTO Y OBJETIVO: La anemia es un hallazgo frecuente en pacientes con cáncer de pulmón(CP). Los valores de hemoglobina en el momento del diagnóstico del CP podrían permitirnosuna más precisa clasificación pronóstica inicial de estos pacientes. El objetivo de nuestro estudioha sido analizar el valor de la hemoglobina en el momento del diagnóstico como factor pronósticoen pacientes con CP.PACIENTES Y MÉTODO: Se ha realizado un estudio retrospectivo de todos los pacientes diagnosticadosde CP (con confirmación citohistológica) durante 3 años en nuestra área sanitaria. Se evaluóla supervivencia en función de la hemoglobina en el momento del diagnóstico, ajustada porotros factores. Según el valor de hemoglobina, los pacientes se clasificaron en 2 grupos: unocon hemoglobina baja (< percentil 25 de la distribución) y otro con pacientes que superabanesta cifra. Mediante regresión de Cox se calculó la influencia en la supervivencia de la hemoglobina.RESULTADOS: Se incluyó finalmente a 421 pacientes, de los que el 52,3% presentaron anemia aldiagnóstico. La edad media fue de 65,8 años y el 92,7% fueron varones. Presentar una hemoglobinainferior al percentil 25 supone una posibilidad de supervivencia un 41% inferior.CONCLUSIONES: La hemoglobina baja se asocia con disminución de la supervivencia. La evaluaciónde este parámetro podría permitir una mayor precisión en el pronóstico del CP y una mejoradecuación de las indicaciones terapéuticas

BACKGROUND AND OBJECTIVE: Anemia is commonly observed in lung cancer (LC). Hemoglobin levelsat the time of diagnosis could be considered a prognostic indicator in patients with LC.The aim of this trial was to analyze hemoglobin levels at the time of diagnosis as a prognosticfactor in patients with LC.PATIENTS AND METHOD: We retrospectively examined all patients with LC (cytologically or histologicallyconfirmed) diagnosed in our health area for a period of 3 years. Correlation between hemoglobinlevels and survival was assessed. All patients were divided into 2 groups: patientswith low hemoglobin levels (lower than percentile 25 of the distribution), and patients who exceededthat figure. By means of Cox’s regression, the influence of hemoglobin levels in survivalwas calculated and adjusted to other factors.Results: 421 patients were included, 52.2% of them presented anemia at the time of diagnosis.Mean age was 65.8 years and 92.7% were male. The group of patients with hemoglobin levelslower than percentile 25 had a survival rate that was 41% inferior.CONCLUSIONS: Low hemoglobin levels are associated with decreased survival in patients with LC.The evaluation of this parameter could be used for a more accurate prognosis in LC and a betteradequacy of therapeutic indications