Lung Tissue Multi-Layer Network Analysis Uncovers the Molecular Heterogeneity of COPD.

BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is a heterogeneous condition. We hypothesized that the unbiased integration of different COPD lung omics using a novel multi-layer approach may unravel mechanisms associated with clinical characteristics. METHODS: We profiled mRNA, miRNA and methylome in lung tissue samples from 135 former smokers with COPD. For each omic (layer) we built a patient network based on molecular similarity. The three networks were used to build a multi-layer network, and optimization of multiplex-modularity was employed to identify patient communities across the three distinct layers. Uncovered communities were related to clinical features. RESULTS: We identified five patient communities in the multi-layer network which were molecularly distinct and related to clinical characteristics, such as FEV1 and blood eosinophils. Two communities (C#3 and C#4) had both similarly low FEV1 values and emphysema, but were molecularly different: C#3, but not C#4, presented B and T cell signatures and a downregulation of secretory (SCGB1A1/SCGB3A1) and ciliated cells. A machine learning model was set up to discriminate C#3 and C#4 in our cohort, and to validate them in an independent cohort. Finally, using spatial transcriptomics we characterized the small airway differences between C#3 and C#4, identifying an upregulation of T/B cell homing chemokines, and bacterial response genes in C#3. CONCLUSIONS: A novel multi-layer network analysis is able to identify clinically relevant COPD patient communities. Patients with similarly low FEV1 and emphysema can have molecularly distinct small airways and immune response patterns, indicating that different endotypes can lead to similar clinical presentation.

Robotic Lobectomy Learning Curve Has Better Clinical Outcomes than Videothoracoscopic Lobectomy.

Introduction: The robotic-assisted (RATS) lobectomy learning curve is usually measured compared to an established videothoracoscopic (VATS) surgery program. The objective of our study is to compare the learning curves of both techniques. Methods: We performed an intention-to-treat analysis comparing the RATS vs. VATS lobectomies. Surgical time, conversions, complications, number of lymph nodes (LNs) and lymph node stations harvested, chest drainage duration, length of stay, readmissions, and 90-day mortality were compared between both groups. The learning curve was assessed using the CUSUM method. Results: RATS cases (30) and VATS cases (35) displayed no significant differences. The RATS learning curve was completed after 23 procedures while the VATS curve required 28 interventions. Complications appeared in four RATS procedures and in eight VATS patients. No differences in the number of LNs and harvested LN stations were reported. Four patients were readmitted in the RATS group, and eight in the VATS group. No 90-day postoperative mortality was observed in either group. The RATS group reported fewer chest tube days (3 (2-5) vs. 5 (4-5.8), p = 0.005) and hospital days (4 (3-6) vs. 5 (4-6), p = 0.023). Conclusions: The RATS curve appears shorter than the VATS curve. RATS lobectomies resulted in reduced chest tube duration and length of stay during the learning time period.

Starting a robotic thoracic surgery program: From wedge resection to sleeve lobectomy in six months. Initial conclusions / Inicio de un programa de cirugía torácica robótica: de resección en cuña a lobectomía con broncoplastia en seis meses. Conclusiones iniciales

Introduction: Robot-assisted thoracic surgery (RATS) is a rapidly expanding technique. In our study, we aimed to analyze the results of the process to adopt robotic surgery in our Department of Thoracic Surgery. Methods: This is an intention-to-treat analysis of a series of consecutive patients operated on using the RATS approach in our hospital from January 2021 to March 2022. Data were registered for patient characteristics, type of surgery, operative times, conversion rate, chest tube duration, length of hospital stay and complications. The IBM SPSS® statistical software was used for the statistical analysis. A cumulative sum analysis of the operating time was performed to define the learning curve. Results: During the study period, 51 patients underwent robotic surgery, including pulmonary and non-pulmonary interventions. In addition, 15 patients (29.4%) underwent non-pulmonary interventions: one pleural (2%), 2 diaphragmatic (3.9%), and 12 mediastinal (23.5%). Among the mediastinal surgeries, one conversion was necessary (8.3%) for a complex vascular malformation, and 11 were completed by RATS, including 7 (58.3%) thymomas, 3 (25%) pleuro-pericardial cysts, and one (8.3%) neurogenic tumor. Mean operative time was 141 min (104–178), mean chest tube duration was 0.9 days (0–2), and mean length of stay was 1.45 days (1–2). Thirty-six patients underwent lung surgery (70.6%). The complete RATS resections (34; 94.4%) included: 3 wedge resections (11.1%), 2 segmentectomies (3.7%), 28 lobectomies (81.5%), and one sleeve lobectomy (3.7%). Mean surgery time was 194.56 min (141–247), chest tube duration was 3.92 days (1–8), and length of stay was 4.6 days (1–8). Complications occurred in 4 patients (11.1%). No 90-day mortalities were registered. (AU)

Introducción: La cirugía torácica asistida por robot (RATS) es una técnica en rápida expansión. Nuestro objetivo fue analizar el resultado del proceso de adopción de la cirugía robótica en nuestro Departamento de Cirugía Torácica. Métodos: Este es un análisis por intención de tratamiento de una serie de pacientes consecutivos operados mediante el método RATS en nuestro centro desde enero de 2021 a marzo de 2022. Se registraron las características de los pacientes, tipo de cirugía, tiempos operatorios, tasa de conversión, duración del drenaje torácico, estancia hospitalaria y complicaciones. Para el análisis estadístico se utilizó el software IBM SPSS®. Se realizó un análisis de suma acumulada del tiempo de operación para definir la curva de aprendizaje. Resultados: Durante el periodo de estudio, 51 pacientes fueron sometidos a cirugía robótica.15 pacientes (29,4%) fueron sometidos a intervenciones no pulmonares: 1 pleural (2%), 2 diafragmáticas (3,9%) y 12 mediastínicas (23,5%). Entre las cirugías mediastínicas, fue necesaria una conversión (8,3%) por malformación vascular compleja y 11 fueron completadas por RATS, incluidos 7 (58,3%) timomas, 3 (25%) quistes pleuro-pericárdicos y 1 (8,3%) tumores neurogénicos. El tiempo operatorio medio fue de 141 minutos [104–178], la duración media del tubo torácico fue de 0,9 días [0–2] y la estancia media fue de 1,45 días [1–2]. 36 pacientes tuvieron cirugías pulmonares (70,6%). Las resecciones RATS completas (34; 94,4%) incluyeron: 3 resecciones en cuña (11,1%), 2 segmentectomías (3,7%), 28 lobectomías (81,5%) y 1 lobectomía con broncoplastia (3,7%). El tiempo medio de cirugía fue de 194,56 minutos [141–247], la duración del tubo torácico fue de 3,92 días [1–8] y la estancia hospitalaria fue de 4,6 días [1–8]. No se registró mortalidad a los 90 días. (AU)

A look ahead to promote the early detection of lung cancer: technical and cost implications of a confirmed diagnosis before surgery / Una mirada al futuro para promover la detección temprana del Cáncer de Pulmón: implicaciones técnicas y económicas de tener un diagnóstico confirmado antes de la cirugía

Objective: To compare the costs and length of hospital stay among patients with a confirmed diagnosis of lung cancer (LC) prior to surgery versus those without confirmation. Methods: This retrospective, single-center study was conducted in patients who underwent a surgical procedure for LC, with or without a pathologically confirmed LC diagnosis prior to surgery, between March 2017 and December 2019. The main outcomes were costs and length of hospital stay (LOS). Results: Among the 269 patients who underwent surgery for lung cancer between March 2017 and December 2019, 203 (75.5%) patients underwent surgery due to a histopathological diagnosis, and 66 (24.5%) because of a Multidisciplinary Cancer Committee indication. The unadjusted mean cost was significantly lower in Group II (patients with surgery based on Multidisciplinary Cancer Committee criteria) (Є2,581.80 ± Є1,002.50) than in Group I (patients with histopathological diagnosis) (Є4,244.60 ± Є2,008.80), P < 0.0001. Once adjusted for covariables, there was a mean difference of −Є1,437.20 in the costs of Group II, P < 0.0001. Unadjusted mean hospital stay was significantly longer in Group I (5.6 days) than in Group II (3.5 days). Conclusions: The results suggest that indicating surgical resection of lung cancer based on Multidisciplinary Cancer Committee criteria, rather than performing CT-guided percutaneous lung biopsy, may result in a significant decrease in cost and length of hospital stay. (AU)

Objetivo: Comparar los costes y la duración de la estancia hospitalaria entre los pacientes con un diagnóstico confirmado de cáncer de pulmón (CP) antes de la cirugía frente a los que no lo tienen. Métodos: Estudio retrospectivo y unicéntrico realizado en pacientes que se sometieron a un procedimiento quirúrgico de CP, con o sin diagnóstico de CP confirmado patológicamente antes de la cirugía, entre marzo de 2017 y diciembre de 2019. Los principales resultados fueron los costes y la duración de la estancia hospitalaria (LOHS). Resultados: Entre los 269 pacientes sometidos a cirugía por cáncer de pulmón entre marzo de 2017 y diciembre de 2019, 203 (75,5%) pacientes se operan por diagnóstico histopatológico y 66 (24,5%) por indicación del Comité Oncológico Multidisciplinar. El coste medio no ajustado fue significativamente menor en el Grupo II (pacientes con intervención quirúrgica basada en criterios del Comité Multidisciplinar del Cáncer) (2.581,8 ± 1.002,5Є) que en el Grupo I (pacientes con diagnóstico histopatológico) (4.244,6Є ± 2.008,8), p < 0,0001. Una vez ajustados por covariables, hubo una diferencia media de −1.437,2Є en los costes del Grupo II, p < 0,0001. La estancia hospitalaria media no ajustada fue significativamente mayor en el Grupo I (5,6 días) que en el Grupo II (3,5 días). Conclusiones: Los resultados sugieren que indicar la resección quirúrgica del cáncer de pulmón basándose en los criterios del Comité Multidisciplinar del Cáncer, en lugar de realizar una biopsia pulmonar percutánea guiada por TAC, puede suponer una disminución significativa del coste y de la duración de la estancia hospitalaria. (AU)

A look ahead to promote the early detection of lung cancer: technical and cost implications of a confirmed diagnosis before surgery.

OBJECTIVE: To compare the costs and length of hospital stay among patients with a confirmed diagnosis of lung cancer (LC) prior to surgery versus those without confirmation. METHODS: This retrospective, single-center study was conducted in patients who underwent a surgical procedure for LC, with or without a pathologically confirmed LC diagnosis prior to surgery, between March 2017 and December 2019. The main outcomes were costs and length of hospital stay (LOS). RESULTS: Among the 269 patients who underwent surgery for lung cancer between March 2017 and December 2019, 203 (75.5%) patients underwent surgery due to a histopathological diagnosis, and 66 (24.5%) because of a Multidisciplinary Cancer Committee indication. The unadjusted mean cost was significantly lower in Group II (patients with surgery based on Multidisciplinary Cancer Committee criteria) (Є2,581.80 ± Є1,002.50) than in Group I (patients with histopathological diagnosis) (Є4,244.60 ± Є2,008.80), P < 0.0001. Once adjusted for covariables, there was a mean difference of -Є1,437.20 in the costs of Group II, P < 0.0001. Unadjusted mean hospital stay was significantly longer in Group I (5.6 days) than in Group II (3.5 days). CONCLUSIONS: The results suggest that indicating surgical resection of lung cancer based on Multidisciplinary Cancer Committee criteria, rather than performing CT-guided percutaneous lung biopsy, may result in a significant decrease in cost and length of hospital stay.

Starting a robotic thoracic surgery program: From wedge resection to sleeve lobectomy in six months. Initial conclusions.

INTRODUCTION: Robot-assisted thoracic surgery (RATS) is a rapidly expanding technique. In our study, we aimed to analyze the results of the process to adopt robotic surgery in our Department of Thoracic Surgery. METHODS: This is an intention-to-treat analysis of a series of consecutive patients operated on using the RATS approach in our hospital from January 2021 to March 2022. Data were registered for patient characteristics, type of surgery, operative times, conversion rate, chest tube duration, length of hospital stay and complications. The IBM SPSS® statistical software was used for the statistical analysis. A cumulative sum analysis of the operating time was performed to define the learning curve. RESULTS: During the study period, 51 patients underwent robotic surgery, including pulmonary and non-pulmonary interventions. In addition, 15 patients (29.4%) underwent non-pulmonary interventions: one pleural (2%), 2 diaphragmatic (3.9%), and 12 mediastinal (23.5%). Among the mediastinal surgeries, one conversion was necessary (8.3%) for a complex vascular malformation, and 11 were completed by RATS, including 7 (58.3%) thymomas, 3 (25%) pleuro-pericardial cysts, and one (8.3%) neurogenic tumor. Mean operative time was 141 min (104-178), mean chest tube duration was 0.9 days (0-2), and mean length of stay was 1.45 days (1-2). Thirty-six patients underwent lung surgery (70.6%). The complete RATS resections (34; 94.4%) included: 3 wedge resections (11.1%), 2 segmentectomies (3.7%), 28 lobectomies (81.5%), and one sleeve lobectomy (3.7%). Mean surgery time was 194.56 min (141-247), chest tube duration was 3.92 days (1-8), and length of stay was 4.6 days (1-8). Complications occurred in 4 patients (11.1%). No 90-day mortalities were registered. CONCLUSIONS: The implementation of RATS was achieved with good clinical results and operative times for all indications. A rapid learning curve was accomplished in short time. Previous VATS experience, patient selection, team training and program continuity are fundamental to successfully develop a RATS program.

Characterization of the MicroRNA Cargo of Extracellular Vesicles Isolated from a Pulmonary Tumor-Draining Vein Identifies miR-203a-3p as a Relapse Biomarker for Resected Non-Small Cell Lung Cancer.

In resected non-small cell lung cancer (NSCLC), post-surgical recurrence occurs in around 40% of patients, highlighting the necessity to identify relapse biomarkers. An analysis of the extracellular vesicle (EV) cargo from a pulmonary tumor-draining vein (TDV) can grant biomarker identification. We studied the pulmonary TDV EV-miRNAome to identify relapse biomarkers in a two-phase study (screening and validation). In the screening phase, a 17-miRNA relapse signature was identified in 18 selected patients by small RNAseq. The most expressed miRNA from the signature (EV-miR-203a-3p) was chosen for further validation. Pulmonary TDV EV-miR-203a-3p was studied by qRT-PCR in a validation cohort of 70 patients, where it was found to be upregulated in relapsed patients (p = 0.0194) and in patients with cancer spread to nearby lymph nodes (N+ patients) (p = 0.0396). The ROC curve analysis showed that TDV EV-miR-203a-3p was able to predict relapses with a sensitivity of 88% (AUC: 0.67; p = 0.022). Moreover, patients with high TDV EV-miR-203a-3p had a shorter time to relapse than patients with low levels (43.6 vs. 97.6 months; p = 0.00703). The multivariate analysis showed that EV-miR-203a-3p was an independent, predictive and prognostic post-surgical relapse biomarker. In conclusion, pulmonary TDV EV-miR-203a-3p is a promising new relapse biomarker for resected NSCLC patients.

Estudio histológico mediante biopsia pulmonar post mortem en pacientes con neumonía por COVID-19 / Histology Study of Postmortem Lung Biopsies in Patients with Covid-19 Pneumonia

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[Translated article] Histology Study of Postmortem Lung Biopsies in Patients With Covid-19 Pneumonia / Estudio histológico mediante biopsia pulmonar post mortem en pacientes con neumonía por COVID-19

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Correlation between preoperative CT scan and lung metastases according to surgical approach in patients with colorectal cancer.

INTRODUCTION: The number of lung metastases (M1) of colorectal carcinoma (CRC) in relation to the findings of computed tomography (CT) is the object of study. METHODS: Prospective and multicenter study of the Spanish Group for Surgery of CRC lung metastases (GECMP-CCR). The role of CT in the detection of pulmonary M1 is evaluated in 522 patients who underwent a pulmonary metastasectomy for CRC. We define M1/CT as the ratio between metastatic nodules and those found on preoperative CT. Disease-specific survival (DSS), disease-free survival (DFS), and surgical approach were analyzed using the Kaplan-Meier method. RESULTS: 93 patients were performed by video-assisted surgery (VATS) and 429 by thoracotomy. In 90%, the M1/CT ratio was ≤1, with no differences between VATS and thoracotomy (94.1% vs 89.7%, p=0.874). In the remaining 10% there were more M1s than those predicted by CT (M1/CT>1), with no differences between approaches (8.6% vs 10%, p=0.874). 51 patients with M1/CT>1, showed a lower median DSS (35.4 months vs 55.8; p=0.002) and DFS (14.2 months vs 29.3; p=0.025) compared to 470 with M1/CT≤1. No differences were observed in DSS and DFS according to VATS or thoracotomy. CONCLUSIONS: Our study shows equivalent oncological results in the resection of M1 of CRC using VATS or thoracotomy approach. The group of patients with an M1/CT ratio >1 have a worse DSS and DFS, which may mean a more advanced disease than predicted preoperatively.

Correlation between preoperative CT scan and lung metastases according to surgical approach in patients with colorectal cancer / Correlación entre TC preoperatoria y metástasis pulmonares según abordaje quirúrgico en pacientes con cáncer colorrectal

Introduction: The number of lung metastases (M1) of colorectal carcinoma (CRC) in relation to the findings of computed tomography (CT) is the object of study. Methods: Prospective and multicenter study of the Spanish Group for Surgery of CRC lung metastases (GECMP-CCR). The role of CT in the detection of pulmonary M1 is evaluated in 522 patients who underwent a pulmonary metastasectomy for CRC. We define M1/CT as the ratio between metastatic nodules and those found on preoperative CT. Disease-specific survival (DSS), disease-free survival (DFS), and surgical approach were analyzed using the Kaplan–Meier method. Results: 93 patients were performed by video-assisted surgery (VATS) and 429 by thoracotomy. In 90%, the M1/CT ratio was ≤1, with no differences between VATS and thoracotomy (94.1% vs 89.7%, p=0.874). In the remaining 10% there were more M1s than those predicted by CT (M1/CT>1), with no differences between approaches (8.6% vs 10%, p=0.874). 51 patients with M1/CT>1, showed a lower median DSS (35.4 months vs 55.8; p=0.002) and DFS (14.2 months vs 29.3; p=0.025) compared to 470 with M1/CT≤1. No differences were observed in DSS and DFS according to VATS or thoracotomy. Conclusions: Our study shows equivalent oncological results in the resection of M1 of CRC using VATS or thoracotomy approach. The group of patients with an M1/CT ratio >1 have a worse DSS and DFS, which may mean a more advanced disease than predicted preoperatively(AU)

Introducción: El número de metástasis pulmonares (M1) de carcinoma colorrectal (CCR) en relación con los hallazgos de la tomografía computarizada (TC), es objeto de estudio. Métodos: Estudio prospectivo y multicéntrico del Grupo Español de Cirugía de las metástasis pulmonares del CCR (GCMP-CCR). Se evalúa el papel de la TC en la detección de M1 pulmonares en 522 pacientes intervenidos de una metastasectomía pulmonar por CCR. Definimos como M1/CT al cociente entre los nódulos metastásicos y los hallados en la TC preoperatoria. Se analizó la supervivencia específica de enfermedad (SEE), la supervivencia libre de enfermedad (SLE) y el abordaje quirúrgico mediante el método de Kaplan-Meier. Resultados: En 93 pacientes se utilizó la cirugía videoasistida (VATS) y 429 toracotomías. En un 90% el cociente M1/TC fue ≤1, sin diferencias entre VATS y toracotomía (94,1 vs. 89,7%; p=0,874). En el 10% restante existían más M1 que las predichas por la TC (M1/CT>1), sin diferencias entre abordajes (8,6 vs. 10%; p=0,874). Cincuenta y un pacientes con M1/CT>1, mostraron una menor mediana de SEE (35,4 vs. 55,8 meses; p=0,002) y SLE (14,2 vs. 29,3 meses; p=0,025) en comparación con 470 con M1/CT≤1. No se observaron diferencias en la SEE y la SLE según VATS o toracotomía. Conclusiones Nuestro estudio muestra unos resultados oncológicos equivalentes en la resección de M1 de CCR mediante abordaje VATS o toracotomía. El grupo de pacientes con un cociente M1/CT>1 presentan una peor SEE y SLE, pudiendo significar una enfermedad más avanzada de la predicha preoperatoriamente(AU)

National evaluation of risk factors for unplanned readmission after lung resection.

OBJECTIVES: Unplanned readmission is defined as the return to inpatient hospitalization within 30 days after discharge. Worldwide, its incidence after lung resection ranges between 8% and 50%, and it has been shown to impact both patient recovery and healthcare resources. Our goal was to identify the risk factors to prioritize early follow-ups. METHODS: We analysed data from the database of the Grupo Español de Cirugía Torácica Video-Asistida from 33 thoracic surgery departments over 15 months. Standard tests were used to compare the different risk groups. Our goal was to present the most relevant explanatory variables for readmission. RESULTS: A total of 174 of 2808 patients (6%) underwent unplanned readmission after a lobectomy. Of all the preoperative individual characteristics, only lung function was found to be a risk factor for readmission [forced expiratory volume in 1 s < 80%, risk ratio (RR) 1.78, P < 0.001; diffusing capacity of carbon monoxide <60%, RR 1.6, P = 0.02; and VO2 < 20 ml/kg/min, RR 1.59, P = 0.02]. The tumour's characteristics and the stage of the disease did not have an influence on the readmission rates. In the readmitted cohort, an open approach or thoracotomy was associated with more frequent readmissions (RR 1.77; P < 0.001). Strong adhesions (RR 1.81; P < 0.001) or adhesions occupying more than half of the hemithorax (RR 1.73, P < 0.001) were also found to be risk factors for readmission and for longer operative times. A length of stay of >10 days after a lobectomy was found to be a risk factor for readmission (RR 1.9). CONCLUSIONS: We identified preoperative, intraoperative and postoperative risk factors for readmission. This information can be a useful tool to help with the prioritization of early follow-ups, especially in centres with high workloads.

Role of a portable gamma-camera with optical view for margins assessment of pulmonary nodules resected by radioguided surgery.

PURPOSE: Radioguided occult lesion localization (ROLL) of pulmonary nodules is an alternative to hook-wire. Both required of a histological margin assessment. The activity emerging from the radiotracer allows to obtain an intraoperative scintigraphic image of the surgical specimen by a portable gamma-camera (PGC) fitted with an optical view, which provides information about the localization of the nodule in relation to the margins. The aim of this study was to evaluate the intraoperative use of a PGC for margin assessment of pulmonary nodules. METHODS: ROLL technique was used in 38 nodules (36 pulmonary, 1 chest wall, and 1 pleural nodules). A PGC intraoperative image of the surgical specimen was obtained in 32. Scintigraphic results were compared to the histological assessment. Other factors, such as nodule size, distance from the pleural surface, or distance covered by the needle, were considered as possible factors for non-centered lesions. RESULTS: PGC images showed that the lesion was in contact with the margins in 8/32 cases and centered in 24. In all cases in which the lesion was considered as centered by the PGC, the margins were free of involvement (NPV 100%), although the PPV is low. CONCLUSIONS: The use of a PGC for margin assessment after pulmonary nodule resection is feasible and provides a high NPV in our series. In addition, the short intraoperative time required for its use makes the PGC a useful tool for providing supplementary information to histopathologic results. Further studies from different surgical teams are required for an external validation.

Thymomectomy plus total thymectomy versus simple thymomectomy for early-stage thymoma without myasthenia gravis: a European Society of Thoracic Surgeons Thymic Working Group Study.

OBJECTIVES: Resection of thymic tumours including the removal of both the tumour and the thymus gland (thymothymectomy; TT) is the procedure of choice and is recommended in most relevant articles in the literature. Nevertheless, in recent years, some authors have suggested that resection of the tumour (simple thymomectomy; ST) may suffice from an oncological standpoint in patients with early-stage thymoma who do not have myasthenia gravis (MG) (non-MG). The goal of our study was to compare the short- and long-term outcomes of ST versus TT in non-MG early-stage thymomas using the European Society of Thoracic Surgeons thymic database. METHODS: A total of 498 non-MG patients with pathological stage I thymoma were included in the study. TT was performed in 466 (93.6%) of 498 patients who had surgery with curative intent; ST was done in 32 (6.4%). The completeness of resection, the rate of complications, the 30-day mortality, the overall recurrence and the freedom from recurrence were compared. We performed crude and propensity score-adjusted comparisons by surgical approach (ST vs TT). RESULTS: TT showed the same rate of postoperative complications, 30-day mortality and postoperative length of stay as ST. The 5-year overall survival rate was 89% in the TT group and 55% in the ST group. The 5-year freedom from recurrence was 96% in the TT group and 79% in the ST group. CONCLUSION: Patients with early-stage thymoma without MG who have a TT show significantly better freedom from recurrence than those who have an ST, without an increase in postoperative morbidity rate.

Correlation between preoperative CT scan and lung metastases according to surgical approach in patients with colorectal cancer.

INTRODUCTION: The number of lung metastases (M1) of colorectal carcinoma (CRC) in relation to the findings of computed tomography (CT) is the object of study. METHODS: Prospective and multicenter study of the Spanish Group for Surgery of CRC lung metastases (GECMP-CCR). The role of CT in the detection of pulmonary M1 is evaluated in 522 patients who underwent a pulmonary metastasectomy for CRC. We define M1/CT as the ratio between metastatic nodules and those found on preoperative CT. Disease-specific survival (DSS), disease-free survival (DFS), and surgical approach were analyzed using the Kaplan-Meier method. RESULTS: 93 patients were performed by video-assisted surgery (VATS) and 429 by thoracotomy. In 90%, the M1/CT ratio was ≤1, with no differences between VATS and thoracotomy (94.1% vs 89.7%, p=0.874). In the remaining 10% there were more M1s than those predicted by CT (M1/CT>1), with no differences between approaches (8.6% vs 10%, p=0.874). 51 patients with M1/CT>1, showed a lower median DSS (35.4 months vs 55.8; p=0.002) and DFS (14.2 months vs 29.3; p=0.025) compared to 470 with M1/CT≤1. No differences were observed in DSS and DFS according to VATS or thoracotomy. CONCLUSIONS: Our study shows equivalent oncological results in the resection of M1 of CRC using VATS or thoracotomy approach. The group of patients with an M1/CT ratio >1 have a worse DSS and DFS, which may mean a more advanced disease than predicted preoperatively.

Is invasive mediastinal staging necessary in intermediate risk patients with negative PET/CT?

BACKGROUND: Tumor involvement of mediastinal lymph nodes is of high importance in non-small cell lung cancer (NSCLC). Invasive mediastinal staging is recommended in selected patients without evidence of mediastinal involvement on staging by imaging. In the present study we aimed to evaluate the effectiveness of invasive mediastinal staging in reducing pN2, its impact on survival and the risk factors for occult pN2. METHODS: Patients with NSCLC tumors larger than 3 cm, central tumors or cN1 cases treated in our institution between 2013 and 2018 were prospectively included in the study. Incidence of pN2 and overall survival was compared among invasively staged (IS) and non-invasively staged groups (NIS). Multivariate analysis was performed to identify risk factors of pN2. RESULTS: A total of 201 patients were included in the study, 79 (39.3%) of whom were not invasively staged (NIS group) and 122 (60.7%) were invasively staged (IS group). Incidence of cN1 and mean PET/CT uptake was different among both groups. Prevalence of pN2 was similar in both groups (7.6% in NIS vs. 12.6% in IS; P>0.05). Median survival in IS-pN2 patients was 11 months longer than in NIS-pN2 group (33.6 vs. 22.5 months; P=0.245). cN1 emerged as the only a risk factor for pN2. CONCLUSIONS: Invasive staging does not reduce the incidence of pN2. However, this finding could be biased because in our series cN1 patients were more often staged and cN1 has been detected as a risk factor for pN2. In addition patient better selection after invasive staging might have an impact on overall survival. To conclude, invasive mediastinal staging in intermediate risk patients for positive mediastinal nodes is justified.

Outcomes and cost of lung cancer patients treated surgically or medically in Catalunya: cost-benefit implications for lung cancer screening programs.

Lung cancer screening programs with computed tomography of the chest reduce mortality by more than 20%. Yet, they have not been implemented widely because of logistic and cost implications. Here, we sought to: (1) use real-life data to compare the outcomes and cost of lung cancer patients with treated medically or surgically in our region and (2) from this data, estimate the cost-benefit ratio of a lung cancer screening program (CRIBAR) soon to be deployed in our region (Catalunya, Spain). We accessed the Catalan Health Surveillance System (CHSS) and analysed data of all patients with a first diagnosis of lung cancer between 1 January 2014 and 31 December 2016. Analysis was carried forward until 30 months (t = 30) after lung cancer diagnosis. Main results showed that: (1) surgically treated lung cancer patients have better survival and return earlier to regular home activities, use less healthcare related resources and cost less tax-payer money and (2) depending on incidence of lung cancer identified and treated in the program (1-2%), the return on investment for CRIBAR is expected to break even at 3-6 years, respectively, after its launch. Surgical treatment of lung cancer is cheaper and offers better outcomes. CRIBAR is estimated to be cost-effective soon after launch.