Análisis comparativo del abordaje para el tratamiento del timoma estadio I-II: VATS versus abordaje convencional / Comparative analysis of video-assisted thoracic surgery versus open resection for early-stage thymoma

INTRODUCCIÓN: La cirugía torácica video-asistida (VATS) es una técnica que ha evolucionado en las últimas décadas. A pesar de sus ventajas, este abordaje continúa siendo discutido para el tratamiento de los timomas. El objetivo de este estudio fue evaluar los resultados obtenidos por el abordaje convencional y la VATS para el tratamiento de timomas en estadio i-ii. MÉTODOS: Estudio comparativo en 59 pacientes a los que se les realizó una timectomía por timoma en estadio i-ii (VATS: 44 y cirugía convencional: 15) entre los años 1993 y 2011. Se analizaron las siguientes variables: características de los pacientes en ambos grupos, morbilidad, mortalidad, estancia hospitalaria, la relación miastenia gravis-timoma, recidiva y supervivencia a los 5 años. RESULTADOS: Los timomas se clasificaron según la clasificación de Masaoka: 38 en la etapa I (grupo VATS: 29 y grupo convencional: 9) y 21 en la etapa II (grupo VATS: 15 y grupo convencional: 6). El tamaño medio del tumor en el grupo convencional fue de 7,6 cm (13-4 cm) y en el grupo VATS 6,9 cm (12-2,5 cm). La duración media de la estancia hospitalaria fue más corta en el grupo VATS que en el grupo de cirugía convencional (p < 0,001). No se encontraron diferencias significativas entre los 2 grupos, en las recidivas ni en la supervivencia a los 5 años (96% vs. 100%). CONCLUSIÓN: La timectomía mediante VATS es una técnica factible y segura en el tratamiento de timomas estadio I-II. Se asocia a una menor estancia hospitalaria y a unos resultados oncológicos a los 5 años similares a los de la cirugía convencional. Los resultados oncológicos con un seguimiento de 5 años fueron similares a los obtenidos por la cirugía convencional

BACKGROUND: Video-assisted thoracic surgery (VATS) has significantly developed over the last decade. However, a VATS approach for thymoma remains controversial. The aim of this study was to evaluate the feasibility of VATS thymectomy for the treatment of early-stage thymoma and to compare the outcomes with open resection. METHODS: A comparative study of 59 patients who underwent surgical resection for early stage thymoma (VATS: 44 and open resection: 15) between 1993 and 2011 was performed. Data of patient characteristics, morbidity, mortality, length of hospital stay, the relationship between miasthenia gravis-thymoma, recurrence, and survival were collected for statistical analysis. RESULTS: Thymomas were classified according to Masaoka staging system: 38 in stage I (VATS group: 29 and open group: 9) and 21 in stage II (VATS group: 15 and open group: 6). The mean tumor size in the open group was 7.6 cm (13-4 cm) and in the VATS group 6.9 cm (12-2.5 cm). The average length of stay was shorter in the VATS group than in the open group (P<.001). No significant differences were found in the estimated recurrence-free and overall 5-year survival rates (96% vs. 100%) between the 2 groups. CONCLUSIONS: VATS thymectomy for early-stage thymoma is technically feasible and is associated with a shorter hospital stay. The 5-year oncologic outcomes were similar in the open and VATS groups

[Comparative analysis of video-assisted thoracic surgery versus open resection for early-stage thymoma]. / Análisis comparativo del abordaje para el tratamiento del timoma estadio i-ii: VATS versus abordaje convencional.

BACKGROUND: Video-assisted thoracic surgery (VATS) has significantly developed over the last decade. However, a VATS approach for thymoma remains controversial. The aim of this study was to evaluate the feasibility of VATS thymectomy for the treatment of early-stage thymoma and to compare the outcomes with open resection. METHODS: A comparative study of 59 patients who underwent surgical resection for early stage thymoma (VATS: 44 and open resection: 15) between 1993 and 2011 was performed. Data of patient characteristics, morbidity, mortality, length of hospital stay, the relationship between miasthenia gravis-thymoma, recurrence, and survival were collected for statistical analysis. RESULTS: Thymomas were classified according to Masaoka staging system: 38 in stage I (VATS group: 29 and open group: 9) and 21 in stage II (VATS group: 15 and open group: 6). The mean tumor size in the open group was 7.6cm (13-4cm) and in the VATS group 6.9cm (12-2.5cm). The average length of stay was shorter in the VATS group than in the open group (P<.001). No significant differences were found in the estimated recurrence-free and overall 5-year survival rates (96% vs. 100%) between the 2 groups. CONCLUSIONS: VATS thymectomy for early-stage thymoma is technically feasible and is associated with a shorter hospital stay. The 5-year oncologic outcomes were similar in the open and VATS groups.

Experiencia y desarrollo de la técnica de lobectomía por cirugía torácica videoasistida: estudio comparativo con cirugía convencional en estadio i de cáncer de pulmón no microcítico / Experience and Development of the Video-Assisted Thoracic Surgery Lobectomy Technique: Comparative Study With Conventional Surgery in Stage I Non-Small Cell Lung Cancer

Objetivo: Analizar nuestra experiencia con la cirugía torácica videoasistida (VATS) y comparar sus resultados a corto y a largo plazo con la lobectomía por cirugía convencional, en el tratamiento quirúrgico del cáncer de pulmón no microcítico (CPNM) en estadio i . Material y métodos: Se realizó un estudio retrospectivo y analítico de los pacientes intervenidos de cáncer de pulmón no microcítico en estadio i durante el periodo de enero de 1993 a diciembre de 2005. Las variables analizadas fueron: supervivencia global, recidiva, metástasis a distancia, morbimortalidad y estancia hospitalaria. Durante este periodo se realizaron 256 resecciones pulmonares anatómicas: 141 por VATS y 115 por cirugía convencional. Resultados: Se encontraron diferencias estadísticamente significativa en: a) estancia media postoperatoria en pacientes que no tuvieron complicaciones (grupo VATS: 4,3 días; grupo de cirugía convencional: 8,7 días; p = 0,0001); b) estancia media postoperatoria en pacientes que tuvieron complicaciones (VATS: 7,2 días; cirugía convencional: 13,7 días; p = 0,0001), y c) morbilidad (VATS: 15,6%; cirugía abierta: 36,52%; p = 0,0001). No se encontraron diferencias estadísticamente significativas en: a) mortalidad (VATS: 2,17%; cirugía convencional: 1,7%; p = 0,88); b) supervivencia global a 5 años (VATS: 68,1%; cirugía convencional: 63,8%); c) recidiva local y metástasis a distancia (p = 0,82). Conclusiones: La lobectomía VATS es una técnica segura y eficaz, con una menor estancia hospitalaria y morbilidad que la cirugía convencional, sin que se observen diferencias estadísticamente significativas en la supervivencia en pacientes intervenidos por cáncer de pulmón no microcítico en estadio I

Background: Surgical treatment of stage I non-small cell lung cancer (NSCLC) can be performed either by thoracotomy or by employing video-assisted thoracic surgery (VATS). The aim of this study was to compare long and short-term results of conventional surgery (CS) vs. VATS lobectomy in the treatment of stage I NSCLC. Materials and methods: We performed a retrospective, analytical study of patients undergoing surgery for stage I NSCLC during the period January 1993 to December 2005. The variables analyzed were overall survival, recurrence, distant metastasis, morbidity, mortality and hospital stay. During this period,256 anatomic lung resections were performed: 141 by CS and 115 by VATS. Results: There were statistically significant differences in: (I) mean hospital stay in patients with no complications (VATS group: 4.3 days vs. CS group: 8.7 days, P = 0.0001); (ii) mean hospital stay in patients with complications (VATS: 7.2 days vs. CS: 13.7 days, P =0.0001), and (iii) morbidity (VATS: 15.6% vs. CS: 36.52%, P = 0.0001). No statistically significant differences were found in: (I) mortality (VATS: 2.17% vs. CS:1.7%, P = .88); (II) 5-year overall survival (VATS: 68.1% vs. CS: 63.8%), and (III) local recurrence and distant metastasis (P = 0.82). Conclusions: VATS lobectomy is a safe and effective approach, with a shorter hospital stay and lower morbidity than CS; no statistically significant differences were observed in survival in patients undergoing surgery for stage I NSCLC

Experience and development of the video-assisted thoracic surgery lobectomy technique: comparative study with conventional surgery in stage I non-small cell lung cancer.

BACKGROUND: Surgical treatment of stage I non-small cell lung cancer (NSCLC) can be performed either by thoracotomy or by employing video-assisted thoracic surgery (VATS). The aim of this study was to compare long and short-term results of conventional surgery (CS) vs. VATS lobectomy in the treatment of stage I NSCLC. MATERIALS AND METHODS: We performed a retrospective, analytical study of patients undergoing surgery for stage I NSCLC during the period January 1993 to December 2005. The variables analyzed were overall survival, recurrence, distant metastasis, morbidity, mortality and hospital stay. During this period, 256 anatomic lung resections were performed: 141 by CS and 115 by VATS. RESULTS: There were statistically significant differences in: (i)mean hospital stay in patients with no complications (VATS group: 4.3 days vs. CS group: 8.7 days, P=.0001); (ii)mean hospital stay in patients with complications (VATS: 7.2 days vs. CS: 13.7 days, P=.0001), and (iii)morbidity (VATS: 15.6% vs. CS: 36.52%, P=.0001). No statistically significant differences were found in: (i)mortality (VATS: 2.17% vs. CS: 1.7%, P=.88); (ii)5-year overall survival (VATS: 68.1% vs. CS: 63.8%), and (iii) local recurrence and distant metastasis (P=.82). CONCLUSIONS: VATS lobectomy is a safe and effective approach, with a shorter hospital stay and lower morbidity than CS; no statistically significant differences were observed in survival in patients undergoing surgery for stage I NSCLC.

Comparative study of talc poudrage versus pleural abrasion for the treatment of primary spontaneous pneumothorax.

Primary spontaneous pneumothorax is a pathology mainly affecting healthy young patients. Clinical guidelines do not specify the type of pleurodesis that should be conducted, due to the lack of comparative studies on the different techniques. The aim of this study was to compare talc poudrage and pleural abrasion in the treatment of spontaneous pneumothorax. A retrospective comparative study was performed, including 787 patients with primary spontaneous pneumothorax. The 787 patients were classified into two groups: Group A (pleural abrasion) n = 399 and Group B (talc pleurodesis) n = 388. The variables studied were recurrence, surgical time, morbidity and in-hospital length of stay. Statistical analysis was done by an unpaired t-test and Fisher's exact test (SSPS 18.0). Statistically significant differences were observed in the variables: surgical time (A: 46 ± 12.3; B: 37 ± 11.8 min; P < 0.001); length of stay (A: 4.7 ± 2.5; B: 4.3 ± 1.8 days; P = 0.01); apical air camera (A: 25; B: 4; P < 0.001); pleural effusion (A: 6; B: 0; P = 0.05). Talc poudrage shows shorter surgical times and length of stay, and lower re-intervention rates. Morbidity is lower in patients with talc poudrage. Statistically significant differences were not observed in recurrence, persistent air leaks, atelectasis and haemothorax.

Posterolateral thoracotomy without muscle division: a new approach to complex procedures.

Today, there is a strong increase in video-assisted thoracic surgery; however, there are still some diseases and interventions that need a wide pleural cavity exposure (i.e. sulcus tumours and extended resections). These complex procedures are usually performed via a standard posterolateral thoracotomy, which is a good approach but has significant disadvantage due to pain and difficulty coughing. We propose a new thoracotomy that avoids a dorsal muscle division but has the same intrathoracic exposure as a posterolateral thoracotomy.

Sympathetic chain clipping for hyperhidrosis is not a reversible procedure.

BACKGROUND: Many techniques have been used to treat palmar hyperhidrosis. Compensatory sweating is a difficult adverse effect. Clipping has been proposed because of its supposed reversibility when clips are removed at a later date. The primary aims of this article are to investigate the neuronal lesion of the sympathetic chain caused by clipping and to study the possibility of regeneration after removal of the clips. METHODS: We performed an experimental study at the Minimally Invasive Surgery Centre Jesus Uson in Caceres (Spain). We used a swine model, performing clipping, unclipping, and extirpation of different segments of sympathetic chain with clips and after clip removal, following a chronogram of 10, 20, and 30 days. Pathologic studies of specimens and statistics were done at the University of Seville. RESULTS: Ten days after clipping, all sympathetic chains displayed evident Wallerian degeneration. Twenty days after clipping, Wallerian degeneration of myelinated fibers was more widespread and also more striking. Thirty days after clipping, a very marked macrophagic reaction was visible, with multiple signs of phagocytosis of myelin debris. By 30 days post operation and 20 days after clip removal, a few residual myelin and amyelinated fibers were visible. These findings suggest that axon regeneration is not possible. CONCLUSIONS: There are Wallerian degeneration and axon loss 10 days after clipping. The almost total absence of myelinated and amyelinated fibers following clip removal suggests that there was no nerve regeneration, and that therefore clipping cannot be considered a reversible technique.

Ventana pericárdica por videotoracoscopia / Pericardial Window by Videothorascopy

Introducción El derrame pericárdico (DP) es una entidad clínica de manejo multidisciplinar. Existen varias técnicas quirúrgicas para su diagnóstico y tratamiento. En el presente estudio aportamos nuestra experiencia en la realización de ventana pericárdica (VP) por videotoracoscopia. Material y métodos Hemos intervenido a 56 pacientes (20 mujeres y 36 hombres) con el diagnóstico de DP crónico moderado-severo. La edad media fue de 56±1,22 años. El lado elegido para el abordaje dependía de la existencia del derrame pleural o lesión pulmonar asociada, en su defecto por el lado izquierdo. Resultados La duración media de la intervención fue de 37,6±16 minutos. Los diagnósticos definitivos fueron en el 23% de los casos por procesos malignos, destacando el carcinoma broncogénico y el cáncer de mama. La mortalidad intraoperatoria fue del 0%.Conclusiones La VP videotoracoscópica es una técnica efectiva y segura para el diagnóstico y tratamiento del DP crónico, que permite en un mismo acto quirúrgico su drenaje y la biopsia pleuropulmonar y/o mediastínica (AU)

Introduction Pericardial effusion is a clinical condition requiring multidisciplinary management. There are several surgical techniques for its diagnosis and treatment. In the present study we report our experience in performing a pericardial window (PW) by videothorascopy. Material and methods We performed surgery on 56 patients (20 females and 36 males), with a mean age of 56±1.22 years, and diagnosed with moderate to severe chronic pericardial effusion. The side chosen for the approach depended on whether there was an associated pleural effusion or lung lesion, and if not the left side was chosen. Results The mean duration of the surgery was 37.6±16min. The definitive diagnoses were malignant processes in 23% of cases, including bronchogenic carcinoma and breast cancer. The intraoperative mortality was 0%.Conclusions Videothorascopic pericardial window is an effective and safe technique for the diagnosis and treatment of chronic pericardial effusion, and which enables it to be drained and perform a pleuropulmonary and/or mediastinal biopsy during the same surgical act (AU)

[Pericardial window by videothorascopy]. / Ventana pericárdica por videotoracoscopia.

INTRODUCTION: Pericardial effusion is a clinical condition requiring multidisciplinary management. There are several surgical techniques for its diagnosis and treatment. In the present study we report our experience in performing a pericardial window (PW) by videothorascopy. MATERIAL AND METHODS: We performed surgery on 56 patients (20 females and 36 males), with a mean age of 56±1.22 years, and diagnosed with moderate to severe chronic pericardial effusion. The side chosen for the approach depended on whether there was an associated pleural effusion or lung lesion, and if not the left side was chosen. RESULTS: The mean duration of the surgery was 37.6±16 minutes. The definitive diagnoses were malignant processes in 23% of cases, including bronchogenic carcinoma and breast cancer. The intra-operative mortality was 0%. CONCLUSIONS: Videothorascopic pericardial window is an effective and safe technique for the diagnosis and treatment of chronic pericardial effusion, and which enables it to be drained and perform a pleuro-pulmonary and/or mediastinal biopsy during the same surgical act.

Extirpación de la primera costilla por videotoracoscopia para el tratamiento del síndrome del estrecho torácico / First Rib Resection Using Videothorascopy for the Treatment of Thoracic Outlet Syndrome

Introducción: El síndrome del estrecho torácico es una patología provocada por la compresión de la arteriasubclavia, vena subclavia y/o el plexo braquial. Su tratamiento más efectivo es la sección de la musculaturaescalena y la extirpación de la primera costilla. El objetivo de este trabajo es mostrar la técnica de laextirpación de la primera costilla por videotoracoscopia.Técnica: Describimos la técnica de extirpación costal por videotoracoscopia a través de tres puertas deentrada de 12mm (si bien una se amplía 3 cm para la introducción de periostotomos y costotomos).Hemos realizado esta intervención a tres casos de síndrome del estrecho torácico con resultados muybuenos.Conclusiones: La extirpación de la primera costilla por videotoracoscopia es una técnica factible, muyestética y de escasa morbilidad. Es una opción muy buena para la mayoría de pacientes afectos de estesíndrome, especialmente en pacientes obesos o con síndrome de Paget-Schroetter(AU)

Objective: Thoracic outlet syndrom is a condition caused by compression of the subclavian artery, subclavianvein and/or the brachial plexus. Scalene muscle section and first rib removal is the most effectivetreatment. The objective of this article is to demonsrate first rib resection using videothoracoscopy.Material and method: We describe first rib removal by videothoracoscopy using three 12mm entranceports (although one is widened to 3 cm to introduce periosteotomy cutters and rib shears). We haveperformed this operation on three cases of thoracic outlet syndrome with very good results.Conclusions: Removal of the first rib by videothoracoscopy is a viable and very aesthetic technique with alow morbidity. It is a very good option for the majority of patients affected by this syndrome, particularlyin obese patients or those with Pager-Schroetter syndrome(AU)

Giant solitary fibrous tumor of the pleura.

Fibrous tumors of the pleura are rare, accounting for <5% of all pleural neoplasms. Although over 80% of pleural fibrous tumors have a benign course, local recurrence postsurgery and occasional malignant transformation have been reported; complete excision of the tumor together with postsurgery follow-up of all patients is therefore recommended. We report on a solitary fibrous tumor of the pleura measuring 30 cm and weighing 3560 g.

First rib resection using videothorascopy for the treatment of thoracic outlet syndrome.

OBJECTIVE: Thoracic outlet syndrome is a condition caused by compression of the subclavian artery, subclavian vein and/or the brachial plexus. Scalene muscle section and first rib removal is the most effective treatment. The objective of this article is to demonstrate first rib resection using videothoracoscopy. TECHNIQUE: We describe first rib removal by videothoracoscopy using three 12 mm entrance ports (although one is widened to 3 cm to introduce periosteotomy cutters and rib shears). We have performed this operation on three cases of thoracic outlet syndrome with very good results. CONCLUSIONS: Removal of the first rib by videothoracoscopy is a viable and very aesthetic technique with a low morbidity. It is a very good option for the majority of patients affected by this syndrome, particularly in obese patients or those with Pager-Schroetter syndrome.

Primary monophasic synovial sarcoma of the pleura: diagnosis and treatment.

Synovial sarcomas are uncommon soft tissue malignancies that usually affect the extremities in the vicinity of large joints. The recognition of this tumor in an unexpected site, such as the pleura, is often difficult and the monophasic variant of synovial sarcoma is often mistaken for some other spindle cell tumor. In this report, we describe a very rare case of primary monophasic synovial sarcoma of the pleura treated with radical surgery.

Video-assisted thoracic surgery lobectomy: results in lung cancer.

BACKGROUND: The application of video-assisted thoracic surgery (VATS) in major pulmonary resections is still far from routine in most hospitals, even though the safety and technical feasibility of the procedure have by now been amply demonstrated. This paper reports on the surgical technique used by the authors for VATS lobectomy, on their experience of the procedure and on the results obtained. METHODS: A retrospective study was performed of all patients undergoing VATS lobectomy at the our Thoracic Surgery Department ,between 1993 and 2009.The clinical records of all patients were reviewed, and the following variables were noted for purposes of analysis: patient age and sex; clinical diagnosis; staging; date of surgery; type of surgery; conversion to conventional surgery and grounds for conversion; duration of surgery; intraoperative, postoperative and long-term complications; postoperative stay, final diagnosis and staging; and death rates. RESULTS: A total of 349 VATS lobectomies were performed over the study period (292 men, 57 women; mean age 59.7) The aetiology was non-small-cell lung carcinoma (NSCLC) in 313 patients and benign processes in 26;four patients had carcinoid tumours, and a further six required lobectomy due to metastases. The overall conversion rate was 9.4%. Mean duration of lobectomy was 148 minutes, and median duration 92 minutes. Mean postoperative was 3.9 days. The morbidity rate was 12.89 %, mostly involving minor complications. Perioperative mortality was 1.43%. There were no intraoperative deaths. The overall five-year survival rate for patients with NSCLC was 80.1%. CONCLUSIONS: VATS lobectomy is a safe and technically-viable procedure that meets oncological criteria for lung-cancer surgery. Major pulmonary resection using VATS should be considered the procedure of choice for a number of benign processes and for early-stage bronchogenic carcinoma (T1-T2 N0 M0).

Videotoracoscopia exploradora y videopericardioscopia en la estadificación definitiva y valoración de la resecabilidad del cáncer de pulmón / Exploratory Videothoracoscopy and Videopericardioscopy in the Definitive Staging and Assessment of Resectability of Lung Cancer

Introducción: El objetivo del artículo es presentar nuestra experiencia en videotoracoscopia para laestadificación y valoración de la resecabilidad del cáncer de pulmón.Pacientes y métodos: Desde 1993 realizamos videotoracoscopia exploradora (VTE) para la estadificación y valoración de la resecabilidad del cáncer de pulmón. Cuando se sospecha que hay afectación vascularintrapericárdica, la exploración intrapericárdica de los vasos mediante videopericardioscopia (VPC) sirvepara valorar la resecabilidad en estos supuestos cT4. Hasta diciembre de 2007 intervenimos a 1.381pacientes con carcinoma broncogénico. En este grupo de pacientes se realizaron 91 VPC, 45 de ellas por sospecha previa de invasión hiliar y vascular en la tomografía computarizada o resonancia magnética; en los 46 restantes se indicó durante la VTE.Resultados: En 1.277 pacientes pudo llevarse a cabo la VTE, que no fue posible en 104 casos por adherenciaspleurales firmes —61 pudieron resecarse trastoracotomía y sólo 43(3,1%) fueron toracotomíasexploradoras—. En 141 casos (10,2%)se hallaron en la VTE causas de irresecabilidad: en 81 invasiónmediastínica, en 38 carcinomatosis pleural, en 6 concurrieron ambas causas y en 16 había invasióntranscisural y/o vascular que impedía la lobectomía en pacientes que no toleraban la neumonectomía. En 61 de los 91 pacientes a quienes se realizó VPC pudo llevarse a cabo la exéresis pulmonar; en los 30restantes había invasión intrapericárdica que impedía su disección: de la arteria pulmonar en 17 casos; de la arteria y vena pulmonar es superiores en 6; de la arteria pulmonar y vena cava superiores en 2, y ampliainvasión de la aurícula izquierda y venas pulmonares en 5.Conclusiones: La VTE y la VPC como primer paso de la intervención por cáncer de pulmón requiere pocosminutos, no añade morbilidad y evita una significativa proporción de toracotomías exploradoras(AU)

Objective: We present our experience in using videothoracoscopy for the staging and assessment of resectability of lung cancer.Patients and Methods: Since 1993 we have carried out exploratory videothoracoscopy (EVT) for lung cancerstaging and assessment of resectability. When intrapericardial vessel involvemen tissu spected, explorationby videopericardioscopy (VPC)is also useful for assessing resectability in the se cT4 cases. Up to December2007 we had studied 1381 patients with bronchogenic carcinoma. VPC was performed in 91 of these patients. In 45, the procedure was indicated because evidence of hilar and vascular invasion had been observed in the computed tomography or magnetic resonance images. In there maining 46, it wasperformed as a result of EVT findings.Results: We were able to perform EVT in 1277 patients. In 104 cases this procedure could not be performed because of firm pleural adhesions. The tumor was resected after thoracotomy in 61 of these patients;thoracotomy was thus only exploratory in only 43 (3.1%). In 141 cases(10.2%) tumors were consideredunresectable based on EVT, due to mediastinal invasion in 81 cases, pleural carcinoma tos is in 38 cases, and both findings in 6 cases. Lobectomy was ruled out because of spread across a fissure or vascular invasion in16 patients who were unable to tolerate pneumonectomy.In 61 of the 91 patients who underwent VPC we were able to perform lung resection; in the remaining 30, intrapericardial dissection was prevented by invasion of the pulmonary artery (17cases), of the upper pulmonary artery and vein(6cases), of the upper pulmonary artery and superior vena cava (2cases), or ofthe left a trium and pulmonary veins(5cases, in which the invasion was extensive).Conclusions: EVT and VPC as a first stepin lung cancer treatment require only a few minutes, do not contribute to morbidity, and avoid a significant proportion of exploratory thoracotomies(AU)

Video-assisted surgery for lung cancer. State of the art and personal experience.

This paper reviews the role of videothoracoscopy in lung cancer, highlighting its utility in definitive staging, diagnosis, and treatment. We show exploratory videothoracoscopy to be the perfect technique for last-minute staging, looking for tumor invasion, especially parietal T3 and vascular T4 (due to videopericardioscopy), management of solitary pulmonary nodules, and the possibility of radical treatment with video-assisted thoracoscopic lobectomy. We perform an overview of the literature and analyze our experience of 1,381 patients with lung cancer. In 1,277 of them, the final decision on resectability was made by exploratory videothoracoscopy, including 91 by videopericardioscopy (only 30 were considered non-resectable on videopericardioscopy). Solitary pulmonary nodules were diagnosed in 382 cases (190 were cancer), and we performed 260 major lung resections by video-assisted thoracoscopic surgery (22 pneumonectomies, 238 lobectomies/bilobectomies).

Utilidad de la videotoracoscopia para una correcta estadificación de tumores T3 por invasión de pared / Usefulness of Video-assisted Thoracoscopy for Correctly Staging Tumors as T3 Because of Chest Wall Invasion

IntroducciónLa videotoracoscopia exploradora (VTE) es una técnica que permite valorar la resecabilidad del carcinoma de pulmón. El objetivo de este trabajo ha sido comprobar su utilidad para diferenciar los verdaderos tumores T3 por invasión parietal de aquellos que se estadificaron de forma incorrecta por las pruebas de imagen.Pacientes y métodosDesde marzo de 1993 hasta diciembre de 2007 se estudió a 1.277 pacientes, de los que 150 (137 varones y 13 mujeres; rango de edad: 28 81 años) presentaron tumores estadificados como cT3 por invasión parietal en las pruebas de imagen.ResultadosTras la realización de la VTE, los tumores pT3 por invasión parietal confirmados intraoperatoriamente y mediante estudio anatomopatológico fueron 44. De ellos, 36 se habían clasificado correctamente como cT3 por tomografía computarizada o resonancia magnética. Se observó además que 6 casos habían sido infravalorados como cT2, y otros 2 supravalorados como cT4. La sensibilidad, especificidad y valor predictivo tanto positivo como negativo obtenidos en nuestra serie han sido del 100%.ConclusionesEn nuestra opinión, la VTE es una técnica claramente superior a la tomografía computarizada y/o resonancia magnética para detectar infiltración de pared, por lo que, además de estadificar correctamente la situación tumoral T3 por invasión parietal, permite decidir la vía de abordaje adecuada para cada caso(AU)

BackgroundExploratory video-assisted thoracoscopy (EVT) can be used to assess the resectability of lung carcinomas. The aim of this study was to investigate the usefulness of this technique for distinguishing between tumors that invade the chest wall and should be staged as T3 and tumors that have been incorrectly staged as T3 on the basis of imaging studies.Patients and MethodsFrom March 1993 through December 2007, we studied 1277 patients, of whom 150 (137 men and 13 women; age range, 28 81 years) presented tumors classified as cT3 because of chest wall invasion on the basis of imaging studies.ResultsAfter exploratory EVT, 44 pT3 tumors with chest wall invasion were confirmed intraoperatively and by histopathology. Of these, 36 had been correctly classified as cT3 by computed tomography or magnetic resonance imaging. However, tumors had been understaged as cT2 in 6patients and overstaged as cT4 in 2 patients. The sensitivity, specificity, and positive and negative predictive values obtained were 100%.ConclusionsWe believe that exploratory EVT is clearly better than computed tomography and/or magnetic resonance imaging for detecting chest wall invasion. In addition to correctly staging a tumor as T3 because of chest wall invasion, the technique can also help decide the best surgical approach in each case(AU)

[Exploratory videothoracoscopy and videopericardioscopy in the definitive staging and assessment of resectability of lung cancer]. / Videotoracoscopia exploradora y videopericardioscopia en la estadificación definitiva y valoración de la resecabilidad del cáncer de pulmón.

OBJECTIVE: We present our experience in using videothoracoscopy for the staging and assessment of resectability of lung cancer. PATIENTS AND METHODS: Since 1993 we have carried out exploratory videothoracoscopy (EVT) for lung cancer staging and assessment of resectability. When intrapericardial vessel involvement is suspected, exploration by videopericardioscopy (VPC) is also useful for assessing resectability in these cT4 cases. Up to December 2007 we had studied 1381 patients with bronchogenic carcinoma. VPC was performed in 91 of these patients. In 45, the procedure was indicated because evidence of hilar and vascular invasion had been observed in the computed tomography or magnetic resonance images. In the remaining 46, it was performed as a result of EVT findings. RESULTS: We were able to perform EVT in 1277 patients. In 104 cases this procedure could not be performed because of firm pleural adhesions. The tumor was resected after thoracotomy in 61 of these patients; thoracotomy was thus only exploratory in only 43 (3.1%). In 141 cases (10.2%) tumors were considered unresectable based on EVT, due to mediastinal invasion in 81 cases, pleural carcinomatosis in 38 cases, and both findings in 6 cases. Lobectomy was ruled out because of spread across a fissure or vascular invasion in 16 patients who were unable to tolerate pneumonectomy. In 61 of the 91 patients who underwent VPC we were able to perform lung resection; in the remaining 30, intrapericardial dissection was prevented by invasion of the pulmonary artery (17 cases), of the upper pulmonary artery and vein (6 cases), of the upper pulmonary artery and superior vena cava (2 cases), or of the left atrium and pulmonary veins (5 cases, in which the invasion was extensive). CONCLUSIONS: EVT and VPC as a first step in lung cancer treatment require only a few minutes, do not contribute to morbidity, and avoid a significant proportion of exploratory thoracotomies.