Biopsia del ganglio centinela en el cáncer de pulmón / Biopsy of the sentinel node in lung cancer

Introducción y objetivo: En el cáncer de pulmón la afectación ganglionar mediastínica puede estar infraestadificada (hasta en el 20% de los casos en estadios i). La detección del ganglio centinela es una técnica estándar en las guías de actuación del cáncer de mama y melanoma y podría ser útil en el cáncer de pulmón. Material y métodos: Con la hipótesis de que es factible la detección del ganglio centinela en el cáncer de pulmón de células no pequeñas (CPCNP) resecable, se realizó un estudio de cohortes prospectivo en 48 pacientes con CPCNP resecables utilizando la inyección intraoperatoria de tecnecio 99 sulfato coloide. Resultados: El radioisótopo migró en todos los casos. La sensibilidad de la prueba es del 88,24% y la precisión del 95,83%, con un valor predictivo negativo del 93,94% y una tasa de falsos negativos del 11,76%. No existieron complicaciones relacionadas con la técnica. Conclusiones: La detección del ganglio centinela en el CPCNP con inyección intraoperatoria de isótopos es factible y segura, y permite tasas de detección y sensibilidad superponibles a las de otros tipos de tumor (AU)

Introduction and objective: Mediastinal lymph node involvement can be understaged in cases of lung cancer (up to 20% in stage i). Sentinel node detection is a standard technique recommended in breast cancer and melanoma action guidelines, and could also be useful in cases of lung cancer. Material and methods: Considering the detection of the sentinel node in non-small cell lung cancer (NSCLC) as feasible, a prospective cohort study was carried out on 48 patients with resectable NSCLC, using the intraoperative injection of colloid sulphate technetium-99. Results: The radioisotope migrated in all cases. The procedure’s sensitivity was 88.24%, its accuracy was 95.83%, its negative predictive value was 93.94% and the false negative rate was 11.76%. No complications were associated with this technique. Conclusions: The detection of a sentinel node in NSCLC with the intraoperative injection of the isotope is feasible and safe, and allows for detection and sensitivity rates comparable to those of other tumour types (AU)

Biopsy of the sentinel node in lung cancer. / Biopsia del ganglio centinela en el cáncer de pulmón.

INTRODUCTION AND OBJECTIVE: Mediastinal lymph node involvement can be understaged in cases of lung cancer (up to 20% in stage i). Sentinel node detection is a standard technique recommended in breast cancer and melanoma action guidelines, and could also be useful in cases of lung cancer. MATERIAL AND METHODS: Considering the detection of the sentinel node in non-small cell lung cancer (NSCLC) as feasible, a prospective cohort study was carried out on 48 patients with resectable NSCLC, using the intraoperative injection of colloid sulphate technetium-99. RESULTS: The radioisotope migrated in all cases. The procedure's sensitivity was 88.24%, its accuracy was 95.83%, its negative predictive value was 93.94% and the false negative rate was 11.76%. No complications were associated with this technique. CONCLUSIONS: The detection of a sentinel node in NSCLC with the intraoperative injection of the isotope is feasible and safe, and allows for detection and sensitivity rates comparable to those of other tumour types.

Embolización arterial como tratamiento de la hiperplasia nodular focal sintomática / Treatment of symptomatic focal nodular hyperplasia by arterial embolization

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Robot-assisted gastroesophageal surgery: usefulness and limitations.

Robot-assisted surgery overcomes some of the limitations of traditional laparoscopic surgery. We present our experience and lessons learned in two surgical units dedicated to gastro-esophageal surgery. From June 2009 to January 2013, we performed 130 robot-assisted gastroesophageal procedures, including Nissen fundoplication (29), paraesophageal hernia repair (18), redo for failed antireflux surgery (11), esophagectomy (19), subtotal (5) or wedge (4) gastrectomy, Heller myotomy for achalasia (22), gastric bypass for morbid obesity (12), thoracoscopic leiomyomectomy (4), Morgagni hernia repair (3), lower-third esophageal diverticulectomy (1) and two diagnostic procedures. There were 80 men and 50 women with a median age of 54 years (interquartile range: 46-65). Ten patients (7.7 %) had severe postoperative complications: eight after esophagectomy (three leaks-two cervical and one thoracic-managed conservatively), one stapler failure, one chylothorax, one case of gastric migration to the thorax, one case of biliary peritonitis, and one patient with a transient ventricular dyskinesia. One redo procedure needed reoperation because of port-site bleeding, and one patient died of pulmonary complications after a giant paraesophageal hernia repair; 30-day mortality was, therefore, 0.8 %. There were six elective and one forced conversions (hemorrhage), so total conversion was 5.4 %. Median length of stay was 4 days (IQ range 3-7). Robot-assisted gastroesophageal surgery is feasible and safe, and may be applied to most common procedures. It seems of particular value for Heller myotomy, large paraesophageal hernias, redo antireflux surgery, transhiatal dissection, and hand-sewn intrathoracic anastomosis.

Contribution of robotics to minimally invasive esophagectomy.

Robot-assisted surgery has the advantages of a three-dimensional view, versatility of instruments and better ergonomics. It allows fine dissection and difficult anastomoses in deep fields. Based on our experience, we try to define what are the main contributions of robotics to minimally invasive esophagectomy. From December 2009 to July 2012, we performed 24 minimally invasive esophagectomies (9 transhiatal, 5 Ivor-Lewis and 10 three-field), 16 of them robotically (8, 5 and 3, respectively). Eighteen patients (18/24 = 75 %) received neoadjuvant therapy. Nine patients (9/24 = 37.5 %) had symptomatic complications: 4 anastomotic leaks treated conservatively, one staple failure of the gastric plasty needing reoperation, one biliary peritonitis secondary to a gangrenous cholecystitis, one intrathoracic gastric migration after the only nonresectable case, one chylothorax and one patient with major cardiopulmonary complications. The median number of lymph nodes harvested was 12 ± 7. Median length of stay was 14 ± 13.5 days. Thirty-day mortality was nil. Complications were not related to the robot itself but to the complexity of both the technique and the patient. Although we found no advantages for the use of robotics during threefield minimally invasive esophagectomy, robotic mediastinal dissection during transhiatal esophagectomy can be performed safely under direct vision. Moreover, hand-sewn robotic-assisted technique in the prone position is promising and maybe the simplest way to carry out thoracic anastomosis during Ivor-Lewis esophagectomy.