Francisco Javier Algar

Periareolar approach for thoracoscopic lobectomy.

In recent years advances in video-assisted thoracoscopic surgery have been aimed at reducing the number of video surgery ports, and especially major lung resections pose the greatest challenge. We describe a new minimally invasive as well as aesthetic approach for thoracoscopic lobectomy. The technique poses no difficulty for the surgeon and has certain advantages over other videothoracoscopic approaches.

Es una buena opción terapéutica la cirugía pulmonar en pacientes mayores de 80 años

INTRODUCTION The number of geriatric patients with lung cancer is expected to increase in the next few years, especially patients over 80, and therefore it is important to know where the therapeutic limits should be drawn. Is surgery a good option in patients over 80? OBJECTIVE To show the results of lung resection in patients over 80 years of age to evaluate the safety and short-term results. MATERIAL AND METHODS Retrospective study of 21 patients who underwent lung resection between October 1999 and October 2011. RESULTS The mean age of the patients was 82 ± 2; 13 lobectomies were performed,5 transegmental resections, 2 segmentectomies, and 1 pneumonectomy. Postoperative complications (28.6%) were: respiratory 66.6%, cardiological 16.7% and digestive 16,7%. Perioperative mortality was 9,5% (2). There was a significant association between mortality and age (P=.023), or pneumonectomy (P=.002). We studied COPD as a risk factor for mortality and found a statistically significant relation with the need for ICU (P<.007), and the appearance of complications (P<.044). CONCLUSIONS Resective lung surgery is feasible and safe in selected patients over 80 years of age. In our experience, squamous cell carcinoma was the most frequent tumor. The most common procedure was lobectomy which is a safe technique with a low complication rate in elderly patients. Pneumonectomy should be avoided, as we have found a significant association with perioperative mortality.INTRODUCTION The number of geriatric patients with lung cancer is expected to increase in the next few years, especially patients over 80, and therefore it is important to know where the therapeutic limits should be drawn. Is surgery a good option in patients over 80? OBJECTIVE To show the results of lung resection in patients over 80 years of age to evaluate the safety and short-term results. MATERIAL AND METHODS Retrospective study of 21 patients who underwent lung resection between October 1999 and October 2011. RESULTS The mean age of the patients was 82 ± 2; 13 lobectomies were performed,5 transegmental resections, 2 segmentectomies, and 1 pneumonectomy. Postoperative complications (28.6%) were: respiratory 66.6%, cardiological 16.7% and digestive 16,7%. Perioperative mortality was 9,5% (2). There was a significant association between mortality and age (P=.023), or pneumonectomy (P=.002). We studied COPD as a risk factor for mortality and found a statistically significant relation with the need for ICU (P<.007), and the appearance of complications (P<.044). CONCLUSIONS Resective lung surgery is feasible and safe in selected patients over 80 years of age. In our experience, squamous cell carcinoma was the most frequent tumor. The most common procedure was lobectomy which is a safe technique with a low complication rate in elderly patients. Pneumonectomy should be avoided, as we have found a significant association with perioperative mortality.

Ganglioneuroma mediastínico, un hallazgo fortuito en metastasectomía pulmonar y hepática de tumor de células germinales

152 Cir Esp. 2008;83(3):150-9 administracion diaria de dosis bajas. La agregacion plaquetaria se inhibe y alcanza una concentracion maxima estable despues de 4-7 dias, y por ello son necesarios 7 dias, despues de la ultima dosis, para que la funcion plaquetaria se restablezca. Recientemente, Payne et al investigaron el efecto del uso combinado del clopidogrel y la aspirina en el tiempo de sangria en voluntarios sanos, observaron que, tras 2 dias de tratamiento con clopidogrel 75 mg/dia y AAS 150 mg/dia, el tiempo de sangria era 3,4 veces mayor que el basal. La cirugia no demorable imposibilita actuar de manera acorde con lo establecido en las guias sobre uso de farmacos antiagregantes plaquetarios, ya que no es posible su demora un minimo de 6 semanas para minimizar los riesgos, ni es posible la sustitucion de los antiagregantes “mayores” (aspirina y tienopiridinas) por antiinflamatorios no esteroideos de vida media corta y con efectos antiagregantes reversibles. En la actualidad, es frecuente que tanto cirujanos como anestesiologos se encuentren con pacientes tratados con este tipo de farmacos, tanto en cirugia electiva como de urgencia, lo que plantea frecuentes controversias entre ambas especialidades en lo que se refiere al momento de realizar la intervencion. En nuestro caso, dado que nos encontrabamos ante una hemorragia grave, favorecida en gran medida por la toma de 2 antiagregantes, el tratamiento incluyo la transfusion de plaquetas, a pesar de aumentar asi el riesgo de trombosis coronaria y reinfarto, como posiblemente sucedio en nuestro enfermo. En ausencia de guias que orienten ante este tipo de situaciones, los riesgos y beneficios de nuestras actuaciones deberan valorarse ad hoc para cada paciente, considerando dos aspectos fundamentales: la posibilidad de complicaciones cardiologicas y la tecnica quirurgica, incluyendo aspectos como duracion, agresividad y sangrado.