Javier Flandes Aldeyturriaga

Recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas

Felipe Villar Álvareza,*,1, Ignacio Muguruza Truebab,1, José Belda Sanchisc, Laureano Molins López-Rodód, Pedro Miguel Rodríguez Suáreze, Julio Sánchez de Cos Escuínf, Esther Barreirog, M. Henar Borrego Pintadoh, Carlos Disdier Vicentei, Javier Flandes Aldeyturriagaj, Pablo Gámez Garcíak, Pilar Garrido Lópezl, Pablo León Atancem, José Miguel Izquierdo Elenan, Nuria M. Novoa Valentíno, Juan José Rivas de Andrésp, Íñigo Royo Crespop, Ángel Salvatierra Velázquezq, Luis M. Seijo Maceirasr, Segismundo Solano Reinas, David Aguiar Bujandat, Régulo J. Ávila Martínezk, José Ignacio de Granda Oriveu, Eva de Higes Martínezv, Vicente Díaz-Hellín Gudek, Raúl Embún Florp, Jorge L. Freixinet Gilarte, María Dolores García Jiménezm, Fátima Hermoso Alarzak, Samuel Hernández Sarmientot, Antonio Francisco Honguero Martínezm, Carlos A. Jiménez Ruizw, Iker López Sanzn, Andrea Mariscal de Albak, Primitivo Martínez Vallinap, Patricia Menal Muñozx, Laura Mezquita Pérezl, María Eugenia Olmedo Garcíal, Carlos A. Rombolám, Íñigo San Miguel Arreguiy, María del Valle Somiedo Gutiérrezj, Ana Isabel Triviño Ramírezm, Joan Carles Trujillo Reyesc, Carmen Vallejoz, Paz Vaquero Lozanos, Gonzalo Varela Simóo y Javier J. ZuluetaaaThe Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.

Sumario ejecutivo de las recomendaciones SEPAR de diagnóstico y tratamiento del cáncer de pulmón de células no pequeñas

The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.

Patología obstructiva no maligna de la vía aérea central

The most common causes of non-malignant central airway obstruction are post-intubation and post-tracheostomytracheal stenosis, followed by the presence of foreign bodies, benign endobronchial tumours and tracheobronchomalacia. Other causes, such as infectious processes or systemic diseases, are less frequent. Despite the existence of numerous classification systems, a consensus has not been reached on the use of any one of them in particular. A better understanding of the pathophysiology of this entity has allowed us to improve diagnosis and treatment. For the correct diagnosis of nonspecific clinical symptoms, pulmonary function tests, radiological studies and, more importantly, bronchoscopy must be performed. Treatment must be multidisciplinary and tailored to each patient, and will require surgery or endoscopic intervention using thermoablative and mechanical techniques.

Tratamiento con válvulas endobronquiales en la fuga aérea prolongada

Persistent air leak (PAL) is the most common complication following lung resection.1,2 It lengthens hospital stay and increases post-surgical morbidity and mortality due to the increased risk of empyema, fever or pneumonia.4 It can contribute to respiratory failure, limit activity, increase the time and costs of hospitalization and add to the risk of hospital-acquired infections.1 PAL is defined as prolonged air leak caused by an alveolopleural fistula lasting more than 7 days.1 Although the length of evolution described in the literature varies, the finding of air leak on day 5 post-surgery is considered as a “significant air leak”. If the air leak is continuous or occurs during inhalation or exhalation and presents with subcutaneous emphysema or respiratory failure, it normally becomes persistent.1,5 An alveolopleural fistula is the abnormal communication between the pulmonary parenchyma distal to a segmentary bronchus and the pleural space.3 After surgery, it may be caused by delayed healing of the lung surface, due mainly to underlying parenchymal disease.1 For this reason, PAL is more common after surgery for secondary spontaneous pneumothorax than after primary pneumothorax. An incidence of around 20% has been reported.1 Standard treatment of PAL is generally conservative, with continuous chest drainage. If the condition prolongs over time, surgical reintervention can be considered as a second option. This procedure can be burdensome in terms of morbidity, does not always guarantee a solution, and in some cases the problem may even be aggravated if the already diseased parenchyma is exposed to more injury.1 The most common surgical techniques currently available for treating this disease are further resection of the lung parenchyma at the site of the anatomical defect, reinforcement of sutures with bovine pericardium, pleurectomy, pleurodesis with autologous blood patches or other chemical agents such as fibrin sealant, sponges, ethanol, trichloroacetic acid, bronchial blockers or cautery using a fiberoptic bronchoscope.2 The wide range of therapeutic options indicate that no single approach is fully effective, and this has led to the introduction of less invasive approaches such as endobronchial valves, which provide shorter recovery

Perforación gástrica durante la broncoscopia al administrar oxigenoterapia por cánula nasofaríngea

Gastric perforation is a rare complication of bronchoscopy, and in recent decades, some cases associated with the administration of oxygen therapy by nasopharyngeal tube have been published. We report the case of a 72-year-old woman with a history of uterine cancer in 2004, in complete remission until 2011, when she attended a follow-up visit in which a chest X-ray was performed that showed a nodule in the right lower lobe. The finding was confirmed by chest computed tomography (CT), which revealed a 35 mm mass in the apical segment of the right lower lobe. Malignancy was suspected. For pathological confirmation, a fiberoptic bronchoscopy was performed under conscious sedation (intravenous midazolam 4 mg and fentanyl 0.5 mg), and samples were