Jayme Rios

[Concordance between clinical and pathological staging in patients with stages I or II non-small cell lung cancer subjected to surgical treatment].

OBJECTIVE To compare clinical and pathological staging in patients with non-small cell lung cancer submitted to surgical treatment, as well as to identify the causes of discordance. METHODS Data related to patients treated at the Department of Thoracic Surgery of the Pontifical Catholic University of Rio Grande do Sul São Lucas Hospital were analyzed retrospectively. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated for clinical stages IA, IB, and IIB. The kappa index was used to determine the concordance between clinical and pathological staging. RESULTS Of the 92 patients studied, 33.7% were classified as clinical stage IA, 50% as IB, and 16.3% as IIB. The concordance between clinical and pathological staging was 67.5% for stage IA, 54.3% for IB, and 66.6% for IIB. The accuracy of the clinical staging was greater for stage IA, and a kappa of 0.74, in this case, confirmed a substantial association with pathological staging. The difficulty in evaluating nodal metastatic disease is responsible for the low concordance in patients with clinical stage IB. CONCLUSIONS The concordance between clinical and pathological staging is low, and patients are frequently understaged (in the present study, only one case was overstaged). Strategies are necessary to improve clinical staging and, consequently, the treatment and prognosis of patients with non-small cell lung cancer.

Retrograde Orotracheal Intubation with a Double-Lumen Tube

BACKGROUND AND OBJECTIVES Difficult airway management in thoracic surgeries is a peculiar subject due to the demands of monopulmonary ventilation with double-lumen tubes. Flexible bronchoscopy guidance is extremely important, but it is not always available. The objective of this report was to describe a case of retrograde selective orotracheal intubation in the absence of specific endoscopy equipment for the procedure. CASE REPORT This is a patient with a history of retosigmoidectomy, admitted for a right thoracotomy for a lung lesion. Preoperative anesthetic evaluation did not reveal any clinical and physical exam particularities. After anesthetic induction and ventilation with face mask, two attempts of orotracheal intubation under direct laryngoscopy were ineffective due to difficult visualization of the vocal folds (Cormack-Lehane grade III). Due to the unavailability of specific material for selective endoscopic intubation it was decided to use the retrograde technique using the double-lumen tube. The patient was extubated in the operating room shortly after the end of the surgery without complications secondary to the alternative technique. CONCLUSIONS Retrograde selective orotracheal intubation is a minimally invasive technique, low cost, safe, and extremely useful whenever flexible bronchoscopy is not available.

Intubação orotraqueal com tubo de duplo-lúmen pela via retrógrada

JUSTIFICATIVA Y OBJETIVOS: El manejo de la via aerea dificil en cirugia toracica es un asunto peculiar, debido a las exigencias de la ventilacion monopulmonar con el uso de tubos de doble lumen. El auxilio de la broncoscopia flexible es de enorme importancia, sin embargo no siempre esta disponible. El objetivo de este relato, es describir un caso de intubacion orotraqueal selectiva retrograda en la ausencia de un equipo de endoscopia especifico para el procedimiento. RELATO DEL CASO: Paciente con historial previo de retosigmoidectomia que fue ingresado para el abordaje quirurgico de la lesion pulmonar por toracotomia derecha. La evaluacion anestesica preoperatoria no revelaba particularidades ni en la historia clinica ni en el examen fisico. Despues de la induccion anestesica y ventilacion con mascara facial, en la laringoscopia derecha dos intentos de intubacion orotraqueal no tuvieron el efecto esperado debido a una dificil visualizacion de las cuerdas vocales (Cormack-Lehane grado III). En funcion de la indisponibilidad de un material especifico para la intubacion selectiva endoscopica, se opto por la tecnica retrograda utilizando un tubo de doble lumen. El paciente fue desentubado en quirofano enseguida que termino la operacion y no presento complicaciones provenientes de la tecnica alternativa. CONCLUSIONES: La intubacion orotraqueal selectiva retrograda fue una tecnica alternativa minimamente invasiva de bajo coste, segura e incluso extremadamente util cuando no se cuenta con la ayuda de la broncoscopia flexible.