María Teresa Gómez Hernández

La neumonectomía ofrece menor supervivencia a los pacientes con carcinoma de pulmón en estadio patológico IB

OBJECTIVE Pneumonectomy may be needed in exceptional cases in patients with early stage NSCLC, especially in stage IB. The aim of this study was to evaluate whether overall survival in stage IB (T2aN0M0) NSCLC patients is worse after pneumonectomy. METHODS Retrospective study of a series of pathological IB (pIB) patients who underwent either lobectomy or pneumonectomy between 2000 and 2011. The dependent variable was all-cause death. Operative mortality was excluded. The relationship between the age, FEV1%, Charlson index and performance of pneumonectomy variables and the dependent variable were analyzed using a Cox regression. Overall survival for both groups of patients was then plotted in Kaplan-Meier graphs and compared using the log-rank test. RESULTS A total of 407 cases were analyzed (373 lobectomies and 34 pneumonectomies). According to Cox regression, age, FEV1% and pneumonectomy were associated with poorer survival (P<.05). Age-adjusted survival and FEV1% showed diminished survival in patients who underwent pneumonectomy (log-rank, P=.0357). CONCLUSIONS In stage pIB NSCLC patients, pneumonectomy is associated with poorer survival compared to lobectomy.

Usefulness of conventional pleural drainage systems to predict the occurrence of prolonged air leak after anatomical pulmonary resection

OBJECTIVES One of the reported advantages of digital pleural drainage system is the possibility of predicting the occurrence of prolonged air leak (PAL) based on the recorded pleural pressures and/or air flow through chest tubes. Nevertheless, this fact has never been well supported. The objective of this investigation is to evaluate if the occurrence of PAL can accurately be predicted using clinical data and air leak measurements 24 h after lung resection on conventional pleural drainage system (CPDS). METHODS Prospective observational study on 100 consecutive non-complicated patients undergoing anatomical lung resection (segmentectomy, lobectomy or bilobectomy). Prior to the operation, the risk of PAL was evaluated according to the score previously published. Twenty-four hours after surgery, two independent observers measured the air flow at forced deep expiration on a CPDS with graduated analogical leak monitor. The agreement between both observers was determined and in case of discrepancy, the mean of both observations was calculated. After discharge, the occurrence of PAL (defined as persistent air leak 5 or more days after the operation) was recorded. A logistic regression model was constructed including two independent categorical variables (PAL score and air flow) and the performance of the model was assessed by non-parametric receiver operating characteristic curves. RESULTS The series includes 81 lobectomies, 8 bilobectomies and 11 anatomical segmentectomies. Median preoperative PAL score was 1 (range 0-3.5). Any postoperative air flow was observed in 30 cases with a median value of 0 (0-3.5). The prevalence of PAL in the series was 10% (10 of 100 cases). Both independent variables entered in the multivariate model (PAL score P = 0.050, air flow: 0.016) and C-index was 0.83. CONCLUSION The performance of this simple predictive model, without any electronic recording, warrants a larger multi-institutional study to validate its usefulness in clinical decision-making regarding the management of patients with air leak after lung resection.

Morbimortalidad de la resección pulmonar en pacientes octogenarios con cáncer de pulmón

OBJECTIVE Evaluate the restrictiveness of selection criteria for lung resection in lung cancer patients over 80 years of age compared to those applied in younger patients. Compare and analyze 30-day mortality and postoperative complications in both groups of patients. METHODS Case-controlled retrospective analysis. STUDY POPULATION Consecutive patients undergoing elective anatomical lung resection. Population was divided into octogenarians (cases) and younger patients (controls). Variables determining surgical risk (BMI, FEV1%, postoperative FEV1%, FEV1/FVC, DLCO and pneumonectomy rate) were compared using either Wilcoxon or Chi-squared tests. Thirty-day mortality and morbidity odds ratio were calculated. A logistic regression model with bootstrap resampling was constructed, including postoperative complications as dependent variable and age and post-operative FEV1% as independent variables. Data were retrieved from a prospective database. RESULTS No statistically significant differences were found in BMI (P=.40), FEV1% (P=.41), postoperative FEV1% (P=.23), FEV1/FVC (P=.23), DLCO (P=.76) and pneumonectomy rate (P=.90). Case mortality was 1.85% and control mortality was 1.26% (OR: 1.48). Cardiorespiratory complications occurred in 12.80% of younger subjects and in 13.21% of patients aged 80 years or older. (OR: 1.03). In the logistic regression, only FEV1% was related to postoperative complications (P<.005). CONCLUSION Selection criteria for octogenarians are similar to those applied in the rest of the population. Advanced age is not a factor for increased 30-day mortality or postoperative morbidity.

The Relationships Between Muscle Power and Physical Activity in Older Men With Chronic Obstructive Pulmonary Disease

The purpose of this study was to determine the potential relationship between muscle power of the lower extremities and the physical activity in older men with chronic obstructive pulmonary disease (COPD). Forty-four men (70.3 ± 6.7 years old) with moderate-to-severe COPD completed the 6-min walk test (6MWT), BODE (body mass index, obstruction, dyspnea, and exercise), a one-repetition maximum strength of the quadriceps femoris (1RMQF), and muscle power at 50% and 70% 1RMQF. Physical activity was measured using an accelerometer. The 6MWT was associated with muscle power at 50% 1RMQF (r = .40; P = .013) but not muscle power at 70% 1RMQF (r = .24; P = .15) or 1RMQF (r = .13; P = .44). Light-intensity activity was positively correlated with muscle power at 50% 1RMQF (r = .52; P = .001). Lower limb muscle power is associated with the 6MWT and light-intensity activities in older men with COPD.

Empalamiento tóraco-abdominal por rama de árbol

A 27-year-old male suffered an accidental fall onto the branch of a tree, resulting in thoracoabdominal impalement with entry site below the left clavicle. A chest-abdominal computed tomography (Fig. 1A and B) revealed subcutaneous emphysema in the chest wall, large left pneumothorax with collapsed lung, parenchymal lesions in both lung lobes and the presence of a foreign body with air density, 2 cm thick, extending in a craniocaudal direction from the left crus of the diaphragm to the psoas and left posterior paravertebral muscle. It had two distal ends that terminated at the level of the left iliac crest.

A greater quality of clinical evidence is needed

The article by Shen and colleagues (1) published in the European Journal of Cardio-Thoracic Surgery tries to resolve one of the most controversial questions in the thoracic surgical field nowadays: does single-port video-assisted thoracoscopic surgery (SP-VATS) offer any advantages over multiport video-assisted thoracoscopic surgery (MP-VATS) lobectomy? The authors compare these two approaches for lobectomy in non-small cell lung cancer (NSCLC) patients. To do that, they have carefully designed and conducted a case-control study with a propensity-matched analysis to evaluate safety and efficacy of SP-VATS lobectomy and compare the perioperative outcomes between SP and MP-VATS lobectomies for NSCLCs.

Synchronous cerebral and pleural solitary fibrous tumour

Solitary fibrous tumours of the pleura (SFTPs) are rare mesenchymal neoplasms usually originating from the visceral pleura, but they have been reported in many other sites. To the best of our knowledge, this report describes the first known case of synchronous SFTP in the left visceral pleura and brain. The SFTP of the brain was resected via craniotomy, whereas the SFTP of the pleura, widely compressing and displacing the left lower lung lobe, was resected via left thoracotomy.