Videotoracoscopia exploradora y videopericardioscopia en la estadificación definitiva y valoración de la resecabilidad del cáncer de pulmón / Exploratory Videothoracoscopy and Videopericardioscopy in the Definitive Staging and Assessment of Resectability of Lung Cancer

Introducción: El objetivo del artículo es presentar nuestra experiencia en videotoracoscopia para laestadificación y valoración de la resecabilidad del cáncer de pulmón.Pacientes y métodos: Desde 1993 realizamos videotoracoscopia exploradora (VTE) para la estadificación y valoración de la resecabilidad del cáncer de pulmón. Cuando se sospecha que hay afectación vascularintrapericárdica, la exploración intrapericárdica de los vasos mediante videopericardioscopia (VPC) sirvepara valorar la resecabilidad en estos supuestos cT4. Hasta diciembre de 2007 intervenimos a 1.381pacientes con carcinoma broncogénico. En este grupo de pacientes se realizaron 91 VPC, 45 de ellas por sospecha previa de invasión hiliar y vascular en la tomografía computarizada o resonancia magnética; en los 46 restantes se indicó durante la VTE.Resultados: En 1.277 pacientes pudo llevarse a cabo la VTE, que no fue posible en 104 casos por adherenciaspleurales firmes —61 pudieron resecarse trastoracotomía y sólo 43(3,1%) fueron toracotomíasexploradoras—. En 141 casos (10,2%)se hallaron en la VTE causas de irresecabilidad: en 81 invasiónmediastínica, en 38 carcinomatosis pleural, en 6 concurrieron ambas causas y en 16 había invasióntranscisural y/o vascular que impedía la lobectomía en pacientes que no toleraban la neumonectomía. En 61 de los 91 pacientes a quienes se realizó VPC pudo llevarse a cabo la exéresis pulmonar; en los 30restantes había invasión intrapericárdica que impedía su disección: de la arteria pulmonar en 17 casos; de la arteria y vena pulmonar es superiores en 6; de la arteria pulmonar y vena cava superiores en 2, y ampliainvasión de la aurícula izquierda y venas pulmonares en 5.Conclusiones: La VTE y la VPC como primer paso de la intervención por cáncer de pulmón requiere pocosminutos, no añade morbilidad y evita una significativa proporción de toracotomías exploradoras(AU)

Objective: We present our experience in using videothoracoscopy for the staging and assessment of resectability of lung cancer.Patients and Methods: Since 1993 we have carried out exploratory videothoracoscopy (EVT) for lung cancerstaging and assessment of resectability. When intrapericardial vessel involvemen tissu spected, explorationby videopericardioscopy (VPC)is also useful for assessing resectability in the se cT4 cases. Up to December2007 we had studied 1381 patients with bronchogenic carcinoma. VPC was performed in 91 of these patients. In 45, the procedure was indicated because evidence of hilar and vascular invasion had been observed in the computed tomography or magnetic resonance images. In there maining 46, it wasperformed as a result of EVT findings.Results: We were able to perform EVT in 1277 patients. In 104 cases this procedure could not be performed because of firm pleural adhesions. The tumor was resected after thoracotomy in 61 of these patients;thoracotomy was thus only exploratory in only 43 (3.1%). In 141 cases(10.2%) tumors were consideredunresectable based on EVT, due to mediastinal invasion in 81 cases, pleural carcinoma tos is in 38 cases, and both findings in 6 cases. Lobectomy was ruled out because of spread across a fissure or vascular invasion in16 patients who were unable to tolerate pneumonectomy.In 61 of the 91 patients who underwent VPC we were able to perform lung resection; in the remaining 30, intrapericardial dissection was prevented by invasion of the pulmonary artery (17cases), of the upper pulmonary artery and vein(6cases), of the upper pulmonary artery and superior vena cava (2cases), or ofthe left a trium and pulmonary veins(5cases, in which the invasion was extensive).Conclusions: EVT and VPC as a first stepin lung cancer treatment require only a few minutes, do not contribute to morbidity, and avoid a significant proportion of exploratory thoracotomies(AU)

[Exploratory videothoracoscopy and videopericardioscopy in the definitive staging and assessment of resectability of lung cancer]. / Videotoracoscopia exploradora y videopericardioscopia en la estadificación definitiva y valoración de la resecabilidad del cáncer de pulmón.

OBJECTIVE: We present our experience in using videothoracoscopy for the staging and assessment of resectability of lung cancer. PATIENTS AND METHODS: Since 1993 we have carried out exploratory videothoracoscopy (EVT) for lung cancer staging and assessment of resectability. When intrapericardial vessel involvement is suspected, exploration by videopericardioscopy (VPC) is also useful for assessing resectability in these cT4 cases. Up to December 2007 we had studied 1381 patients with bronchogenic carcinoma. VPC was performed in 91 of these patients. In 45, the procedure was indicated because evidence of hilar and vascular invasion had been observed in the computed tomography or magnetic resonance images. In the remaining 46, it was performed as a result of EVT findings. RESULTS: We were able to perform EVT in 1277 patients. In 104 cases this procedure could not be performed because of firm pleural adhesions. The tumor was resected after thoracotomy in 61 of these patients; thoracotomy was thus only exploratory in only 43 (3.1%). In 141 cases (10.2%) tumors were considered unresectable based on EVT, due to mediastinal invasion in 81 cases, pleural carcinomatosis in 38 cases, and both findings in 6 cases. Lobectomy was ruled out because of spread across a fissure or vascular invasion in 16 patients who were unable to tolerate pneumonectomy. In 61 of the 91 patients who underwent VPC we were able to perform lung resection; in the remaining 30, intrapericardial dissection was prevented by invasion of the pulmonary artery (17 cases), of the upper pulmonary artery and vein (6 cases), of the upper pulmonary artery and superior vena cava (2 cases), or of the left atrium and pulmonary veins (5 cases, in which the invasion was extensive). CONCLUSIONS: EVT and VPC as a first step in lung cancer treatment require only a few minutes, do not contribute to morbidity, and avoid a significant proportion of exploratory thoracotomies.

[Resection of pulmonary metastases in 148 patients: analysis of prognostic factors]. / Cirugía de metástasis pulmonares en 148 pacientes. Análisis de sus factores pronósticos.

OBJECTIVE: To evaluate the prognostic factors for survival in a series of patients who underwent surgery for pulmonary metastases from primary tumors in distinct organs. PATIENTS AND METHODS: This was a retrospective study of 148 patients operated between May 2001 and May 2007. Multivariate analysis was used to evaluate overall survival. Patients scheduled for tumorectomy were included provided their primary tumor was controlled and they had no extrathoracic recurrence and adequate cardiorespiratory function. The influence of the following prognostic factors was analyzed: number and diameter of the metastases, lymph node infiltration, complete resection, and, above all, histological type. A significance level of 95% was used. RESULTS: A total of 90 men (60.81%) and 58 women (39.19%) were operated. The mean (SD) age was 56.5 (9.7) years. The actuarial survival at 6 years was 30.3% (n=45) and the median survival was 34 months. The factors that affected survival were the number of metastases (P< .05), diameter of the lesions (P< .05), lymph node infiltration (P< .05), complete resection (P< .05), and, above all, histological type (P< .05). Tumorectomy was the most commonly performed operation. CONCLUSIONS: These results suggest that, in the absence of other therapeutic options and contraindications, we should operate on patients in whom the primary tumor is controlled and in whom complete resection can be performed. Even if factors associated with poor prognosis are present, the outcomes are always better than when surgery is not performed, particularly in view of the relatively low morbidity and mortality associated with this type of surgery.

Cirugía de metástasis pulmonares en 148 pacientes. Análisis de sus factores pronósticos / Resection of pulmonary metastases in 148 Patients: analysis of prognostic factors

OBJETIVO: Evaluar los factores pronósticos de supervivenciaen una serie de pacientes intervenidos por metástasispulmonares de diferentes tumores y órganos.PACIENTES Y MÉTODOS: Se ha realizado un estudio retrospectivode 148 pacientes intervenidos entre mayo de 2001 ymayo de 2007, y se ha aplicado un análisis multivariantepara valorar la supervivencia global. Los criterios de inclusiónfueron: control del tumor primario, sin recurrencia extratorácicay función cardiorrespiratoria suficiente, siemprecon intención de tumorectomía. Se valoró qué influencia teníanen el pronóstico los siguientes factores: número de metástasis,diámetro de éstas, adenopatías invadidas, cirugíacompleta y, sobre todo, tipo histológico, para un nivel de significacióndel 95%.RESULTADOS: En total se intervino a 90 varones (60,81%)y 58 mujeres (39,19%). La edad media ± desviación estándarera de 56,5 ± 9,7 años. Se obtuvo una supervivencia actuariala 6 años del 30,3% (n = 45), con una mediana de supervivenciade 34 meses. Los factores que influyeron en elpronóstico fueron el número de metástasis (p < 0,05), el diámetrode éstas (p < 0,05), la presencia de adenopatías invadidas(p < 0,05), la cirugía completa (p < 0,05) y, sobre todo,el tipo histológico (p < 0,05). La tumorectomía fue la intervenciónmás realizada.CONCLUSIONES: Los resultados avalan que aceptemos paratratamiento quirúrgico a los pacientes sin otra posibilidadterapéutica a quienes pueda realizarse una resección completa,que tengan el tumor primario controlado y no presentenotras contraindicaciones, pues, aunque en presencia deciertos factores empeora la supervivencia, los resultados sonsiempre mejores que con la abstención quirúrgica, máximesi se tienen en cuenta las cifras relativamente bajas de morbilidady mortalidad con este tipo de cirugía

OBJECTIVE: To evaluate the prognostic factors for survivalin a series of patients who underwent surgery for pulmonarymetastases from primary tumors in distinct organs.PATIENTS AND METHODS: This was a retrospective study of148 patients operated between May 2001 and May 2007.Multivariate analysis was used to evaluate overall survival.Patients scheduled for tumorectomy were included providedtheir primary tumor was controlled and they had noextrathoracic recurrence and adequate cardiorespiratoryfunction. The influence of the following prognostic factorswas analyzed: number and diameter of the metastases, lymphnode infiltration, complete resection, and, above all,histological type. A significance level of 95% was used.RESULTS: A total of 90 men (60.81%) and 58 women(39.19%) were operated. The mean (SD) age was 56.5 (9.7)years. The actuarial survival at 6 years was 30.3% (n=45) andthe median survival was 34 months. The factors that affectedsurvival were the number of metastases (P<.05), diameter ofthe lesions (P<.05), lymph node infiltration (P<.05), completeresection (P<.05), and, above all, histological type (P<.05).Tumorectomy was the most commonly performed operation.CONCLUSIONS: These results suggest that, in the absence ofother therapeutic options and contraindications, we shouldoperate on patients in whom the primary tumor is controlledand in whom complete resection can be performed. Even iffactors associated with poor prognosis are present, theoutcomes are always better than when surgery is notperformed, particularly in view of the relatively low morbidityand mortality associated with this type of surgery

[Resection of 8 mediastinal bronchogenic cysts by video-assisted thoracoscopy]. / Quiste broncogénico de mediastino. Resección videotoracoscópica en 8 casos.

Mediastinal bronchogenic cysts are an uncommon entity and surgical experience of their removal by video-assisted thoracoscopy is limited. We present our patient outcomes and surgical technique in the treatment of bronchogenic cysts by video-assisted thoracoscopy. The study included 8 patients (4 females and 4 males between the ages of 4 and 52 years), 7 of whom presented clinical symptoms. The mean widest diameter of the cyst was 7.6 cm. In 5 patients the cyst was in the middle mediastinum and in 3, the posterior mediastinum. The intervention was performed using 3 or 4 entry points. Initial puncture of the cyst and removal of its contents greatly facilitated cyst manipulation and subsequent dissection of the cyst sac from the structures to which it was attached. In all 8 cases resection by video-assisted thoracoscopy was carried out with no intraoperative complications. The mean postoperative hospital stay was 3.3 days. During follow-up, which ranged from 4 months to 10 years, no patients presented late-onset or recurrent complications.

Quiste broncogénico de mediastino. Resección videotoracoscópica en 8 casos / Resection of 8 mediastinal bronchogenic cysts by video-assisted thoracoscopy

El quiste broncogénico de mediastino es una entidad poco frecuente y la experiencia quirúrgica de su extirpación por videotoracoscopia es limitada. Presentamos nuestros resultados y técnica quirúrgica en el tratamiento de los quistes broncogénicos por videotoracoscopia. El estudio incluye a 8 pacientes (4 mujeres y 4 varones, con un rango de edad comprendido entre los 4 y los 52 los años), de los que 7 presentaban síntomas clínicos. El tamaño medio del quiste en su diámetro mayor era de 7,6 cm. En 5 pacientes se localizaba en el mediastino medio y en 3 en el posterior. La intervención se realiza a través de 3-4 puertas de entrada, y la apertura y el vaciamiento del contenido del quiste desde el inicio constituye una maniobra que facilita enormemente la manipulación y posterior disección del saco quístico de las estructuras a las que se encuentra adherido. En los 8 casos se realizó la resección por videotoracoscopia sin complicaciones intraoperatorias. La estancia media postoperatoria fue de 3,3 días. Los pacientes no han presentado complicaciones tardías ni recidivas durante el seguimiento, que oscila entre los 4 meses y los 10 años

Mediastinal bronchogenic cysts are an uncommon entity and surgical experience of their removal by video-assisted thoracoscopy is limited. We present our patient outcomes and surgical technique in the treatment of bronchogenic cysts by video-assisted thoracoscopy. The study included 8 patients (4 females and 4 males between the ages of 4 and 52 years), 7 of whom presented clinical symptoms. The mean widest diameter of the cyst was 7.6 cm. In 5 patients the cyst was in the middle mediastinum and in 3, the posterior mediastinum. The intervention was performed using 3 or 4 entry points. Initial puncture of the cyst and removal of its contents greatly facilitated cyst manipulation and subsequent dissection of the cyst sac from the structures to which it was attached. In all 8 cases resection by video-assisted thoracoscopy was carried out with no intraoperative complications. The mean postoperative hospital stay was 3.3 days. During follow-up, which ranged from 4 months to 10 years, no patients presented late-onset or recurrent complications