Estudio comparativo de la supervivencia tras procedimientos videotoracoscópicos para la lobectomía del cáncer de pulmón: abordaje por puerto único frente a múltiple / Comparative study of survival following videothoracoscopic lobectomy procedures for lung cancer: single-versus multiple-port approaches

Introducción: La cirugía toracoscópica videoasistida se ha convertido en la técnica de elección para las intervenciones de cáncer de pulmón en estadio inicial en muchos centros, a pesar de que no se ha probado que la supervivencia a largo plazo sea la misma con todos los abordajes quirúrgicos. Método: Efectuamos una revisión retrospectiva de 276 lobectomías practicadas en nuestro servicio mediante cirugía videoasistida, y analizamos la edad, sexo, comorbilidades, tabaquismo, FEV1 y FCV, abordaje quirúrgico, estadios TNM y patológico, tipo histológico, quimioterapia neoadyuvante o coadyuvante y tiempo hasta la recidiva o la detección de metástasis con el objetivo de evaluar la tasa de supervivencia y la duración del periodo sin enfermedad en relación con el abordaje quirúrgico, dos/tres puertos o puerto único, de los pacientes. Resultados: Las tasas de supervivencia global al cabo de uno y cuatro años fueron del 88,1 y 67,6%, respectivamente. En el análisis bivariante se observó que las variables que se asociaban con la supervivencia eran las comorbilidades, el tipo histológico, el estadio, el abordaje quirúrgico y la necesidad de quimioterapia. Al analizar el abordaje quirúrgico de forma independiente, se observó que la tasa de supervivencia era inferior en el grupo en el que se utilizó la técnica monoportal frente al grupo en el que se utilizaron dos o tres puertos (VATS). Al estratificar a los pacientes según el estadio tumoral (estadio I) y el tamaño del tumor (T2), la supervivencia fue significativamente inferior en los pacientes tratados con el abordaje monoportal, en comparación con la VATS. En el análisis multivariante, el riesgo de muerte fue mayor con la técnica monoportal (HR = 1,78). En el análisis del tiempo transcurrido sin enfermedad se observó una tendencia hacia una mayor supervivencia favorable a la VATS con dos/tres puertos, tanto para la recidiva local (p = 0,093) como para el desarrollo de metástasis (p = 0,091). Conclusiones: Estos resultados cuestionan el uso de la técnica uniportal en las neoplasias malignas de pulmón, lo que sugiere la necesidad de efectuar ensayos clínicos que permitan identificar el papel de esta técnica en la cirugía del cáncer de pulmón

Introduction: Video-assisted thoracoscopic surgery has become the technique of choice in the early stages of lung cancer in many centers although there is no evidence that all of the surgical approaches achieve the same long-term survival. Method: We carried out a retrospective review of 276 VATS lobectomies performed in our department, analyzing age, sex, comorbidities, current smoker, FEV1 and FCV, surgical approach, TNM and pathological stage, histologic type, neoadjuvant or coadjuvant chemotherapy, relapse and metastasis time, with the main aim of evaluating the survival rate and disease-free time, especially with regard to the two/three versus single port approach. Result: The one/four year global survival rate was 88.1 and 67.6% respectively. Bivariate analysis found that the variables associated with survival are comorbidity, histological type, stage, surgical approach and need for chemotherapy. When we independently analyzed the surgical approach, we found a lower survival rate in the single-port group vs. the two/three-port group (VATS). Stratifying by tumoral stage (stage I) and by tumor size (T2) survival was significantly lower for patients with single-port group in comparison to VATS approach. In the multivariate analysis, single-port group is associated with a higher risk of death (HR = 1.78). In analyzing disease-free survival, differences were found in both cases in favor of two/three port VATS: p = .093 for local relapses and p = .091 for the development of metastasis. Conclusions: These results challenge the use of the single port technique in malignant lung pathologies, suggesting the need for clinical trials in order to identify the role this technique may have in lung cancer surgery

Comparative Study of Survival following Videothoracoscopic Lobectomy Procedures for Lung Cancer: Single- versus Multiple-port Approaches. / Estudio comparativo de la supervivencia tras procedimientos videotoracoscópicos para la lobectomía del cáncer de pulmón: abordaje por puerto único frente a múltiple.

INTRODUCTION: Video-assisted thoracoscopic surgery has become the technique of choice in the early stages of lung cancer in many centers although there is no evidence that all of the surgical approaches achieve the same long-term survival. METHOD: We carried out a retrospective review of 276 VATS lobectomies performed in our department, analyzing age, sex, comorbidities, current smoker, FEV1 and FCV, surgical approach, TNM and pathological stage, histologic type, neoadjuvant or coadjuvant chemotherapy, relapse and metastasis time, with the main aim of evaluating the survival rate and disease-free time, especially with regard to the two/three versus single port approach. RESULT: The one/four year global survival rate was 88.1 and 67.6% respectively. Bivariate analysis found that the variables associated with survival are comorbidity, histological type, stage, surgical approach and need for chemotherapy. When we independently analyzed the surgical approach, we found a lower survival rate in the single-port group vs. the two/three-port group (VATS). Stratifying by tumoral stage (stage I) and by tumor size (T2) survival was significantly lower for patients with single-port group in comparison to VATS approach. In the multivariate analysis, single-port group is associated with a higher risk of death (HR=1.78). In analyzing disease-free survival, differences were found in both cases in favor of two/three port VATS: p=.093 for local relapses and p=.091 for the development of metastasis. CONCLUSIONS: These results challenge the use of the single port technique in malignant lung pathologies, suggesting the need for clinical trials in order to identify the role this technique may have in lung cancer surgery.

Single-lung transplantation in emphysema: Retrospective study analyzing survival and waiting list mortality.

AIM: To performed remains a subject of debate and is the principal aim of the study. METHODS: This retrospective analysis included 73 patients with emphysema (2000-2012). The outcomes of patients undergoing single-lung transplantation (SL) (n = 40) or double-lung transplant (DL) (n = 33) were compared in a Cox multivariate analysis to study the impact of the technique, postoperative complications and acute and chronic rejection on survival rates. Patients were selected for inclusion in the waiting list according to the International Society of Heart Lung Transplantation criteria. Pre and postoperative rehabilitation and prophylaxis, surgical technique and immunosuppressive treatment were similar in every patients. Lung transplantation waiting list information on a national level and retrospective data on emphysema patient survival transplanted in Spain during the study period, was obtained from the lung transplantation registry managed by the National Transplant Organization (ONT). RESULTS: Both groups were comparable in terms of gender and clinical characteristics. We found significant differences in the mean age between the groups, the DL patients being younger as expected from the inclusion criteria. Perioperative complications occurred in 27.6% SL vs 54% DL (P = 0.032). Excluding perioperative mortality, median survival was 65.3 mo for SL and 59.4 mo for DL (P = 0.96). Bronchiolitis obliterans and overall 5-year survival were similar in both groups. Bacterial respiratory infection, cytomegalovirus and fungal infection rates were higher but not significant in SL. No differences were found between type of transplant and survival (P = 0.48). To support our results, national data on all patients with emphysema in waiting list were obtained (n = 1001). Mortality on the waiting list was 2.4% for SL vs 6.2% for DL. There was no difference in 5 year survival between 235 SL and 430 DL patients transplanted (P = 0.875). CONCLUSION: Our results suggest that SL transplantation in emphysema produce similar survival than DL with less postoperative complication and significant lower mortality in waiting list.

Éxito a largo plazo de un trasplante combinado de pulmón-riñón en un paciente con fibrosis quística / Long-term Success of Combined Kidney–Lung Transplantation in a Patient With Cystic Fibrosis

La enfermedad renal avanzada suele considerarse una contraindicación absoluta para el trasplante de pulmón, debido a la dificultad de manejo del paciente en el periodo postoperatorio, pero un trasplante combinado de pulmón-riñón podría ofrecer una oportunidad a algunos pacientes seleccionados con disfunción pulmonar y renal. En este trabajo se resume el éxito a largo plazo de un doble trasplante en un paciente varón de 38 años con fibrosis quística que presentaba también insuficiencia respiratoria. Tras un periodo postoperatorio complicado, el paciente vive en la actualidad de manera completamente independiente 46 meses después de la operación y disfruta de una excelente función pulmonar y renal (AU)

Advanced kidney disease is usually considered an absolute contraindication for lung transplantation due to the difficult management of these patients in the post-operative period. Combined lung–kidney transplantation, however, could offer an opportunity for selected patients with renal and pulmonary dysfunction. This study summarizes the long-term success of a double transplantation in a 38-year-old male patient with cystic fibrosis who presented respiratory and kidney failure. After a complicated post-operative period, the patient currently lives completely independently 46 months after the operation and he enjoys excellent pulmonary and renal function (AU)

Long-term success of combined kidney-lung transplantation in a patient with cystic fibrosis.

Advanced kidney disease is usually considered an absolute contraindication for lung transplantation due to the difficult management of these patients in the post-operative period. Combined lung-kidney transplantation, however, could offer an opportunity for selected patients with renal and pulmonary dysfunction. This study summarizes the long-term success of a double transplantation in a 38-year-old male patient with cystic fibrosis who presented respiratory and kidney failure. After a complicated post-operative period, the patient currently lives completely independently 46 months after the operation and he enjoys excellent pulmonary and renal function.

Satisfaction and adherence with immunosuppressant treatment in renal transplant patients living with a working graft.

BACKGROUND: The aim of this study was to analyze patient satisfaction and adherence in a sample of renal transplant patients living with a working allograft. METHODS: An epidemiological cross-sectional multicenter study was carried out with renal recipients who had received a transplant 6-24 months before and were undergoing immunosuppressant therapy (IT). Sociodemographic and clinical variables registered were dosage, allograft functioning, number of medications, health-related quality of life (HRQoL by SF-6D), patients' satisfaction (SAT-Q) and adherence to medication (abnormal levels of immunosuppressant in blood tests [ALIBT] and clinical impression). Relationships between those parameters were contrasted (chi-square test, Spearman correlation coefficient and Mann-Whitney U-test). Multivariate regression models (linear and logistic) were computed to analyze the factors related to patients' satisfaction and adherence to medication, respectively. RESULTS: Data from 206 patients were collected (61.2% males with a mean age of 53.35 years). Nonadherence rates (29.1% and 31.1%) were found according to clinical impression and ALIBT, respectively (chi-square = 31.810, p<0.001). Overall, global patients' satisfaction (74.000 ± 1.251) and HRQoL (0.765 ± 0.011) levels were high. Low-moderate significant associations between satisfaction and adherence to IT and HRQoL were found (p<0.01). Finally, age, vitality, allograft functioning and dosage were correlated with patient satisfaction (R2=0.174; F(1,185)=4.134; p<0.043). Number of medications (odds ratio [OR] = 0.890; 95% confidence interval [95% CI], 0.812-0.975; p=0.012), convenience domain (OR=1.037; 95% CI, 1.005-1.070; p=0.021) and clinical criteria (OR=6.135; 95% CI, 2.945-12.782; p<0.001) were associated with adherence. CONCLUSIONS: In renal transplant patients, satisfaction with IT is related to the levels of HRQoL and compliance.

Normativa para la selección de pacientes candidatos a trasplante pulmonar / Guidelines for the Selection of Lung Transplantation Candidates

La presente normativa ha sido elaborada con el consenso de, al menos, un representante de cada uno delos hospitales con programa de trasplante pulmonar en España. Además, previamente a su publicación,ha sido revisada por un grupo de revisores destacados por su reconocida trayectoria en el campo del trasplantepulmonar. En las siguientes páginas, el lector encontrará los criterios de selección de pacientescandidatos a trasplante pulmonar, cuándo y cómo remitir un paciente a un centro trasplantador y, finalmente,cuándo incluir al paciente en lista de espera. Se ha atribuido un nivel de evidencia a las cuestionesmás relevantes. Este documento pretende ser una guía práctica para los neumólogos que no participandirectamente en el trasplante pulmonar pero que deben considerar este tratamiento para sus pacientes.Finalmente, se ha propuesto de una forma consensuada un documento que recoge de forma estructuradalos datos del paciente potencial candidato a trasplante pulmonar que son relevantes para poder tomar lamejor decisión(AU)

The present guidelines have been prepared with the consensus of at least one representative of eachof the hospitals with lung transplantation programs in Spain. In addition, prior to their publication,these guidelines have been reviewed by a group of prominent reviewers who are recognized for theirprofessional experience in the field of lung transplantation. Within the following pages, the reader willfind the selection criteria for lung transplantation candidates, when and how to remit a patient to atransplantation center and, lastly, when to add the patient to the waiting list. A level of evidence hasbeen identified for the most relevant questions. Our intention is for this document to be a practical guide for pulmonologists who do not directly participate in lung transplantations but who should consider thistreatment for their patients. Finally, these guidelines also propose an information form in order to compilein an organized manner the patient data of the potential candidate for lung transplantation, which arerelevant in order to be able to make the best decisions possible(AU)

Guidelines for the selection of lung transplantation candidates.

The present guidelines have been prepared with the consensus of at least one representative of each of the hospitals with lung transplantation programs in Spain. In addition, prior to their publication, these guidelines have been reviewed by a group of prominent reviewers who are recognized for their professional experience in the field of lung transplantation. Within the following pages, the reader will find the selection criteria for lung transplantation candidates, when and how to remit a patient to a transplantation center and, lastly, when to add the patient to the waiting list. A level of evidence has been identified for the most relevant questions. Our intention is for this document to be a practical guide for pulmonologists who do not directly participate in lung transplantations but who should consider this treatment for their patients. Finally, these guidelines also propose an information form in order to compile in an organized manner the patient data of the potential candidate for lung transplantation, which are relevant in order to be able to make the best decisions possible.

[Video-assisted thoracic surgery, lung transplantation and mediastinitis: major issues in thoracic surgery in 2010]. / Cirugía torácica videoasistida, trasplante pulmonar y mediastinitis, temas destacados de cirugía torácica en 2010.

We reviewed the major issues in thoracic surgery relating to the advances made in our specialty in 2010. To do this, the 43(rd) Congress of the Spanish Society of Pneumology and Thoracic Surgery held in La Coruña and the articles published in the Society's journal, Archivos de Bronconeumología, were reviewed. The main areas of interest were related to the development of video-assisted thoracic surgery, lung transplantation and descending mediastinitis. The new tumor-node-metastasis (TNM) classification (7(th) edition), presented last year, was still a topical issue this year. The First Forum of Thoracic Surgeons and the Update in Thoracic Surgery together with the Nurses' Area have constituted an excellent teaching program.

Cirugía torácica videoasistida, trasplante pulmonar y mediastinitis, temas destacados de cirugía torácica en 2010 / Video-assisted thoracic surgery, lung transplantation and mediastinitis: major issues in thoracic surgery in 2010

Se han revisado los aspectos destacados de la cirugía torácica en relación con los avances producidos en nuestraespecialidad durante el año 2010, analizando el 43.º Congreso SEPAR realizado en A Coruña y los artículospublicados en nuestra revista, ARCHIVOS DE BRONCONEUMOLOGÍA. Las principales áreas de interés se han relacionadocon el desarrollo de la cirugía torácica videoasistida, el trasplante pulmonar y la mediastinitis descendente. Lanueva clasificación TNM (7.ª edición) presentada el pasado año se ha mantenido como actualidad durante elpresente año. Por otra parte, el primer Foro de Cirujanos Torácicos y el Curso sobre Actualización en CirugíaTorácica, junto al área de enfermería, han constituido un excelente programa docente(AU)

We reviewed the major issues in thoracic surgery relating to the advances made in our specialty in 2010. Todo this, the 43rd Congress of the Spanish Society of Pneumology and Thoracic Surgery held in La Coruña andthe articles published in the Society’s journal, ARCHIVOS DE BRONCONEUMOLOGÍA, were reviewed. The main areas ofinterest were related to the development of video-assisted thoracic surgery, lung transplantation anddescending mediastinitis. The new tumor-node-metastasis (TNM) classification (7th edition), presented lastyear, was still a topical issue this year. The First Forum of Thoracic Surgeons and the Update in ThoracicSurgery together with the Nurses’ Area have constituted an excellent teaching program(AU)

[Thoracic surgery 2009]. / Cirugía torácica 2009.

Started with tuberculosis and developed in parallel with smoking and cancer and under the protection of anaesthesia, thoracic surgery appeared in the 1980's as a specialty with a difficult long-term survival. However, with the development of lung transplant, tracheal surgery, the appearance of video-assisted thoracic surgery, along with the confirmation that despite the excellent progress of chemoradiotherapy, surgery continues to be the best option for curing lung cancer, means that it is currently a specialty of great growth and a wider scope in the future.

Cirugía torácica 2009 / Thoracic Surgery 2009

Nacida de la tisiología y desarrollada en paralelo con el tabaquismo y el cáncer de pulmón y al amparo deldesarrollo de la anestesia, la cirugía torácica parecía en la década de 1980 una especialidad con una supervivenciadifícil a largo plazo.Sin embargo, el desarrollo del trasplante pulmonar, de la cirugía traqueal, la aparición de la cirugía torácicavideoasistida, junto a la confi rmación de que, a pesar de la excelente progresión de la quimiorradioterapia,la cirugía sigue siendo la mejor opción de curación en el cáncer de pulmón, hace que en el momento actualsea una especialidad con gran desarrollo y una proyección de futuro elevada(AU)

Started with tuberculosis and developed in parallel with smoking and cancer and under the protection ofanaesthesia, thoracic surgery appeared in the 1980’s as a specialty with a diffi cult long-term survival.However, with the development of lung transplant, tracheal surgery, the appearance of video-assistedthoracic surgery, along with the confi rmation that despite the excellent progress of chemoradiotherapy,surgery continues to be the best option for curing lung cancer, means that it is currently a specialty of greatgrowth and a wider scope in the future(AU)