Multicentre retrospective analysis on pulmonary metastasectomy: an European perspective.

OBJECTIVES: To assess the current practice of pulmonary metastasectomy at 15 European Centres. Short- and long-term outcomes were analysed. METHODS: Retrospective analysis on patients ≥18 years who underwent curative-intent pulmonary metastasectomy (January 2010 to December 2018). Data were collected on a purpose-built database (REDCap). Exclusion criteria were: previous lung/extrapulmonary metastasectomy, pneumonectomy, non-curative intent and evidence of extrapulmonary recurrence at the time of lung surgery. RESULTS: A total of 1647 patients [mean age 59.5 (standard deviation; SD = 13.1) years; 56.8% males] were included. The most common primary tumour was colorectal adenocarcinoma. The mean disease-free interval was 3.4 (SD = 3.9) years. Relevant comorbidities were observed in 53.8% patients, with a higher prevalence of metabolic disorders (32.3%). Video-assisted thoracic surgery was the chosen approach in 54.9% cases. Wedge resections were the most common operation (67.1%). Lymph node dissection was carried out in 41.4% cases. The median number of resected lesions was 1 (interquartile range 25-75% = 1-2), ranging from 1 to 57. The mean size of the metastases was 18.2 (SD = 14.1) mm, with a mean negative resection margin of 8.9 (SD = 9.4) mm. A R0 resection of all lung metastases was achieved in 95.7% cases. Thirty-day postoperative morbidity was 14.5%, with the most frequent complication being respiratory failure (5.6%). Thirty-day mortality was 0.4%. Five-year overall survival and recurrence-free survival were 62.0% and 29.6%, respectively. CONCLUSIONS: Pulmonary metastasectomy is a low-risk procedure that provides satisfactory oncological outcomes and patient survival. Further research should aim at clarifying the many controversial aspects of its daily clinical practice.

The Impact of Liquid Biopsies Positive for EGFR Mutations on Overall Survival in Non-Small Cell Lung Cancer Patients.

In recent years, non-small cell lung cancer treatment has been revolutionized. EGFR tyrosine kinase inhibitors and our improved understanding of its alterations have driven new diagnostic strategies. Liquid biopsies have emerged as a useful tool in these contexts, showing potential utility in early diagnosis combined with low-dose CT scans, as well as potential in monitoring treatment response and predicting the development of patients. We studied the circulating tumor DNA (ctDNA) of 38 EGFR-mutated non-small cell lung cancer patients at diagnosis in different moments of their disease by liquid biopsy techniques. Our results show that mean overall survival was significantly lower when a liquid biopsy was positive for the detection of EGFR mutations compared with wild-type patients in their liquid biopsy in both univariate (29 ± 4 vs. 104 ± 19 months; p = 0.004) and multivariate analysis (p = 0.008). Taking this into consideration, liquid biopsies could be key to improving the control of this disease.

Predictive factors of pathological complete response after induction (ypT0N0M0) in non-small cell lung cancer and short-term outcomes: Results of the Spanish Group of Video-assisted Thoracic Surgery (GE-VATS).

INTRODUCTION: To analyze the predictors of pCR in NSCLC patients who underwent anatomical lung resection after induction therapy and to evaluate the postoperative results of these patients. METHODS: All patients prospectively registered in the database of the GE-VATS working group undergone anatomic lung resection by NSCLC after induction treatment and recruited between 12/20/2016 and 3/20/2018 were included in the study. The population was divided into two groups: patients who obtained a complete pathological response after induction (pCR) and patients who did not obtain a complete pathological response after induction (non-pCR). A multivariate analysis was performed using a binary logistic regression to determine the predictors of pCR and the postoperative results of patients were analyzed. RESULTS: Of the 241 patients analyzed, 36 patients (14.9%) achieved pCR. Predictive factors for pCR are male sex (OR: 2.814, 95% CI: 1.015-7.806), histology of squamous carcinoma (OR: 3.065, 95% CI: 1.233-7.619) or other than adenocarcinoma (OR: 5.788, 95% CI: 1.878-17.733) and induction therapy that includes radiation therapy (OR: 4.096, 95% CI: 1.785-9.401) and targeted therapies (OR: 7.625, 95% CI: 2.147-27.077). Prevalence of postoperative pulmonary complications was higher in patients treated with neoadjuvant chemo-radiotherapy (p = 0.032). CONCLUSIONS: Male sex, histology of squamous carcinoma or other than ADC, and induction therapy that includes radiotherapy or targeted therapy are positive predictors for obtaining pCR. Induction chemo-radiotherapy is associated with a higher risk of postoperative pulmonary complications.

Mortality predictors in complicated patients after anatomical lung resection / Variables predictivas de muerte en pacientes complicados tras resección pulmonar anatómica

Introduction: Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections.Method: Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model.Results: A total of 2.569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77–0.88).Conclusions: Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR. (AU)

Introducción: El fallo en el rescate (FTR) definido como la tasa de fallecimientos entre los pacientes que sufren una complicación postoperatoria, es considerado un indicador de la calidad de los cuidados quirúrgicos. El objetivo de este estudio es investigar los factores de riesgo asociados al FTR después de resecciones pulmonares anatómicas.Método: Se incluyeron en el estudio pacientes sometidos a resección pulmonar anatómica en nuestro centro entre 1994 y 2018. Las complicaciones postoperatorias se clasificaron en menores (grados I y II) y mayores (grados IIIa a V) según la clasificación estandarizada de morbilidad postoperatoria. Los casos que fallecieron tras una complicación mayor fueron considerados FTR. Se creó un modelo de regresión logística por pasos para identificar los factores predictores de FTR. Se consideraron variables independientes en el análisis multivariante la edad, índice de masa corporal, comorbilidad cardiaca, renal, cerebrovascular, VEF1ppo%, abordaje VATS, resección extendida, neumonectomía y reintervención. Se construyó una curva ROC no paramétrica para estimar la capacidad predictiva del modelo.Resultados: Se analizaron 2.569 pacientes. En total, 223 casos (8,9%) tuvieron complicaciones mayores y 49 (22%) no pudieron ser rescatados. Las variables asociadas con FTR fueron: edad (OR: 1,07), antecedente de ACV (OR: 3,53), neumonectomía (OR: 6,67) y reintervención (OR: 12,26). El área bajo la curva de la curva ROC fue 0,82 (IC 95%: 0,77–0,88).Conclusiones: 22% de los pacientes que presentan complicaciones mayores tras la resección pulmonar anatómica en esta serie no sobreviven al alta. La neumonectomía y la reintervención son los factores de riesgo más potentes para FTR. (AU)

Resecciones pulmonares anatómicas por vía robótica: análisis de la curva de aprendizaje / Robotic anatomical lung resections: Analysis of the learning curve

Introducción: La cirugía robótica se ha convertido en una vía de abordaje segura y efectiva para el tratamiento de la patología quirúrgica pulmonar. Sin embargo, la adopción de nuevas técnicas quirúrgicas requiere de la evaluación de la curva de aprendizaje. El objetivo de este estudio es analizar la curva de aprendizaje de las resecciones pulmonares anatómicas por vía robótica. Métodos: Análisis retrospectivo de todas las resecciones pulmonares anatómicas por vía robótica realizadas por un mismo cirujano entre junio de 2018 y marzo de 2020. La curva de aprendizaje se evaluó utilizando gráficas CUSUM para estimar los cambios en la tendencia del tiempo y los fallos quirúrgicos y la aparición de complicaciones cardiorrespiratorias postoperatorias a lo largo de la secuencia de casos. Resultados: El estudio incluyó un total de 73 casos. La mediana de duración de todas las intervenciones fue de 120min (rango intercuartílico: 90-150min), la prevalencia de fallo quirúrgico fue del 23,29%, mientras que 4/73 pacientes presentaron alguna complicación cardiorrespiratoria postoperatoria. Con base en el análisis CUSUM, la curva de aprendizaje fue dividida en 3 fases diferentes: fase i (desde la primera hasta la 14.a intervención), fase ii (entre la 15.a y la 30.a intervención) y fase iii (a partir de la 31.a intervención). Conclusiones: La curva de aprendizaje para las resecciones pulmonares anatómicas por vía robótica puede dividirse en 3 fases. La competencia técnica que asegura resultados perioperatorios satisfactorios se consiguió en la fase iii, a partir de la 31.a intervención. (AU)

Introduction: Robotic surgery has become a safe and effective approach for the treatment of pulmonary surgical pathology. However, the adoption of new surgical techniques requires the evaluation of the learning curve. The objective of this study is to analyze the learning curve of robotic anatomical lung resections. Methods: Retrospective analysis of all robotic anatomical lung resections performed by the same surgeon between June 2018 and March 2020. The learning curve was evaluated using CUSUM charts to estimate trend changes in surgical time, surgical failure and the occurrence of post-operative cardiorespiratory complications throughout the sequence of cases. Results: The study included a total of 73 cases. The median duration of all complications was 120min (interquartile range: 90-150min), the prevalence of surgical failure was 23.29%, while 4/73 patients had any postoperative cardiorespiratory complication. Based on the CUSUM analysis, the learning curve was divided into 3 different phases: phase i (from the first to the 14th intervention), phase ii (between the 15th and 30th intervention) and phase iii (from the 31st intervention). Conclusions: The learning curve for robotic anatomical lung resections can be divided into 3 phases. The technical competence that guarantees satisfactory perioperative outcomes was achived in phase iii from the 31st intervention. (AU)

Robotic anatomical lung resections: Analysis of the learning curve.

INTRODUCTION: Robotic surgery has become a safe and effective approach for the treatment of pulmonary surgical pathology. However, the adoption of new surgical techniques requires the evaluation of the learning curve. The objective of this study is to analyze the learning curve of robotic anatomical lung resections. METHODS: Retrospective analysis of all robotic anatomical lung resections performed by the same surgeon between June 2018 and March 2020. The learning curve was evaluated using CUSUM charts to estimate trend changes in surgical time, surgical failure and the occurrence of post-operative cardiorespiratory complications throughout the sequence of cases. RESULTS: The study included a total of 73 cases. The median duration of all complications was 120 min (interquartile range: 90-150 min), the prevalence of surgical failure was 23.29%, while 4/73 patients had any postoperative cardiorespiratory complication. Based on the CUSUM analysis, the learning curve was divided into 3 different phases: phase i (from the first to the 14th intervention), phase ii (between the 15th and 30th intervention) and phase iii (from the 31st intervention). CONCLUSIONS: The learning curve for robotic anatomical lung resections can be divided into 3 phases. The technical competence that guarantees satisfactory perioperative outcomes was achived in phase iii from the 31st intervention.

Hematoma espontáneo gigante de pared torácica en paciente anticoagulada por COVID-19 / Giant Spontaneous Hematoma of the Chest Wall in a Patient Receiving Anticoagulation for COVID-19

No disponible

El «efecto día de la semana» no tiene impacto en la aparición de complicaciones o mortalidad tras la resección pulmonar: estudio de cohortes histórico / The «Weekday Effect» Does Not Have an Impact on the Development of Complications or Mortality After Pulmonary Resection: Retrospective Cohort Study

Objetivo: Determinar si la cirugía de resección pulmonar anatómica electiva llevada a cabo al final de la semana se asocia con una mayor morbimortalidad postoperatoria que la cirugía realizada al inicio de la semana.Método: Estudio de cohortes histórico en el que se incluyeron todos los pacientes sometidos a resección pulmonar anatómica entre el 1 de enero de 2013 y 1 de noviembre de 2018 en nuestro centro. Se consideraron «expuestos» los pacientes intervenidos al final de la semana (jueves o viernes) y «no expuestos» los intervenidos al inicio de la semana (lunes, martes o miércoles). Se comparó la probabilidad de complicaciones cardiorrespiratorias y muerte operatoria (30días) en las dos cohortes calculada mediante los modelos de riesgo Eurolung1 y2. Como variables de resultado se estudiaron la mortalidad a 30días y la ocurrencia de complicaciones cardiorrespiratorias relacionadas con la técnica postoperatoria. Se calculó la incidencia de estos efectos adversos para la serie global y para ambas cohortes y se determinó el riesgo relativo (RR) y su intervalo de confianza al 95% (IC95%).Resultados: La mortalidad global de la serie fue del 0,9% (10/1.172), la incidencia de complicaciones cardiorrespiratorias fue del 10,2% (120/1.172) y la de complicaciones técnicas, del 20,6% (242/1.172). El RR calculado para las complicaciones cardiorrespiratorias, técnicas y mortalidad en expuestos y no expuestos fue: 0,914 (IC95%: 0,804-1,039), 0,996 (IC95%: 0,895-1,107) y 0,911 (IC95%: 0,606-1,37), respectivamente.Conclusiones: Los pacientes intervenidos al final de la semana no presentan un mayor riesgo de efectos adversos postoperatorios. (AU)

Objective: To determine whether elective anatomic pulmonary resection surgery carried out at the end of the week is associated with a higher mortality and postoperative morbidity than surgery performed at the beginning of the week. Method: Historical cohort study. All patients undergoing anatomical pulmonary resection between January 2013 and November 2018 in our center were included. Patients operated at the end of the week (Thursday or Friday) were considered «not exposed» and patients operated at the beginning of the week (Monday, Tuesday or Wednesday) were considered «exposed». The likelihood of cardiorespiratory complications and operative death (30days) was compared in the two cohorts calculated using the Eurolung1 and2 risk models. 30-day mortality and the occurrence of cardiorespiratory and technical complications were studied as outcome variables. The incidence of these adverse effects was calculated for the overall series and for both cohorts, and the relative risk (RR) and its 95% confidence interval (95%CI) were determined. Results: The overall mortality of the series was 0.9% (10/1172), the incidence of cardiorespiratory complications was 10.2% (120/1172) and that of technical complications was 20.6% (242/1172). The RR calculated for cardiorespiratory, technical complications and mortality in exposed and unexposed subjects was: 0.914 (95%CI: 0.804-1.039), 0.996 (95%CI: 0.895-1.107) and 0.911 (95%CI: 0.606-1.37), respectively. Conclusions: Patients operated at the end of the week do not present a higher risk of postoperative adverse effects. (AU)

Predictive factors of pathological complete response after induction (ypT0N0M0) in non-small cell lung cancer and short-term outcomes: results of the Spanish Group of Video-assisted Thoracic Surgery (GE-VATS). / Factores predictores de respuesta completa patológica tras inducción (ypT0N0M0) en cáncer de pulmón no microcítico y resultados a corto plazo: resultados del Grupo Español de Cirugía Torácica Videoasistida (GE-VATS).

INTRODUCTION: To analyze the predictors of pathological complete response (pCR) in not small cells lung carcinoma (NSCLC) patients who underwent anatomical lung resection after induction therapy and to evaluate the postoperative results of these patients. METHODS: All patients prospectively registered in the database of the GE-VATS working group undergone anatomic lung resection by NSCLC after induction treatment and recruited between December 20th 2016, and March 20th 2018, were included in the study. The population was divided into two groups: patients who obtained a complete pathological response after induction (pCR) and patients who did not obtain a complete pathological response after induction (non-pCR). A multivariate analysis was performed using a binary logistic regression to determine the predictors of pCR and the postoperative results of patients were analyzed. RESULTS: Of the 241 patients analyzed, 36 patients (14.9%) achieved pCR. Predictive factors for pCR are male sex (OR 2.814, 95% CI 1.015-7.806), histology of squamous carcinoma (OR 3.065, 95% CI 1.233-7.619) or other than adenocarcinoma (ADC) (OR 5.788, 95% CI 1.878-17.733) and induction therapy that includes radiation therapy (OR 4.096, 95% CI 1.785-9.401) and targeted therapies (OR 7.625, 95% CI 2.147-27.077). Prevalence of postoperative pulmonary complications was higher in patients treated with neoadjuvant chemo-radiotherapy (p = 0.032). CONCLUSIONS: Male sex, histology of squamous carcinoma or other than ADC, and induction therapy that includes radiotherapy or targeted therapy are positive predictors for obtaining pCR. Induction chemo-radiotherapy is associated with a higher risk of postoperative pulmonary complications.

The «Weekday Effect¼ Does Not Have an Impact on the Development of Complications or Mortality After Pulmonary Resection: Retrospective Cohort Study. / El «efecto día de la semana¼ no tiene impacto en la aparición de complicaciones o mortalidad tras la resección pulmonar: estudio de cohortes histórico.

OBJECTIVE: To determine whether elective anatomic pulmonary resection surgery carried out at the end of the week is associated with a higher mortality and postoperative morbidity than surgery performed at the beginning of the week. METHOD: Historical cohort study. All patients undergoing anatomical pulmonary resection between January 2013 and November 2018 in our center were included. Patients operated at the end of the week (Thursday or Friday) were considered «not exposed¼ and patients operated at the beginning of the week (Monday, Tuesday or Wednesday) were considered «exposed¼. The likelihood of cardiorespiratory complications and operative death (30days) was compared in the two cohorts calculated using the Eurolung1 and2 risk models. 30-day mortality and the occurrence of cardiorespiratory and technical complications were studied as outcome variables. The incidence of these adverse effects was calculated for the overall series and for both cohorts, and the relative risk (RR) and its 95% confidence interval (95%CI) were determined. RESULTS: The overall mortality of the series was 0.9% (10/1172), the incidence of cardiorespiratory complications was 10.2% (120/1172) and that of technical complications was 20.6% (242/1172). The RR calculated for cardiorespiratory, technical complications and mortality in exposed and unexposed subjects was: 0.914 (95%CI: 0.804-1.039), 0.996 (95%CI: 0.895-1.107) and 0.911 (95%CI: 0.606-1.37), respectively. CONCLUSIONS: Patients operated at the end of the week do not present a higher risk of postoperative adverse effects.

Mortality predictors in complicated patients after anatomical lung resection.

INTRODUCTION: Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections. METHOD: Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model. RESULTS: A total of 2.569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77-0.88). CONCLUSIONS: Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.

Executive Summary of the Consensus Statement of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP), on the Management of Cystic Echinococcosis / Resumen ejecutivo de la Declaración de consenso de la Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI), la Asociación Española de Cirujanos (AEC), la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la Sociedad Española de Cirugía Torácica (SECT), la Sociedad Española de Radiología Vascular e Intervencionista (SERVEI) y la Sociedad Española de Infectología Pediátrica (SEIP) sobre el tratamiento de la equinococosis quística

The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Tropical Medicine and International Health (SEMTSI), the Spanish Association of Surgeons (AEC), the Spanish Society of Pneumology and Thoracic Surgery (SEPAR), the Spanish Society of Thoracic Surgery (SECT), the Spanish Society of Vascular and Interventional Radiology (SERVEI), and the Spanish Society of Paediatric Infectious Diseases (SEIP) considered it pertinent to issue a consensus statement on the management of cystic echinococcosis (CE) to guide healthcare professionals in the care of patients with CE. Specialists from several fields (clinicians, surgeons, radiologists, microbiologists, and parasitologists) identified the most clinically relevant questions and developed this Consensus Statement, evaluating the available evidence-based data to propose a series of recommendations on the management of this disease. This Consensus Statement is accompanied by the corresponding references on which these recommendations are based. Prior to publication, the manuscript was open for comments and suggestions from the members of the SEIMC and the scientific committees and boards of the various societies involved

La Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica (SEIMC), la Sociedad Española de Medicina Tropical y Salud Internacional (SEMTSI), la Asociación Española de Cirujanos (AEC), la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), la Sociedad Española de Cirugía Torácica (SECT), la Sociedad Española de Radiología Vascular e Intervencionista (SERVEI) y la Sociedad Española de Infectología Pediátrica (SEIP) han considerado pertinente la elaboración de una declaración de consenso sobre el tratamiento de la equinococosis quística (EQ) que sirva de ayuda al personal sanitario en la atención de pacientes con EQ. Varios tipos de profesionales (médicos, cirujanos, radiólogos, microbiólogos y parasitólogos) han seleccionado las preguntas más clínicamente relevantes y han desarrollado esta Declaración de consenso, en la que evalúan los datos basados en la evidencia disponibles para proponer una serie de recomendaciones sobre el tratamiento de esta enfermedad. Esta Declaración de consenso se acompaña de la bibliografía correspondiente que fundamenta estas recomendaciones. Antes de su publicación, el manuscrito estuvo abierto a comentarios y sugerencias de los miembros de la SEIMC y de los comités científicos y juntas directivas de las diferentes sociedades implicadas

Mortality Predictors In Complicated Patients After Anatomical Lung Resection. / Variables predictivas de muerte en pacientes complicados tras resección pulmonar anatómica.

INTRODUCTION: Failure to rescue (FTR), defined as the mortality rate among patients suffering from postoperative complications, is considered an indicator of the quality of surgical care. The aim of this study was to investigate the risk factors associated with FTR after anatomical lung resections. METHOD: Patients undergoing anatomical lung resection at our center between 1994 and 2018 were included in the study. Postoperative complications were classified as minor (grade I and II) and major (grade IIIA to V), according to the standardized classification of postoperative morbidity. Patients who died after a major complication were considered FTR. A stepwise logistic regression model was created to identify FTR predictors. Independent variables included in the multivariate analysis were age, body mass index, cardiac, renal, and cerebrovascular comorbidity, ppoFEV1%, VATS approach, extended resection, pneumonectomy, and reintervention. A non-parametric ROC curve was constructed to estimate the predictive capacity of the model. RESULTS: A total of 2,569 patients were included, of which 223 (8.9%) had major complications and 49 (22%) could not be rescued. Variables associated with FTR were: age (OR: 1.07), history of cerebrovascular accident (OR: 3.53), pneumonectomy (OR: 6.67), and reintervention (OR: 12.26). The area under the ROC curve was 0.82 (95% CI: 0.77-0.88). CONCLUSIONS: Overall, 22% of patients with major complications following anatomical lung resection in this series did not survive until discharge. Pneumonectomy and reintervention are the most significant risk factors for FTR.

Modificación del riesgo de mortalidad y morbilidad tras resección pulmonar en los últimos 20 años / Changes in the Risk of Mortality and Morbidity After Lung Resection in the Last 20 Years

Introducción: El objetivo del estudio es evaluar las modificaciones del riesgo de mortalidad y morbilidad cardiorrespiratoria calculada mediante los modelos de riesgo Eurolung 1 y 2 en los últimos 20 años para identificar variaciones en la selección de los pacientes o en la práctica quirúrgica que hayan conducido a cambios en el riesgo de muerte y complicaciones tras resecciones anatómicas pulmonares. Método: Análisis retrospectivo de una serie de 2435 casos consecutivos sometidos a resección pulmonar anatómica. La población fue dividida en tres períodos de tiempo: 1994-2006 (976 casos), 2007-2015 (945 casos) y 2016-2017 (420 casos). Se aplicaron los modelos Eurolung 1 y 2 a la serie y se calculó la probabilidad individual de efectos adversos. Se comparó dicha probabilidad media, así como la prevalencia o las medias de cada una de las variables que constituyen los modelos en cada período y se representó gráficamente la evolución del riesgo. Resultados: Se observó un descenso progresivo de ambos efectos adversos a lo largo del tiempo. La prevalencia de las variables binarias, excepto enfermedad coronaria, fue mayor en el último período. El porcentaje de neumonectomías y de resecciones ampliadas descendió en los dos últimos períodos y el número de casos abordados por VATS se incrementó considerablemente en 2016-2017. Conclusiones: El descenso del número de neumonectomías y el incremento de la tasa de procedimientos mínimamente invasivos se consideran las variables más relacionadas con la disminución del riesgo. Otros cambios en las características clínicas de los pacientes no parecen haber influido en los resultados

Introduction: The aim of this study is to evaluate changes in the risk of cardiorespiratory mortality and morbidity calculated by Eurolung risk models 1 and 2 in the last 20 years, and to identify variations in patient selection or surgical practice that might have altered the risk of death and complications after anatomical lung resections. Method: This was a retrospective analysis of a series of 2,435 consecutive patients who underwent anatomical lung resection. The population was divided into three time periods: 1994-2006 (976 cases), 2007-2015 (945 cases), and 2016-2017 (420 cases). Eurolung models 1 and 2 were applied to the series, and the individual probability of adverse effects was calculated. We compared this mean probability, and the prevalence or means of each of the variables included in the models in each period and plotted the evolution of the risk. Results: A progressive decrease was observed in both adverse effects over time. The prevalence of the binary variables, except for coronary heart disease, was higher in the last period. The percentage of pneumonectomies and extended resections fell in the last two periods and the number of cases treated with VATS increased substantially in 2016-2017. Conclusions: The decline in the number of pneumonectomies and the increase in the rate of minimally invasive procedures appear to be the variables most closely associated with decreased risk. Other changes in the clinical characteristics of the patients do not seem to have influenced the outcomes

Changes in the Risk of Mortality and Morbidity After Lung Resection in the Last 20 Years. / Modificación del riesgo de mortalidad y morbilidad tras resección pulmonar en los últimos 20 años.

INTRODUCTION: The aim of this study is to evaluate changes in the risk of cardiorespiratory mortality and morbidity calculated by Eurolung risk models 1 and 2 in the last 20 years, and to identify variations in patient selection or surgical practice that might have altered the risk of death and complications after anatomical lung resections. METHOD: This was a retrospective analysis of a series of 2,435 consecutive patients who underwent anatomical lung resection. The population was divided into three time periods: 1994-2006 (976 cases), 2007-2015 (945 cases), and 2016-2017 (420 cases). Eurolung models 1 and 2 were applied to the series, and the individual probability of adverse effects was calculated. We compared this mean probability, and the prevalence or means of each of the variables included in the models in each period and plotted the evolution of the risk. RESULTS: A progressive decrease was observed in both adverse effects over time. The prevalence of the binary variables, except for coronary heart disease, was higher in the last period. The percentage of pneumonectomies and extended resections fell in the last two periods and the number of cases treated with VATS increased substantially in 2016-2017. CONCLUSIONS: The decline in the number of pneumonectomies and the increase in the rate of minimally invasive procedures appear to be the variables most closely associated with decreased risk. Other changes in the clinical characteristics of the patients do not seem to have influenced the outcomes.