ABSTRACT
BACKGROUND: The Spanish Customized Adjuvant Therapy (SCAT) trial assessed the role of individualized adjuvant therapy in clinical N0 incidental pN1 and/or N2 non-small cell lung cancer (NSCLC) completely resected. We assessed surgical topics with an in-depth analysis of quality of lymphadenectomy based on International Association for the Study of Lung Cancer (IASLC) recommendations. METHODS: Patients with information about lymphadenectomy available were included (N=451). Prospectively collected data about tumor, type of resection, and postoperative morbidity and quality of lymph node dissection (LND) were retrospectively evaluated. Role of lymph node assessment on survival was analyzed using Kaplan-Meier curves, using regression models to identify prognostic factors. RESULTS: In 33.7%, 17.7% and 49.9% of cases, regions 7, 10 and 11 respectively were not assessed. In 21.1% of patients, less than three lymph node regions were biopsied, while in 19.6% of patients less than six lymph nodes were assessed. In 53,4% of patients only one N1 region was evaluated. From patients with positive N2, 8.9% had no N1 regions biopsied. Twenty-nine percent of patients with at least one N2 lymph node resected shown the highest region involved. Thirty-day postoperative mortality was unknown. Five-year overall survival (OS) was 61.7% (95% CI: 55.4-67.4%), 51.5% (95% CI: 39.2-62.4%) and 42.3% (95% CI: 32.1-52.2%) for patients with N1, N2 and N1+N2 disease, respectively (P<0.01). Both number of lymph nodes resected and number of lymph nodes involved by tumor were significantly related to prognosis. CONCLUSIONS: IASLC recommendations for surgical resections were not followed in a high proportion of surgical procedures. Hilar and mediastinal lymph node assessment and involvement showed to impact prognosis. Surgical issues such as postoperative mortality could not be evaluated owing to trial design.
ABSTRACT
Intrathoracic goitre is defined as that goitre which is partially or totally found in the anterior or posterior mediastinum, and its incidence is associated with multinodular goitre. The diagnosis is relatively easy, mainly with imaging tests, and treatment varies, but of choice, surgical treatment is recommended. This article attempts to present a review of the literature on the diagnosis and management of this disease.
Subject(s)
Goiter, Substernal , Goiter, Substernal/diagnosis , Goiter, Substernal/therapy , HumansSubject(s)
Mucormycosis/diagnosis , Tracheal Diseases/diagnosis , Adult , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Bronchoscopy , Combined Modality Therapy , Diabetes Mellitus, Type 1/complications , Drainage , Female , Humans , Intraoperative Complications/etiology , Intraoperative Complications/surgery , Mucormycosis/drug therapy , Mucormycosis/surgery , Pneumonia/diagnosis , Pneumonia/drug therapy , Pneumothorax/etiology , Pneumothorax/surgery , Tracheal Diseases/drug therapy , Tracheal Diseases/surgeryABSTRACT
Surgical resection of pulmonary metastasis is appropriate provided the general principals of oncological surgery are followed. Complete excision of the metastatic tumor is associated with long-term survival and low perioperative mortality. We present 2 cases of single pulmonary metastasis from osteosarcoma with cardiac involvement. In both cases, complete excision required left pneumonectomy by sternotomy with extracorporeal circulation. The outcomes were favorable, no perioperative complications were reported, and the patients remained free of disease at 14 and 17 months after surgery. In conclusion, we believe that the cases presented confirm that extended pneumonectomy with extracorporeal circulation if necessary is a valid approach for complete resection of pulmonary metastasis.
