Protocolo ERATS en cirugía pulmonar / ERATS Protocol in Pulmonary Surgery

Introducción: Los cuidados perioperatorios estandarizados ayudan a asegurar que todos los pacientes reciban un tratamiento óptimo. Objetivo: Aplicar un método de cuidados perioperatorios multimodales sistemáticos, en pacientes sometidos a cirugía pulmonar mayor. Métodos: Se realizó una revisión narrativa de la literatura relevante, publicada sobre el tema en las bases de datos MEDLINE, Cochrane, además de Medigraph, en idiomas inglés, español y francés. Se hizo énfasis en los artículos de los últimos 5 años, sobre todo estudios aleatorizados, bases de datos institucionales y nacionales, revisiones sistemáticas, metanálisis y programas y protocolos ERAS/ERATS, además de artículos de revisión. Desarrollo: Los estudios obtenidos fueron evaluados por los autores por separado y, más tarde, en conjunto para definir cuáles se ajustaban a los objetivos. El protocolo se dividió en 5 fases: preoperatoria, ingreso hospitalario, preoperatoria inmediata, intraoperatoria, posoperatoria. Para cada una de ellas se definieron las acciones a realizar, según la evidencia disponible. Conclusiones: La implantación del protocolo permitirá pasar de una fase empírica a una investigativa, de manera que se podrán obtener resultados superiores en el tratamiento quirúrgico de los pacientes enrolados en las investigaciones que se realicen(AU)

Introduction: Standardized perioperative care helps ensure that all patients receive optimal treatment. Objective: To apply a method of systematic multimodal perioperative care in patients undergoing major pulmonary surgery. Methods: A narrative review was performed of the relevant literature published on the subject in MEDLINE, Cochrane, and Medigraph databases in English, Spanish, and French. Emphasis was made on articles from the last 5 years, especially randomized studies, institutional and national databases, systematic reviews, meta-analyses, and ERAS/ERATS programs and protocols, as well as review articles. Discussion: The studies retrieved were evaluated by the authors separately and, later, together to define which ones met the objectives. The protocol was divided into 5 phases: preoperative, hospital admission, immediate preoperative, intraoperative, and postoperative. For each of them, the actions to be carried out were defined, according to the available evidence. Conclusions: The implementation of the protocol will allow to go from an empirical phase to an investigative one, so that better results can be obtained in the surgical treatment of patients enrolled in the investigations(AU)

Simultaneous Thoracoscopic Approach in a Patient with Long-Standing Persistent Atrial Fibrillation and Primary Lung Cancer: the First Described Case.

Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.

Simultaneous thoracoscopic approach in a patient with long-standing persistent atrial fibrillation and primary lung cancer: the first described case

Abstract Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.

Role of gender in the survival of surgical patients with nonsmall cell lung cancer.

PURPOSE: There are reports of greater survival rates in nonsmall cell lung cancer (NSCLC) patients of female gender. The objective of this study was to evaluate the role of gender in survival of NSCLC patients treated surgically with curative intent (stage I/II). METHODS: In a retrospective cohort design, we screened 498 NSCLC patients submitted to thoracotomies at the hospital Sγo Lucas, in Porto Alegre, Brazil from 1990 to 2009. After exclusion of patients that did not fit to all the inclusion criteria, we analyzed survival rates of 385 subjects. Survival was analyzed using the Kaplan-Meier method. The Cox regression model was used to evaluate potential confounding factors. RESULTS: Survival rates at 5 and 10 years were 65.3% and 49.5% for women and 46.5% and 33.2% for men, respectively (P = 0.006). Considering only stage I patients, the survival rates at 5 and 10 years were 76.2% and 55.1% for women and 50.7% and 35.4% for men, respectively (P = 0.011). No significant differences in survival rates were found among stage II patients. CONCLUSIONS: Our results show female gender as a possible protective factor for better survival of stage I NSCLC patients, but not among stage II patients. This study adds data to the knowledge that combined both genders survival rates for NSCLC is not an adequate prognosis.