[Lung transplantation: bronchogenic carcinoma in the native lung]. / Trasplante pulmonar. Carcinoma broncogénico en pulmón nativo.

In lung transplantation, the presence of bronchogenic carcinoma in the native organ is uncommon, but doubtless affects patient survival, independently of the transplantation process itself. We describe 2 cases in which a primary tumor was found in the explanted lung--1 case of adenocarcinoma in a patient with pulmonary emphysema and 1 case of bronchioloalveolar carcinoma in a patient with idiopathic pulmonary fibrosis. Both patients died due to the recurrence of the neoplastic disease. Distant metastasis was the initial manifestation of the recurrence.

Trasplante pulmonar. Carcinoma broncogénico en pulmón nativo / Lung transplantation: bronchogenic carcinoma in the native lung

En el trasplante pulmonar, la presencia de un carcinoma broncogénico en el órgano nativo es una situación muy poco frecuente, pero que, sin duda, condiciona la supervivencia de los pacientes, independientemente del propio proceso del trasplante en sí. Se describen 2 casos donde se hallaron sendos tumores primarios pulmonares en el órgano extraído, un adenocarcinoma en el contexto de un enfisema pulmonar, y un carcinoma bronquioloalveolar en un paciente con fibrosis pulmonar idiopática. Ambos pacientes fallecieron por la recidiva de la enfermedad neoplásica, cuya manifestación inicial fue la presencia de enfermedad metastásica a distancia

In lung transplantation, the presence of bronchogenic carcinoma in the native organ is uncommon, but doubtless affects patient survival, independently of the transplantation process itself. We describe 2 cases in which a primary tumor was found in the explanted lung--1 case of adenocarcinoma in a patient with pulmonary emphysema and 1 case of bronchioloalveolar carcinoma in a patient with idiopathic pulmonary fibrosis. Both patients died due to the recurrence of the neoplastic disease. Distant metastasis was the initial manifestation of the recurrence

[Lung transplantation for emphysema: retrospective study of 65 patients]. / Trasplante pulmonar por enfisema: análisis retrospectivo de 65 pacientes.

BACKGROUND AND OBJECTIVE: Our goal was to analyze the incidence of perioperative complications in patients with pulmonary emphysema who underwent lung transplantation and to identify variables associated with the incidence of morbidity and mortality during the immediate postoperative period. PATIENTS AND METHOD: We undertook a retrospective study of 65 pulmonary emphysema patients who received lung transplants from 1994 through 2002 with the aim of determining the most common intra- and early postoperative complications in the ICU. An univariate analysis was carried out in order to identify variables associated with the incidence of mortality and postoperative complications. Those variables showing statistical significance underwent a multivariate analysis, by means of a pattern of logistic regression, in order to calculate the odds ratio and confidence interval. RESULTS: Seventeen patients received single-lung transplants (SLT) and 48 patients received sequential double-lung transplants (DLT). Intraoperative complications appeared more frequently in the DLT group. Most frequent complications during surgery were reperfusion syndrome (44.6%) and pulmonary hypertension (16.9%). The intraoperative survival was 100%. Fifty-five patients had some type of postoperative complication. Commonest postoperative complications were infection (56.9%) and primary graft failure (36.6%). In the early postoperative period the mortality rate was 16.9%. Main cause of death in the ICU was sepsis (54.5%). A time of mechanical ventilation > 48 hours and postoperative hemorrhage were the variables with a higher predictive value for mortality in the early postoperative period. CONCLUSIONS: Patients with SLT had a lower rate of perioperative complications and a higher survival during their stay in the ICU. Time of mechanical ventilation > 48 hours and postoperative hemorrhage were the variables that best predicted death in the early postoperative period following lung transplantation. Despite our experience, however, perioperative mortality in lung transplantation remains high up to this day.

Trasplante pulmonar por enfisema: análisis retrospectivo de 65 pacientes / Lung transplantation for emphysema: retrospective study of 65 patients

Fundamento y objetivo: Describir la incidencia de complicaciones perioperatorias de los pacientes trasplantados de pulmón por enfisema pulmonar y estudiar los factores de riesgo asociados a la morbimortalidad en el postoperatorio inmediato. Pacientes y método: Estudio retrospectivo que incluye a 69 pacientes trasplantados de pulmón por enfisema pulmonar durante los años 1994-2002. Se realizó un análisis univariante para identificar las variables asociadas con la incidencia de la mortalidad en la Unidad de Reanimación o con el aumento de complicaciones postoperatorias. Las variables que presentaron significación estadística se sometieron a análisis multivariante mediante el modelo de regresión logística. Resultados: Se incluyó a 65 pacientes. Diecisiete recibieron un trasplante unipulmonar (TUP) y 48 un transplante bilateral secuencial (TBP). Las complicaciones intraoperatorias fueron más habituales en el grupo del trasplante bipulmonar (35,3% en el TBP frente a 72,9% en el TUP, p < 0,006), y las complicaciones intraoperatorias más frecuentes fueron el síndrome posreperfusión y la hipertensión pulmonar . No hubo ningún caso de mortalidad intraoperatoria en la serie. Las complicaciones postoperatorias más frecuentes fueron la infección (56,9%) y el fallo primario del injerto (36,6%). Cincuenta y cinco pacientes presentaron alguna complicación en el postoperatorio inmediato. La mortalidad global en el postoperatorio fue del 16,9%, y que la sepsis (54,5%) la causa más frecuente de fallecimiento en el postoperatorio inmediato. La ventilación mecánica durante más de 48 h y la hemorragia posquirúrgica fueron las variables con mayor valor predictivo de mortalidad en el postoperatorio Conclusiones: Los pacientes con TUP tienen menor número de complicaciones en el perioperatorio, lo que condiciona una mayor supervivencia durante la estancia en reanimación. La ventilación mecánica durante más de 48 h y la hemorragia posquirúrgica fueron las variables que mejor predijeron la mortalidad en el postoperatorio inmediato

Background and objective: Our goal was to analyze the incidence of perioperative complications in patients with pulmonary emphysema who underwent lung transplantation and to identify variables associated with the incidence of morbidity and mortality during the immediate postoperative period. Patients and method: We undertook a retrospective study of 65 pulmonary emphysema patients who received lung transplants from 1994 through 2002 with the aim of determining the most common intra- and early postoperative complications in the ICU. An univariate analysis was carried out in order to identify variables associated with the incidence of mortality and postoperative complications. Those variables showing statistical significance underwent a multivariate analysis, by means of a pattern of logistic regression, in order to calculate the odds ratio and confidence interval. Results: Seventeen patients received single-lung transplants (SLT) and 48 patients received sequential double-lung transplants (DLT). Intraoperative complications appeared more frecuently in the DLT group. Most frequent complications during surgery were reperfusion syndrome (44.6%) and pulmonary hypertension (16.9%). The intraoperative survival was 100%. Fifty-five patients had some type of postoperative complication. Commonest postoperative complications were infection (56.9%) and primary graft failuree (36.6%). In the early postoperative period the mortality rate was 16.9 %. Main cause of death in the ICU was sepsis (54.5%). A time of mechanical ventilation > 48 hours and postoperative hemorrhage were the variables with a higher predictive value for mortality in the early postoperative period. Conclusions: Patients with SLT had a lower rate of perioperative complications and a higher survival during their stay in the ICU. Time of mechanical ventilation > 48 hours and postoperative hemorrhage were the variables that best predicted death in the early postoperative period following lung transplantation. Despite our experience, however, perioperative mortality in lung transplantation remains high up to this day

Surgical results of stage I non-small cell lung cancer: comparison between elderly and younger patients.

OBJECTIVE: The aim of this study was to evaluate the overall cancer-related survival in younger and elderly (over 70 years old) patients with stage I non-small cell lung cancer (NSCLC) together with prognostic factors in the elderly. METHODS: The patient records of 797 patients who underwent surgery for stage I NSCLC were analyzed retrospectively. A total of 132 patients were over 70 years old. The clinical variables and overall cancer-related survival were compared between two groups. An analysis was performed to determine the risk factors that influenced the survival of elderly patients. Variables analyzed included sex, presence of symptoms, operative procedure, histopathology, size of tumor and tumor classification. RESULTS: Between the two groups, the nature of the operation performed (pneumonectomy or not) and the presence of symptoms reached statistical significance (P<0.001). Overall 5- and 10-year survival rates were 64.5% and 53.68% in younger patients and 58.23% and 52.24% in the elderly. There was no significant difference in survival between the groups (P=0.35). The only significant prognostic factor in the elderly patients was the size of the tumor in the multivariate analysis (P=0.0442, relative risk 2.28 (1.02-5.10 95% CI)). CONCLUSIONS: Surgical resection for stage I NSCLC in elderly patients over the age of 70 years results in a comparable overall cancer-related survival to that evident in younger patients. The size of the tumor is the only significant factor to influence the survival of elderly patients. Continued careful selection of elderly patients for surgical resection is important for acceptable operative results.