Guía de Práctica Clínica para el diagnóstico temprano y la referencia oportuna del cáncer de pulmón.

OBJETIVO: Proporcionar recomendaciones para la detección temprana de pacientes con alto riesgo de desarrollar cáncer de pulmón (CP) en el primer nivel de atención y su referencia oportuna. Material y métodos. Se realizó una búsqueda detallada de la evidencia científica disponible para responder las preguntas de investigación clínica y se utilizó el Panel Delphi modificado para lograr un consenso entre expertos. RESULTADOS: Se generaron 14 recomendaciones siguiendo los estándares de una GPC. Conclusión. El CP representa un problema de salud pública en México; por ello, esta guía establece recomendaciones que apoyan la toma de decisiones sobre la detección precoz y la referencia de pacientes con sospecha de CP en el primer nivel de atención.

Surgical care of thoracic malignancies during the COVID-19 pandemic in México: An expert consensus guideline from the Sociedad Mexicana de Oncología (SMeO) and the Sociedad Mexicana de Cirujanos Torácicos Generales (SMCTG).

To date, the impact, timeline and duration of COVID-19 pandemic remains unknown and more than ever it is necessary to provide safe pathways for cancer patients. Multiple triage systems for nonemergent surgical procedures have been published, but potentially curative cancer procedures are essential surgery rather than elective surgery. In the present and future scenario of our country, thoracic oncology teams may have the difficult decision of weighing the utility of surgical intervention against the risk for inadvertent COVID-19 exposure for patients and medical staff. In consequence, traditional pathways of surgical care must be adjusted to reduce the risk of infection and the use of resources. It is recommended that all thoracic cancer patients should be offered treatment according to the accepted standard of care until shortage of services require a progressive reduction in surgical cases. Here, we present a consensus of recommendations discussed by a multidisciplinary panel of experts on thoracic oncology and based on the best available evidence, and hope it will provide a modifiable framework of guidance for local strategy planners in thoracic cancer care services in Mexico. KEY POINTS: SIGNIFICANT FINDINGS OF THE STUDY: This article provides recommendations to guarantee the continuity of surgical care for thoracic oncology cases during COVID-19 pandemic, whilst maintaining the safety of patients and medical staff. WHAT THIS STUDY ADDS: This guideline is the result of an expert consensus on thoracic surgical oncology with recommendations adapted to medical, economic and social realities of Mexico.

Extended resections of large thymomas: importance of en bloc thymectomy.

BACKGROUND: Primary tumors of the thymus are rare; the most common histologic type is thymoma. Most important prognostic factors are anatomical extent of tumor and completeness of surgical resection. Large size has not been directly associated with survival, but is strongly associated with advanced disease and high rates of incomplete resections. METHODS: A retrospective cohort of patients who underwent thymectomy for thymomas of 5 cm or larger at the National Cancer Institute (INCan) of México from January 2005 to December 2016 was analyzed. Primary end-points were rate of complete resection, morbidity and mortality of thymectomy. Secondary end-points were overall survival (OS) and disease-free survival (DFS). RESULTS: A total of 25 patients were identified and included in the final analysis. Mean age was 56.6 years (27-82 years). Median size of thymoma was 8.3 cm (5-14 cm). Transesternal approach was used in 72% of cases, most of cases (68%) required an extended resection to achieve negative margins. Complete resection was achieved on 23 cases (92%). A 90-day morbidity of 24% and mortality of 8% was found, with a median follow-up of 34.5 months (1-113 months). The only factor associated with OS was completeness of surgical resection (P<0.0001). CONCLUSIONS: Size of thymomas should not be considered as a contraindication for surgical treatment. Our data suggest that extended surgery is feasible even in advanced cases and provides the best chance for cure. Complete resection remains as one of the most important prognostic factor in thymomas and is associated with prolonged DFS and OS.