Surgical resources in advanced thyroid cancer treatment with aerodigestive tract invasion.

BACKGROUND: Despite papillary thyroid cancer (PTC) excellent prognosis, 10-15% of patients may present aggressive local behaviour. We present two cases with different aerodigestive tract invasion partners in which two reconstructions were used, out of all the surgical resources we have planned preoperatively [1-4]. METHODS: Case 1: 57-year-old woman with asymmetric goitre and a 60mm nodule (Bethesda-VI). CT showed suspected involvement of aero-digestive tract. Endobronchial ultrasound (EBUS) showed no tracheal invasion. Per oral endoscopic-US confirmed transmural oesophageal involvement. Surgery included total thyroidectomy(left recurrent laryngeal nerve was sacrificed), bilateral central and left lateral lymph node dissection, oesophageal partial resection and reconstruction with free radial flap. Case 2: 75-year-old male with cervical mass and haemoptysis. US showed a 62 mm nodule (Bethesda-VI). PET-CT showed tracheal invasion(bronchoscopy confirmatory). Per oral endoscopic-US showed no transmural oesophageal involvement. Surgery included total thyroidectomy (right recurrent laryngeal nerve was sacrificed), bilateral central lymph node dissection, tracheal resection and extra-mucosal oesophageal resection. RESULTS: First patient required tracheostomy. She presented a self-limiting salivary fistula. She was discharged after 6 weeks with good oral intake and tracheostomy closed. Pathology report showed multifocal papillary thyroid cancer(tall cells, 70mm),micro-metastatic lymph node involvement. Afterwards, radioiodine ablation was performed. Six months after surgery there was no evidence of structural disease and analysis showed Tg 1 µg/L. Second patient developed nosocomial pneumonia and was discharged after 3 weeks. Pathology report showed papillary thyroid cancer (insular growth, 52 mm), bilateral neck central lymph nodes involvement, transmural tracheal infiltration, free margins. Radioiodine ablation is pending. CONCLUSIONS: Surgical treatment of advanced/invasive PTC offers good results in terms of survival and quality of life. Adequate pre-surgical planning, which includes multiple surgical resources, and a multidisciplinary team approach are required.

Role of surgical manipulation in lung inflammatory response in a model of lung resection surgery.

OBJECTIVES: Lung resection surgery with one-lung ventilation leads to an inflammatory response. Surgical manipulation can play a key role in this response. Sevoflurane, a commonly used volatile anaesthetic, has a proven anti-inflammatory effect. Our main goal was to evaluate the segregated effect of surgical manipulation during lung resection surgery and the protective role of sevoflurane with regard to this response. METHODS: Fifteen pigs underwent left thoracotomy for caudal lobectomy under general anaesthesia. The animals were divided into 3 groups: control, sevoflurane and sham. The animals in the sham group underwent left thoracotomy and one-lung ventilation over 120 min, without lobectomy. The animals in the sevoflurane group received anaesthetic maintenance with sevoflurane. The animals in the sham group and the control group received propofol during the procedure. Lung biopsies were collected before the procedure (left caudal lobe) and 24 h later (right mediastinal lobe and left upper lobe). The samples were stored to measure levels of inflammatory markers (IL-1, TNF-α and ICAM-1), apoptotic mediators (BAD, BAX, BCL-2 and Caspase-3), Syndecan-1, MicroRNAs 182, 145 and lung oedema. RESULTS: Surgical manipulation increased the expression of inflammation (IL-1, TNF-α and ICAM-1) and proapoptotic mediators (BAX, BAD and Caspase-3). It also caused degradation of endothelial glycocalyx (Syndecan-1) and pulmonary oedema. Administration of sevoflurane reduced the elevation of inflammatory markers, degradation of glycocalyx and pulmonary oedema observed in the control group. CONCLUSIONS: Surgical manipulation of the collapsed lung could increase the expression of inflammation and proapoptotic mediators and cause tissue damage in the form of pulmonary oedema. Sevoflurane could attenuate this molecular response and pulmonary oedema.

Metaloptisis: ¿un nuevo caso con otra causa? / Metalloptysis: A new case with another cause?

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Bullhorn and bullfighting injuries.

PURPOSE: Our purpose was to present our hospital experience with bullhorn injuries. METHODS: A retrospective analysis of patients in our Trauma Registry (1993-2012). RESULTS: Fifteen patients were included. All were hemodynamically stable on presentation, with a mean Glasgow Coma Scale (GCS) score and a Revised Trauma Score (RTS) of 15 and 11.9, respectively. The Injury Severity Score (ISS) and New Injury Severity Score were 13.6 ± 6 and 15.9 ± 9, respectively. Seven had an ISS > 15. Injuries resulted from an isolated blunt trauma (BT) in four, penetrating trauma (PT) in seven, with extensive soft tissue injuries (STI) in three, and a combined BT + PT mechanism in four patients, with extensive STI in all. Three patients had injuries to vessels in the groin, two with prehospital vein ligation. Five patients had abdominal visceral injuries, and another had a sheathed goring, with a traumatic abdominal wall hernia and retroperitoneal hematoma. Four patients had thoracic injuries, and one of them had a traumatic thoracoplasty with a large open thoracic wound, a flail chest, and extensive STI. Two patients had traumatic brain injury, and six had bone fractures. Two-thirds of patients required a surgical procedure under general anesthesia. Morbidity included three surgical site infections, one leg compartment syndrome, and one persistent lymph drainage. There was no mortality, and the mean length of hospital stay was 16 days. CONCLUSIONS: Bullhorn and bullfighting injuries frequently have a multimechanistic origin which goes beyond a pure penetrating trauma. Associated blunt and STI were common in our series, and the overall prognosis of patients admitted to hospital was good.

Influencia pronóstica de la pérdida de la expresión del antígeno del grupo sanguíneo A en el carcinoma no microcítico de pulmón en estadio I patológico / Prognostic Influence of Loss of Blood Group A Antigen Expression in Pathologic Stage I Non-Small-Cell Lung Cancer

Introducción: En la literatura científica se han publicado resultados contradictorios sobre el valor pronóstico de la pérdida de la expresión del antígeno de grupo sanguíneo A (GSA) en el cáncer de pulmón, por lo que analizamos retrospectivamente este hecho en nuestra serie quirúrgica. Pacientes y métodos. En un estudio multicéntrico de 402 pacientes con carcinoma no microcítico de pulmón (CNMP) en estadio I patológico según la nueva clasificación TNM-2009 se analizó la influencia pronóstica de la pérdida de la expresión del antígeno del GSA en los 209 pacientes con grupos sanguíneos A o AB. Resultados: La supervivencia a los 5 años de los pacientes en estadio I patológico que mantenían la expresión del antígeno del GSA fue del 73%, frente a una supervivencia del 53% en los pacientes que habían perdido la expresión del mismo (p=0,03). Cuando se analizó la supervivencia subdividiendo la muestra en estadios IA y IB, solo se alcanzó la significación estadística en el estadio IA (p=0,038). Al analizar la supervivencia según el tipo histológico, los pacientes con adenocarcinoma que perdían la expresión del antígeno del GSA tenían una menor supervivencia, con una p estadísticamente muy significativa (p=0,003). El análisis multivariable mostró que la edad, el género y la expresión del antígeno del GSA eran factores pronósticos independientes. Conclusiones: La pérdida de la expresión del antígeno del grupo sanguíneo A tiene una influencia pronóstica negativa en el CNMP estadio I patológico, sobre todo en el tipo histológico adenocarcinoma(AU)

Introduction: In the scientific literature, contradictory results has been published on the prognostic value of the loss of expression of blood group antigen A (BAA) in lung cancer. The objective of our study was to analyze this fact in our surgical series. Patients and methods: In a multicenter study, 402 non-small-cell lung cancer (NSCLC) patients were included. All were classified as stage-I according to the last 2009-TNM classification. We analyzed the prognostic influence of the loss of expression of BAA in the 209 patients expressing blood group A or AB. Results: The 5-year cumulative survival was 73% for patients expressing BAA vs 53% for patients with loss of expression (P=.03). When patients were grouped into stages IA and IB, statistical significance was only observed in stage I-A (P=.038). When we analyzed the survival according to histologic type, those patients with adenocarcinoma and loss of expression of BAA had a lower survival rate that was statistically very significant (P=.003). The multivariate analysis showed that age, gender and expression of BAA were independent prognostic factors. Conclusions: The loss of expression of blood group antigen A has a negative prognostic impact in stage I NSCLC, especially in patients with adenocarcinoma(AU)

Prognostic influence of loss of blood group A antigen expression in pathologic stage I non-small-cell lung cancer.

INTRODUCTION: In the scientific literature, contradictory results has been published on the prognostic value of the loss of expression of blood group antigen A (BAA) in lung cancer. The objective of our study was to analyze this fact in our surgical series. PATIENTS AND METHODS: In a multicenter study, 402 non-small-cell lung cancer (NSCLC) patients were included. All were classified as stage-I according to the last 2009-TNM classification. We analyzed the prognostic influence of the loss of expression of BAA in the 209 patients expressing blood group A or AB. RESULTS: The 5-year cumulative survival was 73% for patients expressing BAA vs 53% for patients with loss of expression (P=.03). When patients were grouped into stages IA and IB, statistical significance was only observed in stage I-A (P=.038). When we analyzed the survival according to histologic type, those patients with adenocarcinoma and loss of expression of BAA had a lower survival rate that was statistically very significant (P=.003). The multivariate analysis showed that age, gender and expression of BAA were independent prognostic factors. CONCLUSIONS: The loss of expression of blood group antigen A has a negative prognostic impact in stage I NSCLC, especially in patients with adenocarcinoma.

Complicaciones quirúrgicas de la resección pulmonar / Surgical complications of pulmonary resection

En este trabajo se revisan la incidencia, las causas, el diagnóstico, la prevención y el tratamiento de las siguientes complicaciones quirúrgicas que pueden ocurrir tras procedimientos de resección pulmonar: fuga aérea prolongada, enfisema subcutáneo, cámaras pleurales residuales, dehiscencia precoz del muñón bronquial, hemorragia, empiema pleural, fístula broncopleural, fístula esófago-pleural, quilotórax, hernia cardíaca, torsión lobular, síndrome posneumonectomía, lesiones nerviosas y embolización tumoral (AU)

We review incidence, etiology, diagnosis, prevention and treatment of the following complications of pulmonary resection: prolonged air leak, subcutaneous emphysema, residual pleural spaces, early bronchial stump dehiscence, bleeding, pleural empyema, bronchopleural fistula, esophagopleural fistula, chylothorax, cardiac herniation, pulmonary torsion, postpneumonectomy syndrome, nerve injuries and tumor embolism (AU)

Análisis multicéntrico de supervivencia y factores pronósticos en el carcinoma no microcítico de pulmón en estadio I patológico según la nueva clasificación TNM de 2009 / Multicenter Analysis of Survival and Prognostic Factors in Pathologic Stage I Non-Small-Cell Lung Cancer According to the New 2009 TNM Classification

Introducción: La nueva clasificación TNM de 2009 ha introducido importantes modificaciones en la estadificacióndel cáncer de pulmón. El objetivo de este trabajo es validar nuestra serie de pacientes concarcinoma no microcítico de pulmón en estadio I patológico según la séptima edición de la clasificaciónTNM de los tumores malignos y analizar los factores relacionados con el pronóstico.Pacientes y métodos: Se realizó un estudio retrospectivo y multicéntrico. Para el análisis de supervivenciase utilizó el método de Kaplan-Meier y para el análisis multivariable, la regresión de Cox. Se analizaronlas siguientes variables: edad, sexo, estadio patológico, categoría T, tipo histológico, tipo de resección ytamaño tumoral.Resultados: Se incluyó a 402 pacientes con un seguimiento medio de 70,18 meses. La supervivencia globala los 5 años fue del 68%. Los varones y los pacientes mayores de 70 años tenían una menor supervivencia.El pronóstico empeoraba a medida que aumentaba el estadio patológico, la categoría T y el tamañotumoral. No encontramos diferencias pronósticas estadísticamente significativas en relación con el tipohistológico y el tipo de resección practicada. El análisis multivariable mostró que la edad, el sexo y elestadio patológico son factores pronósticos independientes.Conclusiones: Los resultados de supervivencia y el análisis de factores pronósticos de nuestra serie seajustan a los publicados en la nueva clasificación TNM de 2009. El factor pronóstico más importante esel estadio patológico. Otros factores pronósticos desfavorables son el sexo masculino y la edad mayor de70 años (AU)

Introduction: The new 2009 TNM classification introduced important modifications in lung cancer staging. The aim of this study is to validate our series of patients with pathologic stage I non-small-cell lung canceraccording to the 7th edition of the TNM classification of malignant tumors and to the factors related withprognosis.Patients and methods: A multicenter retrospective study was performed. Survival rates were calculated by the Kaplan-Meier method, and for multivariate analyses, Cox proportional hazards regression model was used. The following variables were analyzed: age, sex, pathologic stage, T category, histology, type of resection and tumor size. Results: A total of 402 patients were included. Mean follow-up was 70.18 months. Overall 5-year survivalwas 68%. Males and patients over 70 had lower survival. Prognosis worsened with increasing pathologicstage, T category and tumor size. We found no statistically significant differences in prognosis for histologyor type of resection. Multivariate analysis showed age, sex and pathologic stage to be independentprognostic factors.Conclusions: Survival results and the analysis of prognostic factors in our series are similar to those publishedin the new 2009 TNM classification. The most important prognostic factor is pathologic stage. Otheradverse prognostic factors include male sex and age over 70 (AU)

Multicenter analysis of survival and prognostic factors in pathologic stage I non-small-cell lung cancer according to the new 2009 TNM classification.

INTRODUCTION: The new 2009 TNM classification introduced important modifications in lung cancer staging. The aim of this study is to validate our series of patients with pathologic stage I non-small-cell lung cancer according to the 7th edition of the TNM classification of malignant tumors and to the factors related with prognosis. PATIENTS AND METHODS: A multicenter retrospective study was performed. Survival rates were calculated by the Kaplan-Meier method, and for multivariate analyses, Cox proportional hazards regression model was used. The following variables were analyzed: age, sex, pathologic stage, T category, histology, type of resection and tumor size. RESULTS: A total of 402 patients were included. Mean follow-up was 70.18 months. Overall 5-year survival was 68%. Males and patients over 70 had lower survival. Prognosis worsened with increasing pathologic stage, T category and tumor size. We found no statistically significant differences in prognosis for histology or type of resection. Multivariate analysis showed age, sex and pathologic stage to be independent prognostic factors. CONCLUSIONS: Survival results and the analysis of prognostic factors in our series are similar to those published in the new 2009 TNM classification. The most important prognostic factor is pathologic stage. Other adverse prognostic factors include male sex and age over 70.

Procedimiento de autotrasplante pulmonar en el cerdo como modelo experimental para el estudio del síndrome de isquemia-reperfusión / Experimental Swine Lung Autotransplant Model to Study Lung Ischemia-Reperfusion Injury

Introducción: El daño pulmonar agudo por isquemia reperfusión (IR) ha sido estudiado fundamentalmenteen modelos experimentales y clínicos con IR fría. Son limitados los estudios que profundizan en lasalteraciones bioquímicas durante la IR normotérmica (caliente). El objetivo del este trabajo es presentarun modelo de autotrasplante pulmonar en cerdo para el estudio de las fases más precoces del síndromede IR normotérmica pulmonar.Animales y métodos: Seis cerdos de la raza Large-White fueron sometidos a neumonectomía izquierda,lobectomía craneal ex situ, reimplantación del lóbulo caudal y reperfusión del mismo durante 30 min.Durante el procedimiento se analizaron diferentes parámetros para identificar cambios hemodinámicos,gasométricos y bioquímicos en el modelo. El estudio estadístico se realizó con pruebas no paramétricas.Resultados: Tras la isquemia, se observó en tejido pulmonar un aumento significativo (p < 0,05) de metabolitosde peroxidación lipídica, de citoquinas y quemoquinas proinflamatorias (TNF- , IL-1 y MCP-1),de actividad leucocitaria (mieloperoxidasa o MPO), de actividad óxido nítrico sintasa inducible y de laproteína quinasaMAPKp38, mientras que se observóundescenso de actividad tisular de las formas constitutivasde NOS y de monóxido de carbono sérico. Estas alteraciones se mantuvieron o acentuaron durantela reperfusión, donde se observó también una mayor actividad tisular hemo-oxigenasa constitutiva.Conclusiones: Se presenta un procedimiento experimental de IR normotérmica pulmonar describiendo enprofundidad cambios hemodinámicos, gasométricos y bioquímicos. Tanto el modelocomolos parámetrosanalizados podrían ser útiles en el estudio de nuevas terapias moduladoras del da˜no pulmonar agudo ensituaciones clínicas de IR normotérmica(AU)

Introduction: Ischemia-reperfusion (IR) lung injury has been investigated extensively on clinical andexperimental models of cold ischemia. However, relatively few studies examine the detailed biochemicalchanges occurring during normothermic (warm) IR.The objective of this work was to establish an experimental lung autotransplant model to be carried outon pigs in order to study the early stages of normothermic lung IR.Animals y methods: Six Large-White pigs underwent a lung autotransplant which entailed left pneumonectomy,ex situ cranial lobectomy, caudal lobe reimplantation and its reperfusion for 30 min. Throughoutthe procedure, several parameters were measured in order to identify hemodynamic, gasometric andbiochemical changes. Non-parametric statistical analyses were used to compare differences between periods. Results: After ischemia, a significant increase (P < 0.05) in lipid peroxidation metabolites, proinflammatorycytokines and chemokines (TNF- , IL-1 y MCP-1), neutrophil activation, inducible nitric oxide synthaseactivity and protein-kinase MAPK p38 levels were observed in lung tissue. However, constitutive nitricoxide synthase activity in lung tissue and carbon monoxide plasma levels were decrease. The same heldtrue throughout the reperfusion period, when an increase in the constitutive heme-oxygenase activitywas also shown.Conclusions: An experimental model of normothermic lung IR injury is presented and detailed changes inhemodynamic, gasometric and biochemical parameters are shown. Both the model and the studied parametersmay be clinically useful in future investigations testing new therapies to prevent normothermicIR induced lung injury(AU)

Experimental Swine lung autotransplant model to study lung ischemia-reperfusion injury.

INTRODUCTION: Ischemia-reperfusion (IR) lung injury has been investigated extensively on clinical and experimental models of cold ischemia. However, relatively few studies examine the detailed biochemical changes occurring during normothermic (warm) IR. The objective of this work was to establish an experimental lung autotransplant model to be carried out on pigs in order to study the early stages of normothermic lung IR. ANIMALS Y METHODS: Six Large-White pigs underwent a lung autotransplant which entailed left pneumonectomy, ex situ cranial lobectomy, caudal lobe reimplantation and its reperfusion for 30 min. Throughout the procedure, several parameters were measured in order to identify hemodynamic, gasometric and biochemical changes. Non-parametric statistical analyses were used to compare differences between periods. RESULTS: After ischemia, a significant increase (P < 0.05) in lipid peroxidation metabolites, proinflammatory cytokines and chemokines (TNF-α, IL-1ß y MCP-1), neutrophil activation, inducible nitric oxide synthase activity and protein-kinase MAPK p38 levels were observed in lung tissue. However, constitutive nitric oxide synthase activity in lung tissue and carbon monoxide plasma levels were decrease. The same held true throughout the reperfusion period, when an increase in the constitutive heme-oxygenase activity was also shown. CONCLUSIONS: An experimental model of normothermic lung IR injury is presented and detailed changes in hemodynamic, gasometric and biochemical parameters are shown. Both the model and the studied parameters may be clinically useful in future investigations testing new therapies to prevent normothermic IR induced lung injury.

Surgery of female genital tract tumour lung metastases.

INTRODUCTION: Lung metastases originating from tumours of the female genital tract are rare. Due to this rarity and their variable histology, it has been difficult to compare different patient series. MATERIAL AND METHODS: A retrospective study of patients undergoing resection of lung metastases of female genital tract tumours (uterine and cervical cancer) during the period 01/01/1989 to 12/31/2006. Epidemiological, diagnostic and treatment data were collected. Non-parametric tests and survival analysis were performed using the Kaplan-Meier and log-rank test. RESULTS: A resection was performed on 27 patients during the study period. Disease-free interval (DFI) from initial diagnosis of lung metastases was 58 months (1-195 months). The median survival from diagnosis of metastases was 94 months. The overall survival at 5 years after diagnosis of metastasis was 84.1%. A second surgery of metastases was performed on 5 patients (18.5%). Survival after second surgery of metastases: 80.5 months. Survival from diagnosis of metastasis at five years: endometrial carcinoma 100%, cervical cancer 62.5%, uterine sarcoma 60%. Adjuvant hormonal therapy was prescribed in 15 out of 16 patients with endometrial carcinoma. There was a statistically significant difference in the survival depending on the histological type and disease free interval. CONCLUSION: Surgical treatment of lung metastases originating from female genital tract tumours (mainly endometrial carcinoma) is associated with a high long-term survival.

Cirugía de las metástasis pulmonares de tumores del tracto genital femenino / Surgery of female genital tract tumour lung metastases

IntroducciónLos tumores del tracto genital femenino constituyen una etiología poco frecuente de metástasis pulmonares. Debido a esto y a su variada histología, la comparación de resultados ha resultado complicada hasta la fecha.Material y métodosEstudio retrospectivo de pacientes intervenidos de metástasis pulmonares de tumores del tracto genital femenino (cuerpo, trompa y cuello de útero) en el periodo 01/01/1989–31/12/2006. Se recogen datos referentes a aspectos epidemiológicos, de diagnóstico y tratamiento. Se han utilizado tests no paramétricos, y el análisis de supervivencia se ha realizado con curvas de Kaplan-Meier y el log-rank test.ResultadosDurante el periodo descrito se ha intervenido a 27 pacientes. Intervalo libre de enfermedad (ILE) desde el diagnóstico inicial al de metástasis pulmonares 58 meses (1-195 meses). Mediana de supervivencia desde el diagnóstico de metástasis 94 meses. Supervivencia global tras diagnóstico de metástasis a 5 años: 84,1%. Segunda cirugía de metástasis: 5 pacientes (18,5%). Supervivencia tras segunda cirugía de metástasis: 80,5 meses. Supervivencia desde el diagnóstico de metástasis a 5 años: carcinoma de endometrio 100%; cáncer de cérvix 62,5%; sarcoma uterino 60%. Recibieron hormonoterapia adyuvante 15 de 16 pacientes con carcinoma de endometrio. Hallamos diferencias estadísticamente significativas en la supervivencia en función de: tipo histológico, e intervalo libre de enfermedad.ConclusiónEl tratamiento quirúrgico de las metástasis del tracto genital femenino (principalmente de las de carcinoma de endometrio) se asocia a una elevada supervivencia a largo plazo(AU)

IntroductionLung metastases originating from tumours of the female genital tract are rare. Due to this rarity and their variable histology, it has been difficult to compare different patient series.Material and MethodsA retrospective study of patients undergoing resection of lung metastases of female genital tract tumours (uterine and cervical cancer) during the period 01/01/1989 to 12/31/2006. Epidemiological, diagnostic and treatment data were collected. Non-parametric tests and survival analysis were performed using the Kaplan-Meier and log-rank test.ResultsA resection was performed on 27 patients during the study period. Disease-free interval (DFI) from initial diagnosis of lung metastases was 58 months (1-195 months). The median survival from diagnosis of metastases was 94 months. The overall survival at 5 years after diagnosis of metastasis was 84.1%. A second surgery of metastases was performed on 5 patients (18.5%). Survival after second surgery of metastases: 80.5 months. Survival from diagnosis of metastasis at five years: endometrial carcinoma 100%, cervical cancer 62.5%, uterine sarcoma 60%. Adjuvant hormonal therapy was prescribed in15 out of 16 patients with endometrial carcinoma. There was a statistically significant difference in the survival depending on the histological type and disease free interval.ConclusionSurgical treatment of lung metastases originating from female genital tract tumours (mainly endometrial carcinoma) is associated with a high long-term survival(AU)

[Surgical complications of pulmonary resection]. / Complicaciones quirúrgicas de la resección pulmonar.

We review incidence, etiology, diagnosis, prevention and treatment of the following complications of pulmonary resection: prolonged air leak, subcutaneous emphysema, residual pleural spaces, early bronchial stump dehiscence, bleeding, pleural empyema, bronchopleural fistula, esophagopleural fistula, chylothorax, cardiac herniation, pulmonary torsion, postpneumonectomy syndrome, nerve injuries and tumor embolism.

Neumotórax de repetición / Recurrent pneumothorax

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Lung cancer surgery in the elderly.

Non-small cell lung cancer (NSCLC) is a typical disease of the elderly, and is becoming increasingly more common as a result of the gradual aging of the population. Although patient age is known to be an independent prognostic factor of postoperative survival, lung resection should not be denied on the basis of age alone. In patients of this kind, careful evaluation and selection is very important. In early-stage NSCLC, surgery is the treatment of choice. In the advanced stages of the disease treatment usually comprises primary radiotherapy or combined radio-chemotherapy. Preoperative preparation and postoperative care are very important in chest surgery, and particularly in elderly patients. The 5-year survival rate in octogenarians exceeds 40%, but is much lower in pneumonectomized patients (close to 10%). In conclusion, elderly patients should be offered the best treatment possible, bearing in mind that surgery offers the best results when the disease is resectable.

[Immunohistochemistry and surgical approaches in solitary fibrous tumor of the pleura]. / Inmunohistoquímica y vías de abordaje en el tumor fibroso pleural.

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory.

Inmunohistoquímica y vías de abordaje en el tumor fibroso pleural / Inmunohistochemistry and surgical approaches in solitary fibrous tumor of the pleura

El tumor fibroso pleural (TFP) es una neoplasia benigna poco frecuente, de crecimiento lento, que se origina a partir de las células submesoteliales de la pleura. Habitualmente, la resección del tumor y de las estructuras adyacentes, si están afectadas, suele ser suficiente para su resolución. Actualmente, la videotoracoscopia (VTC) permite un acceso adecuado para el tratamiento de estos tumores. La positividad para CD34 es un rasgo diferencial con el mesotelioma. Se presentan 15 casos de TFP (9 mujeres y 6 varones) intervenidos en nuestro servicio en los últimos 12 años (10 toracotomías, 1 esternotomía y 4 mediante VTC). Sólo 4 casos presentaron síntomas al diagnóstico. Se plantea la VTC como un método diagnóstico y terapéutico, menos invasivo que la toracotomía, que permite un abordaje adecuado para la resección del TFP, en casos seleccionados. El seguimiento a largo plazo es obligado, dado su potencial maligno (AU)

Solitary fibrous tumor of the pleura (SFTP) is a rare, benign, slow-growing neoplasm that arises from the submesothelial cells of the pleura. Usually, resection of the tumor and adjacent structures are sufficient for resolution. Nowadays, videothoracoscopy (VTC) allows adequate access for the surgical treatment of these tumors. CD34 antigen positivity is a differential feature with mesothelioma. We present our experience with 15 patients with SFTP (nine women and six men) who underwent surgical resection in the last 12 years (10 thoracotomies, one sternotomy and four VTC). Only four patients were symptomatic at diagnosis. In our opinion, VTC is a less invasive diagnostic and therapeutic approach than thoracotomy that provides an adequate approach for the resection of SFTP in selected patients. Because of the malignant potential of this tumor, long-term follow-up is mandatory (AU)