[show abstract][hide abstract] ABSTRACT: In recent years, there has been debate regarding the diagnostic accuracy of computed tomography (CT) in the identification of lung metastases and the need for lung palpation to determine the number of metastatic nodules. The aim of this study was to determine in which patients the CT scan was more effective in detecting all metastases.
We studied all patients who underwent curative thoracotomy for pulmonary metastasis between 1998 and 2012. All cases were reviewed by two expert pulmonary radiologists before surgery. Statistical analyses were performed using Systat version 13.
The study included 183patients (63.6% male) with a mean age of 61.7 years who underwent 217interventions. The CT scan was correct in 185cases (85.3%). Discrepancies observed: 26patients (11.9%) with more metastases resected than observed and 6cases (2.8%) with fewer metastases. In patients with one or two metastases of colorectal origin or a single metastasis of any other origin, the probability of finding extra nodules was 9.5%. In the remaining patients, the probability was 27.8%, with statistically significant differences (P=.001). The mean age of the patients in whom no unobserved nodules were detected was 62.9 years compared to 56.5 years on average in patients who were free from any metastases (P=.001).
Patients older than 60years, with one or two metastases of colorectal origin or a single metastasis from any other origin were considered to be the group with low probability of having more metastases resected than observed.
Archivos de Bronconeumología 07/2013; · 2.17 Impact Factor
[show abstract][hide abstract] ABSTRACT: The hemiclamshell incision is a valid but infrequent surgical alternative for the resection of tumors from mediastinum. This point makes this approach impossible to be studied under a randomized controlled trial. The triple association of thoracotomy, sternotomy and cervicothomy makes the hemiclamshell approach a high intensity postoperative pain sur-gery. However, there is no published data on this topic, and the reviewed articles only mention the analgesic regimens as a secondary point. Indeed, no author defines the best epidural drugs mixture for the patients. Multimodal analgesic regimen based on regional anesthesia should be used. Based on the recent advances on spinal opioids, morphine could be a good choice as epidural coadjutant to local anesthetics for hemiclamshell incision.
The Open Anesthesiology Journal 05/2013; 333036(3):156-160.
[show abstract][hide abstract] ABSTRACT: Castleman's disease is an infrequent lymphoproliferative disorder. Clinically, the localized form is distinguished from the multicentric form. Despite the low incidence of this entity, other cases of Castleman's disease in pregnant woman have been published, suggesting that there may be a relationship between pregnancy and this disorder. We present a case of Castleman's disease in a pregnant woman treated in our hospital and review the literature on this uncommon entity.
[show abstract][hide abstract] ABSTRACT: To analyse patient survival after the resection of lung metastases from colorectal carcinoma and specifically to verify whether presence of liver metastasis prior to lung metastasectomy affects survival.
All patients who, between 1998 and 2008, underwent lung metastasectomy due to colorectal cancer were included in the study. Kaplan-Meier survival analysis was performed with the log-rank test and Cox regression multivariate analysis.
During this period, 101 metastasectomies were performed on 84 patients. The median age of patients was 65.4 years, and 60% of patients were male. The 30-day mortality rate was 2%, and incidence of complications was 7%. The overall survival was 72 months, with 3-and 5-year survival rates of 70% and 54%, respectively. A total of 17 patients (20%) had previously undergone resection of liver metastasis. No significant differences were found in the distribution of what were supposed to be the main variables between patients with and without previous hepatic metastases. Multivariate analysis identified the following statistically significant factors affecting survival: previous liver metastasectomy (p = 0.03), tumour-infiltrated pulmonary lymph nodes (p = 0.04), disease-free interval ≥ 48 months (p = 0.03), and presence of more than one lung metastasis (p < 0.01). In patients with previous liver metastasis, the shorter the time between primary colorectal surgery and the hepatectomy, the lower the survival rate after pulmonary metastasectomy (p = 0.048).
A previous history of liver metastasis shortens survival after lung metastasectomy. The time between hepatic resection and lung metastasectomy does not affect survival; however, patients with synchronous liver metastasis and colorectal neoplasia have poorer survival rates than those with metachronous disease.
European journal of surgical oncology: the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology 06/2011; 37(9):786-90. · 2.56 Impact Factor
[show abstract][hide abstract] ABSTRACT: Since the International Registry of Lung Metastases established the factors that determine survival after performing lung metastasectomy in 1997, numerous studies have attempted to determine these prognostic factors of survival. Our objective has been to analyse the mortality, survival and disease-free survival lung metastasis surgery by studying the different variables that determine them.
All patients subjected to surgery for lung metastasectomy between 1998 and 2008 were included in this study. The Kaplan-Meier and log-rank tests were performed, as well as a Cox regression using multivariate analysis.
A total of 178 lung metastases were removed in 146 patients during this period. The mean age was 62.22 years (median 63 years) and 64.6% were males. There were 2 cases (1.1%) of mortality and the incidence of complications was 5.02% (9 cases). The overall survival was 67.75 months with a 3 and 5 year survival of 67.4% and 52.4%, respectively. The variables that showed statistical significance in the multivariate analysis were: age disease free interval, number of nodules and size of nodules. The "state of the margins" variable was almost significant (P=.054).
To have only one metastasis and it is less than 1cm, a long disease free interval, and a resection with free margins, are the most favourable prognostic factors after resection of lung metastasis.
Cirugía Española 02/2011; 89(4):243-8. · 0.87 Impact Factor
[show abstract][hide abstract] ABSTRACT: IntroductionSince the International Registry of Lung Metastases established the factors that determine survival after performing lung metastasectomy in 1997, numerous studies have attempted to determine these prognostic factors of survival. Our objective has been to analyse the mortality, survival and disease-free survival lung metastasis surgery by studying the different variables that determine them.
[show abstract][hide abstract] ABSTRACT: Spontaneous pneumothorax is an extremely frequent pathology. Despite this, there is still no clear consensus on managing these patients. Therefore, we perform a systematic review and meta-analysis of the effectiveness of percutaneous aspiration compared with tube drainage for treating idiopathic spontaneous pneumothorax. Controlled, randomised clinical trials were selected, in which the effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission. Relevant articles were identified by searching electronic databases (e.g., Medline, EMBASE, CENTRAL, mRCT and Pascal), as well as the references of the papers found in this manner, with a cut-off date of April 2009. Quality was assessed by two independent evaluators, using the CASPe appraisal tool. Effectiveness of percutaneous aspiration is compared with that of chest tube drainage, in terms of resolution of the pneumothorax and rates of relapse and hospital admission.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 05/2010; 37(5):1129-35. · 2.40 Impact Factor
[show abstract][hide abstract] ABSTRACT: In the treatment of primary spontaneous pneumothorax (PSP) the latest guidelines rec-ommend video-assisted thoracoscopy, but do not specify the best technique for performing pleurodesis. Indeed, there are no clinical trials comparing the effectiveness of talc pleurode-sis, mechanical pleurodesis and pleurectomy. Our objective was to compare outcomes in patients who underwent surgery for primary pneumothorax with the talc procedure or with pleural abrasion using dry gauze. Patients undergoing video-assisted thoracoscopic sur-gery for PSP in two hospitals were retrospec-tively recruited between 2007 and 2008, and followed-up until December 2010. The vari-ables measured to compare the outcomes were: recurrence, complications, and mortality, as well as the duration of air leaks and of drainage and the length of postoperative hos-pital stay (in days). Statistical analysis: The two groups were compared using the Chi square test for qualitative variables and non-parametric tests for continuous variables. A total of 106 interventions were carried out in 104 patients (74 in group A: pleural abrasion with dry gauze; 32 in group B: chemical pleu-rodesis with talc), with a mean age of 28 years (median 25) and 85.6% were male. Complications were observed in nine patients (8.5%) and there were no deaths in the 30 days after surgery; there were, however, four cases of recurrence (3.8%). The mean air leak dura-tion was 0.78 days (median 0), the mean drainage duration 1.95 days (median 1) and the mean length of postoperative hospital stay 2.68 days (median 2). In 74 cases (69.8%), mechanical pleurodesis was performed, while 32 cases were treated with talc (30.2%). Comparing the two groups, we did not find sta-tistically significant differences in recurrence (4.1% vs 3.1%, P=0.82), complications (6.8% vs 12.5%, P=0.45) or mortality (no cases of death). On the other hand, the mean postoper-ative hospital stay was lower in the mechanical pleurodesis group than in the talc group (2.2 vs 3.8 days, P=0.005). Video-assisted surgery in the treatment of PSP is a safe technique. In the mechanical pleurodesis group, we observed the same rate of recurrence, half the number of complications and a shorter hospital stay. We consider it necessary that well-designed multicentre clinical trials be carried out to compare these techniques and determine which produces the best outcomes, providing stronger scientific evidence given that the data available to date are not conclusive.