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Gómez Hernández MT, Novoa Valentín NM, Embún Flor R, Varela Simó G, Jiménez López MF. Predictive factors of prolonged postoperative length of stay after anatomic pulmonary resection. Cir Esp 2023; 101:43-50. [PMID: 35787477 DOI: 10.1016/j.cireng.2022.06.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/21/2021] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The objective of this study is to create a predictive model of prolonged postoperative length of stay (PLOS) in patients undergoing anatomic lung resection, to validate it in an external series and to evaluate the influence of PLOS on readmission and 90-day mortality. METHODS All patients registered in the GEVATS database discharged after the intervention were included. We define PLOS as the postoperative stay in days above the 75th percentile of stay for all patients in the series. A univariate and multivariate analysis was performed using logistic regression and the model was validated in an external cohort. The possible association between PLOS and readmission and mortality at 90 days was analyzed. RESULTS 3473 patients were included in the study. The median postoperative stay was 5 days (IQR: 4-7). 815 patients had PLOS (≥8 days), of which 79.9% had postoperative complications. The final model included as variables: age, BMI, male sex, ppoFEV1%, ppoDLCO% and thoracotomy; the AUC in the referral series was 0.684 (95% CI: 0.661-0.706) and in the validation series was 0.73 (95% CI: 0.681-0.78). A significant association was found between PLOS and readmission (p < .000) and 90-day mortality (p < .000). CONCLUSIONS The variables age, BMI, male sex, ppoFEV1%, ppoDLCO% and thoracotomy affect PLOS. PLOS is associated with an increased risk of readmission and 90-day mortality. 20% of PLOS are not related to the occurrence of postoperative complications.
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Affiliation(s)
- María Teresa Gómez Hernández
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Universidad de Salamanca, Salamanca, Spain.
| | - Nuria M Novoa Valentín
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Universidad de Salamanca, Salamanca, Spain
| | - Raúl Embún Flor
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, Spain; Servicio de Cirugía Torácica, Hospital Universitario Lozano Blesa, Zaragoza, Spain; Instituto de Investigación Sanitaria Aragón (IIS Aragón), Zaragoza, Spain
| | | | - Marcelo F Jiménez López
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain; Instituto de Investigación Biomédica de Salamanca (IBSAL), Salamanca, Spain; Universidad de Salamanca, Salamanca, Spain
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Gómez Hernández MT, Novoa Valentín NM, Fuentes Gago MG, Embún Flor R, Gómez de Antonio D, Jiménez López MF. Predictive factors of pathological complete response after induction (ypT0N0M0) in non-small cell lung cancer and short-term outcomes: Results of the Spanish Group of Video-assisted Thoracic Surgery (GE-VATS). Cir Esp 2022; 100:345-351. [PMID: 35643356 DOI: 10.1016/j.cireng.2022.05.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 01/18/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION To analyze the predictors of pCR in NSCLC patients who underwent anatomical lung resection after induction therapy and to evaluate the postoperative results of these patients. METHODS All patients prospectively registered in the database of the GE-VATS working group undergone anatomic lung resection by NSCLC after induction treatment and recruited between 12/20/2016 and 3/20/2018 were included in the study. The population was divided into two groups: patients who obtained a complete pathological response after induction (pCR) and patients who did not obtain a complete pathological response after induction (non-pCR). A multivariate analysis was performed using a binary logistic regression to determine the predictors of pCR and the postoperative results of patients were analyzed. RESULTS Of the 241 patients analyzed, 36 patients (14.9%) achieved pCR. Predictive factors for pCR are male sex (OR: 2.814, 95% CI: 1.015-7.806), histology of squamous carcinoma (OR: 3.065, 95% CI: 1.233-7.619) or other than adenocarcinoma (OR: 5.788, 95% CI: 1.878-17.733) and induction therapy that includes radiation therapy (OR: 4.096, 95% CI: 1.785-9.401) and targeted therapies (OR: 7.625, 95% CI: 2.147-27.077). Prevalence of postoperative pulmonary complications was higher in patients treated with neoadjuvant chemo-radiotherapy (p = 0.032). CONCLUSIONS Male sex, histology of squamous carcinoma or other than ADC, and induction therapy that includes radiotherapy or targeted therapy are positive predictors for obtaining pCR. Induction chemo-radiotherapy is associated with a higher risk of postoperative pulmonary complications.
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Affiliation(s)
| | | | - Marta G Fuentes Gago
- Servicio de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
| | - Raúl Embún Flor
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet and Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón, Universidad de Zaragoza, Zaragoza, Spain
| | - David Gómez de Antonio
- Servicio de Cirugía Torácica, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
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Gómez Hernández MT, Novoa Valentín NM, Fuentes Gago MG, Embún Flor R, Gómez de Antonio D, Jiménez López MF. Predictive factors of pathological complete response after induction (ypT0N0M0) in non-small cell lung cancer and short-term outcomes: results of the Spanish Group of Video-assisted Thoracic Surgery (GE-VATS). Cir Esp 2021; 100:S0009-739X(21)00039-7. [PMID: 33640140 DOI: 10.1016/j.ciresp.2021.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/08/2021] [Accepted: 01/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION To analyze the predictors of pathological complete response (pCR) in not small cells lung carcinoma (NSCLC) patients who underwent anatomical lung resection after induction therapy and to evaluate the postoperative results of these patients. METHODS All patients prospectively registered in the database of the GE-VATS working group undergone anatomic lung resection by NSCLC after induction treatment and recruited between December 20th 2016, and March 20th 2018, were included in the study. The population was divided into two groups: patients who obtained a complete pathological response after induction (pCR) and patients who did not obtain a complete pathological response after induction (non-pCR). A multivariate analysis was performed using a binary logistic regression to determine the predictors of pCR and the postoperative results of patients were analyzed. RESULTS Of the 241 patients analyzed, 36 patients (14.9%) achieved pCR. Predictive factors for pCR are male sex (OR 2.814, 95% CI 1.015-7.806), histology of squamous carcinoma (OR 3.065, 95% CI 1.233-7.619) or other than adenocarcinoma (ADC) (OR 5.788, 95% CI 1.878-17.733) and induction therapy that includes radiation therapy (OR 4.096, 95% CI 1.785-9.401) and targeted therapies (OR 7.625, 95% CI 2.147-27.077). Prevalence of postoperative pulmonary complications was higher in patients treated with neoadjuvant chemo-radiotherapy (p = 0.032). CONCLUSIONS Male sex, histology of squamous carcinoma or other than ADC, and induction therapy that includes radiotherapy or targeted therapy are positive predictors for obtaining pCR. Induction chemo-radiotherapy is associated with a higher risk of postoperative pulmonary complications.
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Affiliation(s)
| | | | - Marta G Fuentes Gago
- Servicio de Cirugía Torácica. Hospital Universitario de Salamanca, Salamanca, España
| | - Raúl Embún Flor
- Servicio de Cirugía Torácica. Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, Instituto de Investigación Sanitaria Aragón. Universidad de Zaragoza, Zaragoza, España
| | - David Gómez de Antonio
- Servicio de Cirugía Torácica. Hospital Universitario Puerta de Hierro, Majadahonda, España
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Ordóñez Lozano PA, Royo Crespo I, Muñoz-González N, Embún Flor R. Second Lung Lobectomies: Are They Safe And Feasible? Arch Bronconeumol 2017; 54:227-228. [PMID: 29102339 DOI: 10.1016/j.arbres.2017.08.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Revised: 08/08/2017] [Accepted: 08/11/2017] [Indexed: 10/18/2022]
Affiliation(s)
| | - Iñigo Royo Crespo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España
| | - Nadia Muñoz-González
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Raúl Embún Flor
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, España
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Villar Álvarez F, Muguruza Trueba I, Belda Sanchis J, Molins López-Rodó L, Rodríguez Suárez PM, Sánchez de Cos Escuín J, Barreiro E, Borrego Pintado MH, Disdier Vicente C, Flandes Aldeyturriaga J, Gámez García P, Garrido López P, León Atance P, Izquierdo Elena JM, Novoa Valentín NM, Rivas de Andrés JJ, Royo Crespo Í, Salvatierra Velázquez Á, Seijo Maceiras LM, Solano Reina S, Aguiar Bujanda D, Avila Martínez RJ, de Granda Orive JI, de Higes Martinez E, Diaz-Hellín Gude V, Embún Flor R, Freixinet Gilart JL, García Jiménez MD, Hermoso Alarza F, Hernández Sarmiento S, Honguero Martínez AF, Jimenez Ruiz CA, López Sanz I, Mariscal de Alba A, Martínez Vallina P, Menal Muñoz P, Mezquita Pérez L, Olmedo García ME, Rombolá CA, San Miguel Arregui I, de Valle Somiedo Gutiérrez M, Triviño Ramírez AI, Trujillo Reyes JC, Vallejo C, Vaquero Lozano P, Varela Simó G, Zulueta JJ. Executive Summary of the SEPAR Recommendations for the Diagnosis and Treatment of Non-small Cell Lung Cancer. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2016.02.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Villar Álvarez F, Muguruza Trueba I, Belda Sanchis J, Molins López-Rodó L, Rodríguez Suárez PM, Sánchez de Cos Escuín J, Barreiro E, Borrego Pintado MH, Disdier Vicente C, Flandes Aldeyturriaga J, Gámez García P, Garrido López P, León Atance P, Izquierdo Elena JM, Novoa Valentín NM, Rivas de Andrés JJ, Royo Crespo Í, Salvatierra Velázquez Á, Seijo Maceiras LM, Solano Reina S, Aguiar Bujanda D, Avila Martínez RJ, de Granda Orive JI, de Higes Martinez E, Diaz-Hellín Gude V, Embún Flor R, Freixinet Gilart JL, García Jiménez MD, Hermoso Alarza F, Hernández Sarmiento S, Honguero Martínez AF, Jimenez Ruiz CA, López Sanz I, Mariscal de Alba A, Martínez Vallina P, Menal Muñoz P, Mezquita Pérez L, Olmedo García ME, Rombolá CA, San Miguel Arregui I, de Valle Somiedo Gutiérrez M, Triviño Ramírez AI, Trujillo Reyes JC, Vallejo C, Vaquero Lozano P, Varela Simó G, Zulueta JJ. Executive summary of the SEPAR recommendations for the diagnosis and treatment of non-small cell lung cancer. Arch Bronconeumol 2016; 52:378-88. [PMID: 27237592 DOI: 10.1016/j.arbres.2016.02.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 02/07/2023]
Abstract
The Thoracic Surgery and Thoracic Oncology groups of the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) have backed the publication of a handbook on recommendations for the diagnosis and treatment of non-small cell lung cancer. Due to the high incidence and mortality of this disease, the best scientific evidence must be constantly updated and made available for consultation by healthcare professionals. To draw up these recommendations, we called on a wide-ranging group of experts from the different specialties, who have prepared a comprehensive review, divided into 4 main sections. The first addresses disease prevention and screening, including risk factors, the role of smoking cessation, and screening programs for early diagnosis. The second section analyzes clinical presentation, imaging studies, and surgical risk, including cardiological risk and the evaluation of respiratory function. The third section addresses cytohistological confirmation and staging studies, and scrutinizes the TNM and histological classifications, non-invasive and minimally invasive sampling methods, and surgical techniques for diagnosis and staging. The fourth and final section looks at different therapeutic aspects, such as the role of surgery, chemotherapy, radiation therapy, a multidisciplinary approach according to disease stage, and other specifically targeted treatments, concluding with recommendations on the follow-up of lung cancer patients and surgical and endoscopic palliative interventions in advanced stages.
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Affiliation(s)
| | | | - José Belda Sanchis
- Servicio de Cirugía Torácica, Hospital Universitari Mútua Terrassa, España
| | | | | | | | - Esther Barreiro
- Grupo de Investigación en Desgaste Muscular y Caquexia en Enfermedades Crónicas Respiratorias y Cáncer de Pulmón, Instituto de Investigación del Hospital del Mar (IMIM)-Hospital del Mar, Departamento de Ciencias Experimentales y de la Salud (CEXS), Universidad Pompeu Fabra, Parc de Recerca Biomèdica de Barcelona (PRBB); Centro de Investigación en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Barcelona. España
| | | | | | - Javier Flandes Aldeyturriaga
- Unidad de Broncoscopias y Neumología Intervencionista, Servicio de Neumología, ISS Fundación Jiménez Díaz, UAM, CIBERES, Madrid, España
| | - Pablo Gámez García
- Servicio de Cirugía Torácica, Hospital Universitario 12 de Octubre, Madrid, España
| | - Pilar Garrido López
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Pablo León Atance
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, España
| | | | | | - Juan José Rivas de Andrés
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | - Íñigo Royo Crespo
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | | | | | | | - David Aguiar Bujanda
- Servicio de Oncología Médica, Hospital Universitario de Gran Canaria «Dr. Negrín», España
| | | | | | | | | | - Raúl Embún Flor
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | | | | | | | | | | | | | - Iker López Sanz
- Servicio de Cirugía Torácica, Hospital Universitario Donostia, España
| | | | - Primitivo Martínez Vallina
- Hospital Universitario Miguel Servet, Hospital Clínico Universitario Lozano Blesa e IIS Aragón, Zaragoza, España
| | - Patricia Menal Muñoz
- Servicio de Radiología, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Laura Mezquita Pérez
- Servicio de Oncología Médica, Hospital Universitario Ramón y Cajal, Madrid, España
| | | | - Carlos A Rombolá
- Servicio de Cirugía Torácica, Complejo Hospitalario Universitario de Albacete, España
| | - Iñigo San Miguel Arregui
- Servicio de Oncología Radioterápica, Hospital Universitario de Gran Canaria «Dr. Negrín», España
| | - María de Valle Somiedo Gutiérrez
- Unidad de Broncoscopias y Neumología Intervencionista, Servicio de Neumología, ISS Fundación Jiménez Díaz, UAM, CIBERES, Madrid, España
| | | | | | - Carmen Vallejo
- Servicio de Oncología Radioterápica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - Paz Vaquero Lozano
- Unidad de Tabaquismo, Servicio de Neumología H.G.U. Gregorio Marañón, Madrid, España
| | - Gonzalo Varela Simó
- Servicio de Cirugía Torácica, Complejo Asistencial Universitario de Salamanca, España
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Freixinet Gilart J, Varela Simó G, Rodríguez Suárez P, Embún Flor R, de Andrés JJR, de la Torre Bravos M, Molins López-Rodó L, Pac Ferrer J, Izquierdo Elena JM, Baschwitz B, López de Castro PE, Fibla Alfara JJ, Hernando Trancho F, Carvajal Carrasco Á, Canalís Arrayás E, Salvatierra Velázquez Á, Canela Cardona M, Torres Lanzas J, Moreno Mata N. Benchmarking in Thoracic Surgery. Third Edition. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.arbr.2016.02.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Recuero Díaz JL, Rivas de Andrés JJ, Embún Flor R, Royo Crespo Í, Ramírez Gil E. Outcomes of pulmonary resection in single-lung patients. Cir Esp 2015; 93:589-93. [PMID: 26277461 DOI: 10.1016/j.ciresp.2015.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 05/19/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND After pneumonectomy, the development of a new lung cancer or a recurrence in the residual lung is a challenge. Surgery often is considered contraindicated. The goal of our study is to assess the morbidity and mortality of lung resection on a single lung. METHODS All patients who underwent lung resection after pneumonectomy from January 1996 through December 2012 were reviewed. RESULTS There were 12 patients (10 men and 2 women). Mean age was 71 years (range, 54-81 years). Mean preoperative FEV1 was 1,470 ml (52%) and preoperative FVC 2,153 ml (61,5%). Subsequent pulmonary resection was performed after a median follow-up of 34,5 months. Wedge resection was performed in all patients. Diagnosis was pulmonary mestastatic lung cancer in 2 patients, metachronous lung cancer in 6, metastatic extrathoracic cancer in 3 and benign nodule in one. Complications occurred in 4 patients (33,4%) while operative mortality was nil. CONCLUSIONS Lung resection on a single lung is a safe procedure associated with acceptable morbidity and mortality. Careful patient selection is very important.
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Affiliation(s)
- José Luis Recuero Díaz
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, España; Servicio de Cirugía Torácica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
| | - Juan José Rivas de Andrés
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, España; Servicio de Cirugía Torácica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Raúl Embún Flor
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, España; Servicio de Cirugía Torácica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Íñigo Royo Crespo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, España; Servicio de Cirugía Torácica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Elena Ramírez Gil
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, España; Servicio de Cirugía Torácica, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
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Royo Crespo I, Rivas de Andrés JJ, Embún Flor R, Cortés Franco S. Chondroid chordoma in an atypical location. Arch Bronconeumol 2013; 49:491-3. [PMID: 23791243 DOI: 10.1016/j.arbres.2013.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 03/12/2013] [Accepted: 03/13/2013] [Indexed: 10/26/2022]
Abstract
Chondroid chordoma is an extremely rare tumour with an annual incidence of around 0.1 cases per 100,000population. Involvement of the thoracic vertebrae may be present in 2-5% of cases. Definitive diagnosis usually requires a suitable distinction between this and other mesenchymal tumours such as chondrosarcomas, so immunohistochemical analysis is virtually mandatory. In spite of its slow-growing nature, chondroid chordoma tends to relapse, and it may eventually become malignant, often jeopardising the patient's prognosis. Although surgery remains the main therapeutic approach, research into the molecular and genetic aspects of this tumour is ongoing. These new advances are likely to improve future oncology therapies by complementing surgery and radiotherapy, changing the currently poor prognosis. We report the case of a patient with a chondroid chordoma involving the thoracic vertebrae and pleural cavity, and the treatment performed.
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Affiliation(s)
- Iñigo Royo Crespo
- Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet y Hospital Clínico Universitario Lozano Blesa, Zaragoza, España.
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Royo Crespo I, Embún Flor R, Ramírez Gil E, Menal Muñoz P, Alvarez Alegret R. [Spontaneous haemothorax after rupture of an intercostal artery aneurysm]. Cir Esp 2009; 86:317-9. [PMID: 19524879 DOI: 10.1016/j.ciresp.2008.09.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Accepted: 09/25/2009] [Indexed: 11/16/2022]
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