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      Resultados del tratamiento quirúrgico del cáncer de pulmón de células no pequeñas, estadio III

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          Abstract

          Con el objetivo de evaluar los resultados del tratamiento quirúrgico en los pacientes con cáncer primario del pulmón de células no pequeñas, en el estadio III A, se estudiaron a los enfermos operados en el Servicio de Cirugía General del Hospital Clinicoquirúrgico "Hermanos Ameijeiras", desde enero de 1995 hasta enero del 2000. Para el análisis se usaron técnicas descriptivas y pruebas de hipótesis; la muestra estuvo constituida por 44 pacientes, 18 mujeres y 26 hombres. El 90,1 % tenía más de 50 años. La incisión axilovertical se uso en el 81,8 %. La neoplasia se localizó en el pulmón derecho en el 59,1 % y el 47,7 % tuvo una posición central. La neumonectomía alcanzó el 50 %. Se apreció el 13,6 % de accidentes quirúrgicos. Las complicaciones respiratorias predominaron al alcanzar el 20,4 %, y fue la mortalidad posoperatoria del 18,9 %. Hubo relación estadística significativa (p < 0,05) entre la mortalidad con las complicaciones, y el hábito de fumar, debiéndose fortalecer la fisioterapia respiratoria preoperatoria, trans y posoperatoria

          Translated abstract

          The patients with stage III-A non-small-cell-lung primary cancer that were operated on at the General Surgery Service of "Hermanos Ameijeiras" Clinical and Surgical Hospital from January, 1995, to January, 2000, were studied aimed at evaluating the results of the surgical treatment. Descriptive techniques and hypothesis testing were used for this analysis. The sample consisted of 44 patients: 18 women and 26 men. 90.1 % were over 50. The axilovertical incision was made in 81.8 %. The neoplasia was located in the right lung in 59.1 %, whereas 47.7 % were located in the center. Pneumonectomy was performed in 50 %. There was 13.6 % of surgical accidents. Respiratory complications prevailed with 20.4 %. A postoperative mortality of 18.9 % was observed. There was a significant statistical relation (p< 0.05) between mortality from complications and smoking. The pre-, trans- and postoperative respiratory physiotherapy should be strengthened

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          Pneumonectomy for malignant disease: factors affecting early morbidity and mortality.

          The purpose of this report is to analyze factors affecting morbidity and mortality after pneumonectomy for malignant disease. We retrospectively reviewed the cases of all patients who underwent pneumonectomy for malignancy at the Mayo Clinic. Between January 1, 1985, and September 30, 1998, 639 patients (469 men and 170 women) were identified. Median age was 64 years (range 20 to 86 years). Indication for pneumonectomy was primary lung cancer in 607 (95.0%) patients and metastatic disease in 32 (5.0%). Factors affecting morbidity and mortality were analyzed by univariate and multivariate analysis. Cardiopulmonary complications occurred in 245 patients (38.3%; 95% confidence interval 34.6%-42.2%). Factors adversely affecting morbidity with univariate analysis included age (P <.0001), male sex (P =.04), associated respiratory (P =.02) or cardiovascular disease (P <.0001), cigarette smoking (P =.02), decreased vital capacity (P =.01), forced expiratory volume in 1 second (P <.0001), forced vital capacity (P =.002), diffusion capacity of the lung to carbon monoxide (P =.005), oxygen saturation (P <.05), arterial PO (2) (P =.007), preoperative radiation (P =.02), bronchial stump reinforcement (P =.007), crystalloid infusion (P =.01), and blood transfusion (P =.02). Factors adversely affecting morbidity with multivariate analysis included age (P =.0001), associated cardiovascular disease (P =.001), and bronchial stump reinforcement (P =.0005). There were 45 deaths (7.0%; 95% confidence intervals 5.2%-9.3%). Factors adversely affecting mortality with univariate analysis included associated cardiovascular (P <.0001) or hematologic disease (P <.005), lower preoperative serum hemoglobin level (P =.004), preoperative chemotherapy (P =.01), decreased diffusion capacity of lung to carbon monoxide (P =.002), right pneumonectomy (P =.0006), extended resection (P =.04), bronchial stump reinforcement (P =.007), and crystalloid infusion (P =.01). Factors affecting mortality with multivariate analysis included hematologic disease (P =.01), lower preoperative serum hemoglobin (P =.003), and completion pneumonectomy (P =.01). Multiple factors adversely affected morbidity and mortality after pneumonectomy for malignant disease. Appropriate selection and meticulous perioperative care are paramount to minimize risks in those patients who require pneumonectomy.
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            Surgery

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              Empyema and bronchopleural fistula after pneumonectomy: factors affecting incidence.

              Factors affecting the incidence of empyema and bronchopleural fistula (BPF) after pneumonectomy were analyzed. All patients who underwent pneumonectomy at the Mayo Clinic in Rochester, Minnesota, from January 1985 to September 1998 were reviewed. There were 713 patients (514 males and 199 females). Ages ranged from 12 to 86 years (median 64 years). Indication for resection was primary malignancy in 607 patients (85.1%), metastatic disease in 32 (4.5%), and benign disease in 74 (10.4%). One hundred fifteen patients (16.1%) underwent completion pneumonectomy. Factors affecting the incidence of postoperative empyema and BPF were analyzed using univariate and multivariate analysis. Empyema was documented in 53 patients (7.5%; 95% confidence interval [CI], 5.7% to 9.7%) and a BPF in 32 (4.5%; 95% CI, 3.1% to 6.3%). Univariate analysis demonstrated that the development of empyema was adversely affected by benign disease (p = 0.0001), lower preoperative forced expiratory volume in 1 second (FEV1; p < 0.01) and diffusion capacity of lung to carbon monoxide (DLCO; p = 0.0001), lower preoperative serum hemoglobin (p = 0.05), right pneumonectomy (p = 0.0109), bronchial stump reinforcement (p = 0.007), completion pneumonectomy (p < 0.01), timing of chest tube removal (p = 0.01), and the amount of blood transfusions (p < 0.01). Similarly, the development of BPF was significantly associated with benign disease (p = 0.03), lower preoperative FEV1 (p = 0.03) and DLCO (p = 0.01), right pneumonectomy (p < 0.0001), bronchial stump reinforcement (p = 0.03), timing of chest tube removal (p = 0.004), increased intravenous fluid in the first 12 hours (p = 0.04), and blood transfusions (p = 0.04). Bronchial stump closure with staples had a protective effect against BPF compared with suture closure (p = 0.009). No risk factors were identified as being jointly significant in multivariate analysis. Multiple perioperative factors were associated with an increased incidence of empyema and BPF after pneumonectomy. Prophylactic reinforcement of the bronchial stump with viable tissue may be indicated in those patients suspected at higher risk for either empyema or BPF.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                cir
                Revista Cubana de Cirugía
                Rev Cubana Cir
                Editorial Ciencias Médicas (Ciudad de la Habana )
                1561-2945
                March 2003
                : 42
                : 1
                : 0
                Affiliations
                [1 ] Hospital Clínico Quirúrgico Hermanos Ameijeiras Cuba
                Article
                S0034-74932003000100004
                688943e9-a99f-4b07-9243-74589c950418

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Cuba

                Self URI (journal page): http://scielo.sld.cu/scielo.php?script=sci_serial&pid=0034-7493&lng=en
                Categories
                SURGERY

                Surgery
                CARCINOMA,NON-SMALL-CELL-LUNG,PNEUMONECTOMY,EPIDEMIOLOGY, DESCRIPTIVE,HYPOTHESIS TESTING,CARCINOMA DEL PULMON DE CELULA NO PEQUEÑA,NEUMONECTOMIA,EPIDEMIOLOGIA DESCRIPTIVA,PRUEBAS DE HIPOTESIS

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