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Vol. 41. Issue 2.
Pages 84-87 (February 2005)
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Vol. 41. Issue 2.
Pages 84-87 (February 2005)
Original Article
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Agreement Between Type of Lung Resection Planned and Resection Subsequently Performed on Lung Cancer Patients
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G. Varela
Corresponding author
gvs@usal.es

Correspondence: Dr. G. Varela. Sección de Cirugía Torácica. Hospital Universitario. P.° San Vicente, 58. 37007 Salamanca. España
, M.F. Jiménez, N. Novoa, J.L. Aranda
Sección de Cirugía Torácica, Hospital Universitario de Salamanca, Salamanca, Spain
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Abstract
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Objective

TO assess agreement between planned lung resections and the type subsequently performed on a series of patients, to assess whether tumor location (central or peripheral) affected the degree of discrepancy, and, in the case of unscheduled pneumonectomies, to examine why the planned resection had to be extended.

Method

Prospective, observational clinical study of 199 patients scheduled for lung cancer surgery. Tumors were preoperatively classified as central or peripheral, and the type of operation planned—lobectomy (or bilobectomy) or pneumonectomy—was compared with the operation finally performed. Rates of agreement and Wilks' lambda statistic were calculated.

Results

Twenty unscheduled pneumonectomies were performed. Agreement between planned and performed operations was found in 86.9% of cases (76.9% in central tumors and 95.4% in peripheral tumors). Wilks' lambda statistic was 0.38 (0.42 for central tumors and 0.17 for peripheral tumors). Seven unscheduled pneumonectomies were performed due to hilar node involvement.

Conclusions

The resections performed differed from the resections initially planned in 13% of the bronchial carcinoma operations, in most cases because the planned lobectomy had to be converted to pneumonectomy, a situation which occurred more often with central tumors and was more often due to direct invasion of anatomic structures rather than hilar spread.

Key Words:
Non-small cell lung cancer
Lung resection
Risk prediction
Objetivo

Cuantificar la concordancia entre la cirugía de resección planeada y la efectuada en una serie de pacientes, evaluar si la localización del tumor (central o periférico) in-fluye en el grado de discrepancia encontrado y valorar, en los casos de neumonectomías no programadas, la causa que obligó a ampliar la resección prevista.

Métodos

Estudio clínico prospectivo observacional en 199 pacientes programados para intervención quirúrgica por cáncer de pulmón. Se clasificaron los tumores preopera-toriamente como centrales o periféricos, y el tipo de intervención programada -lobectomía (o bilobectomía) o neumo-nectomía- se comparó con la efectuada. Se han calculado las tasas de concordancia y el estadístico lambda.

Resultados

Se practicaron 20 neumonectomías no programadas. Se encontró concordancia entre lo programado y lo efectuado en el 86,9% de los casos (un 76,9% en tumores centrales y un 95,4% en periféricos). El valor del estadístico lambda es de 0,38 (0,42 en tumores centrales y 0,17 en periféricos). En 7 ocasiones la neumonectomía no programada se debió a afectación ganglionar hiliar.

Conclusiones

En el 13% de los pacientes sometidos a cirugía por carcinoma bronquial, la resección efectuada no coincide con la que se había programado inicialmente, la mayor parte de las veces debido a la necesidad de efectuar una neumonectomía cuando se había previsto una lobectomía. Este hecho es más frecuente en los tumores centrales y es debido con más frecuencia a invasión directa de las es-tructuras ana tó micas que a extensión ganglionar hiliar.

Palabras clave:
Carcinoma bronquial no microcítico
Resección pulmonar
Predicción del riesgo quirúrgico
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Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
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