Article information
Resumen
Este trabajo se basa en el análisis de distintas publicaciones relacionadas con la estadificación y el tratamiento quirúrgico de procesos neoplásicos pulmonares primitivos y metastásicos. En los pacientes con carcinoma broncogénico, determinar la afectación ganglionar resulta imprescindible para programar un tratamiento adecuado. La indicación y la secuencia del procedimiento a emplear (tomografía computarizada, tomografía por emisión de positrones, punción transbronquial, punción aspirativa transbronquial guiada por ultrasonidos, videomediastinoscopia, mediastinotomía anterior, videotoracoscopia) se evalúan en razón de la sensibilidad, la especificidad y el valor predictivo positivo y negativo de los distintos métodos.
Otro reto de interés es la definición del criterio de indicación de una resección sublobar en determinados tumores y pacientes. Se analizan distintos factores, como la edad, la función pulmonar, la localización tumoral y el tipo de resección sublobar. También se consideran los niveles de evidencia y los grados de recomendación del procedimiento.
En el tratamiento de metástasis pulmonares de carcinoma colorrectal, la resección quirúrgica es una opción terapéutica aceptada. Se analiza de forma pormenorizada su indicación, basada en la obtención de tasas aceptables de supervivencia y el conocimiento de la repercusión de distintos factores pronósticos (intervalo libre de enfermedad, número de metástasis, presencia de metástasis hepáticas, presencia de afectación ganglionar, o valores preoperatorios elevados de antígeno carcinoembrionario).
Palabras clave:
Mediastinoscopia
Mediastinoscopia extendida
EBUS-TBNA
Resección sublobar
Metastasectomía pulmonar
Abstract
An analysis is made of different publications associated with the surgical staging and treatment of primary and metastasic pulmonary neoplastic processes. A suitable treatment program is essential to determine lymph node involvement in patients with bronchogenic carcinoma. The indication and sequence of the procedure to use (CT-PET, transbronchial puncture, videomediastinoscopic ultrasound guided transbronchial needle aspiration) is evaluated in accordance to the sensitivity, specificity and positive and negative predictive value of the different methods.
Another interesting challenge is to define the criteria for indicating a sublobar resection in certain tumours and patients. Different factors, age, lung function, tumour location and type of sublobar resection, are analysed. Levels of evidence and recommendations of the procedure are also considered.
Surgical resection is an accepted therapeutic option in the treatment of colorectal cancer lung metastases. Its indication is based on acceptable survival rates and knowledge of the impact of various factors (interval free of disease, number of metastases, presence of liver metastasis, presence of lymph node involvement, or increased pre-operative levels of carcinoembryonic antigen), is analysed in detail.
Keywords:
Mediastinoscopy
Extended mediastinoscopy
EBUS-TBNA
Sublobar resection
Pulmonary metastasectomy
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