[Pionnering figures of Spanish chest surgery].
Explore the source record for details and available documents.
History, 19th Century↗
Biomedical subjects
F París Romeu
Publications and source records attributed to F París Romeu.
[Postoperative survival in stage II non-small-cell bronchogenic carcinoma].
OBJECTIVE: This study aimed to validate in our population changes in the stage II criteria for non-small cell bronchogenic carcinoma. PATIENTS AND METHODS: We retrospectively reviewed and followed the course of disease in 336 patients who underwent complete resection in our hospital between January 1969 and December 1995 with stage II disease, classified as T1N1M0 (41), T2N1M0 (144) and T3N0M0 (151). RESULTS: The expected five-year survival in our population was 43.19 +/- 2.90%. Estimated mean survival was 3 +/- 0.71 years (95% confidence interval: 1.60-4.40). Mean survival was 8.82 +/- 0.67 years (95% confidence interval 7.51-10.13). Five-year survival was 53.32 +/- 8.55% for tumors classified as T1N1M0, 38.57 +/- 4.40% for T2N1M0, and 44.46 +/- 4.30% for T3N0M0. We observed significant differences in survival depending on histological type, tumor size, and IIA or IIB staging, degree of tumor invasion (T), number of nodes involved (N1) and location. T3N0M0 tumors displayed great variation in expected survival rates in relation to structures involved (27.53% to 59.98%). Multivariate analysis confirmed degree of tumor invasion, size and histological type to be the main prognostic factors. CONCLUSIONS: We conclude that the new staging system gives a more realistic prognosis for patients in our practice. The stage IIA and IIB division is appropriate and gives significantly different prognoses. However, the T3N0M0 category is heterogeneous and is not significantly different from T1-2N1M0, such that stage II overall continues to be an indivisible, homogeneous group of patients. Other prognostic variables, such as histological type, affect survival in our patients.
Adult↗
[Prognosis of T3N0M0 small-cell non-anaplastic bronchogenic carcinoma].
We analyzed the survival after surgery for non-small cell lung cancer (NSCLC) classified as T3N0. Between January 1969 and 1995, 151 patients underwent surgery for NSCLC in our hospital. Survival analysis was performed using the Kaplan-Meier statistical method and the curves were compared using Mantel-Cox, Breslow and Tarone-Ware tests. The estimated five-year survival in the studied population was 44.46 +/- 4.30%. Four groups were defined based on degree of tumoral invasion of mediastinal structures, parietal pleura, chest wall or superior sulcus. Significant differences in five-year survival were observed between groups. Patients in the mediastinal group (59.98 +/- 8.71%) had the best prognosis, followed by patients with parietal pleura involvement (52.79 +/- 6.69%). Survival in the chest wall group was 27.53 +/- 7.22%. No patients with superior sulcus tumors survived over five years (median survival 1.50 +/- 1.16 years; 95% confidence interval 0.00 to 3.77 years). Prognosis is clearly determined by degree of tumoral invasion in T3N0 patients. In spite of the evident conceptual improvements achieved with the revised International Staging System, the system still fails to fully define prognosis in such cases.
Carcinoma, Bronchogenic↗
[The indications for and results of video thoracoscopic surgery. Reflections on 152 procedures].
Since thoracoscopy was first described in 1910, its application has been confined mainly to diagnosis and symptomatic treatment of pleural diseases. Recent technological advances in endoscopy and the refinement of surgical technique have brought wider applications, giving rise to video-assisted thoracoscopy (VAT). VAT surgery allows us to view, access and act upon internal thoracic organs without recourse to thoracotomy, thus circumventing inherent risk. We have reviewed our experience from April 1994 through November 1998 in 152 procedures with 141 consecutive patients. Diagnoses were pneumothorax in 94 cases, sympathetic nervous system alteration in 10, diffuse lung disease in 10, lung tumors in 9, pulmonary metastasis in 4, pleural tumors in 5, mediastinal tumors in 2, pericardial effusion in 2, spinal disease in 2 and chronic pancreatitis in 1. No deaths associated with the procedure occurred. The incidence of non-fatal postoperative complication was 11%. The most common complications were prolonged air leak (5%) and bloody pleural effusion (3.5%). The mean length of postoperative hospital care was 3.8 days (range 1 to 18 days). Our experience indicates that VAT is increasingly used to diagnose and treat a variety of chest lesions. Complications are fewer than in procedures in which thoracotomy is needed. Prolonged air leakage does not occur significantly more often with VAT than with thoracotomy. VAT is apparently safe and is particularly useful in some situations, as postoperative morbidity is low and clinical tolerance good.
Adolescent↗
[Cardiac hernia after intrapericardial pneumonectomy].
Cardiac herniation secondary to intrapericardial pneumonectomy is a rare complication, although its real incidence has surely been underestimated. We describe a patient with left cardiac herniation presenting after intrapericardial pulmonectomy for primary lung cancer. The signs were severe hemodynamic shock requiring additional surgery involving a wide opening in the pericardium. The outcome after surgery was fully satisfactory.
Carcinoma, Large Cell↗
[Benign acquired tracheoesophageal fistulas].
Benign acquired tracheoesophageal fistula (TEF) is a rare though serious occurrence associated with a high degree of morbidity and mortality. We review 18 cases of TEF treated over 16 years in our hospital. The variables analyzed descriptively were demographic (age, sex and others), clinical (etiology, time of intubation, time and symptoms leading to clinical suspicion, diagnostic techniques, and others), and therapeutic (dependence on mechanical ventilation, location of tissues, tracheal resection, tissue interposition, postoperative course of disease, and others). Fifteen of the 18 patients required surgery. The rate of success (80%) was high in terms of respiration, swallowing and phonation. Surgery involved simple closure of the TEF, with half the patients requiring a second operation to correct tracheal stenosis. Resection and anastomosis were performed in the remaining 11 cases, with only one requiring a second operation for recurrence of stenosis. Two cases of perioperative mortality and one TEF recurrence related to assisted ventilation were recorded. Tracheoscopy was the most effective diagnostic technique, complemented by computerized tomography of the trachea. Presurgical evaluation of tracheal stenosis, the absence of mechanical ventilation, preoperative preparation and postoperative care are the factors that determine success in this type of surgery. When tracheal stenosis is associated with TEF, resection and anastomosis should be performed in the affected zone.
Adolescent↗