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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Bibliografía
[1.]
S. Call, R. Rami-Porta, M. Serra-Mitjans, R. Saumench, C. Bidegain, M. Iglesias, et al.
Extended cervical mediastinoscopy in the staging of bronchogenic carcinoma of the lung.
Eur J Cardiothoracic Surg, 34 (2008), pp. 1081-1084
[2.]
I. Garcia-Olivé, E. Monsó, F. Andreo, J. Sanz, E. Castellà, M. Llatjós, et al.
Sensitivity of linear endobronchial ultrasonographyand guided transbronchial needle aspiration for the identification of nodal metastases in lung cancer staging.
Ultrasound in Med and Biol, 35 (2009), pp. 1271-1273
[3.]
R. Rami-Porta, M. Tsuboi.
Sublobar resection for lung cancer.
Eur Respir J, 33 (2009), pp. 426-435
[4.]
R. Mongil Poce, C. Pagés Navarrete, J.A. Ruiz Navarrete, J. Roca Fernández, R. Arrabal Sánchez, A. Benítez Doménech, et al.
Análisis de supervivencia de la cirugía de resección de metástasis pulmonares de cáncer colorrectal.
Arch Bronconeumol, 45 (2009), pp. 235-239
[5.]
J. Kuzdzal, M. Zielinski, B. Papla, A. Szlubowski, L. Hauer, T. Nabialek, et al.
Transcervical extended mediastinal lymphadenectomy - the new operative technique and early results in lung cancer staging.
Eur J Cardiothorac Surg, 27 (2005), pp. 384-390
[6.]
C.F. Mountain, C.M. Dresler.
Regional lymph node classification for lungcancer staging.
Chest, 111 (1997), pp. 1718-1723
[7.]
D. Lardinois, P. De Leyn, P. Van Schil, R. Rami-Porta, D. Waller, B. Passlick, et al.
ESTS guidelines for intraoperative lymph node staging in non-small cell lung cancer.
Eur J Cardiothorac Surg, 30 (2006), pp. 787-792
[8.]
R.J. Ginsberg, T.W. Rice, M. Golberg, P.F. Walters, B.J. Schomocker.
Extended cervical mediastinoscopy. A single procedure for bronchogenic carcinoma of the left upper lobe.
J Thorac Cardiovasc Surg, 94 (1984), pp. 673-678
[9.]
J. Freixenet Guilart, P. Gámez García, P. Rodriguez de Castro, P. Rodriguez Suarez, N. Santana Rodriguez, A. Varela de Ugarte.
Extended cervical mediastinoscopy in the staging of bronchogenic carcinoma.
Ann Thorac Surg, 70 (2000), pp. 1641-1643
[10.]
R.J. Ginsber.
The role of preoperative surgical staging in left upper lobe tumors.
Ann Thorac Surg, 57 (1994), pp. 526-527
[11.]
L. López, A. Varela, J. Freixinet, S. Quevedo, J. López Pujol, F. Rodriguez de Castro, et al.
Extended cervical mediastinoscopy: prospective study of fifty cases.
Ann Thorac Surg, 57 (1994), pp. 555-558
[12.]
H. Kramer, H.J.M. Groen.
Current concepts in the mediastinal lymph node staging of nonsmall cell lung cancer.
Ann Surg, 238 (2003), pp. 180-188
[13.]
P. De Leyn, D. Lardinois, P.E. Van Schil, R. Rami-Porta, B. Passlick, M. Zielinski, et al.
ESTS guidelines for preoperative lymph node staging for non-small cell lung cancer.
Eur J Cardiothorac Surg, 32 (2007), pp. 1-8
[14.]
O. Birim, A.P. Kappetein, T. Stijnen, A.J. Bogers.
Meta-analysis of positron emission tomographic and computed tomographic imaging in detecting mediastinal lymph node metastases in non-small cell lung cancer.
Ann Thorac Surg, 79 (2005), pp. 375-382
[15.]
M. Hürtgen, G. Friedel, H. Tomes, P. Fritz.
Radical video-assisted mediastinoscopic lymphadenectomy (VAMLA)-technique and first results.
Eur J Cardiothorac Surg, 21 (2002), pp. 348-351
[16.]
A. López-Encuentra, J.L. Martín de Nicolás, L. Paz-Ares, A. Bartolomé, Por el Grupo Cooperativo de Carcinoma Broncogénico del Hospital Universitario 12 de Octubre de Madrid.
Tratamiento multimodal en el carcinoma broncogénico no microcítico (N2) clínico: ¿cuál es la respuesta?.
Arch Bronconeumol, 42 (2006), pp. 154
[17.]
R. Rami Porta, J. Belda Sanchis, M. Serra Mitjans.
Identificación del carcinoma broncogénico N0cy.
Arch Bronconeumol, 43 (2007), pp. 183
[18.]
F. Pozo-Rodriguez, J.L. Martín de Nicolas, M.A. Sanchez-Nistal, A. Maldonado, S. García de Barajas, R. Calero-García, et al.
Accuracy of helical computed tomography and [18F] fluorodeoxyglucose positron emission tomography for identifying lymph node mediastinal metastases in potentially resectable non-small-cell lung cancer.
J Clin Oncol, 23 (2005), pp. 8283-8285
[19.]
F.J.F. Herth, R. Eberhardt, P. Vilmann, M. Krasnik, A. Ernst.
Real time endobronchial ultrasound guided transbronchial needle aspiration for sampling mediastinal lymph nodes.
Thorax, 61 (2006), pp. 795-798
[20.]
F.J.F. Herth, R. Eberhardt, M. Krasnik, A. Ernst.
Endobronchial ultrasound-guided transbronchial needle aspiration of lymph nodes in the radiologically and positron emission tomography normal mediastinum in patients with lung cancer.
Chest, 133 (2008), pp. 887-891
[21.]
F.C. Detterbeck.
Please Lead, But Don’t Mislead.
Chest., 134 (2008), pp. 672
[22.]
B.F. Meyers, F. Haddad, B.A. Siegel, J.B. Zoole, R.J. Battafarano, N. Veeramachaneni, et al.
Cost-effectiveness of routine mediastinoscopy in computed tomography- and positron emission tomography-screened patients with stage I lung cancer.
J Thorac Cardiovasc Surg, 131 (2006), pp. 822-829
[23.]
F.C. Detterbeck.
Integration of mediastinal staging techniques for lung cancer.
Semin Thorac Cardiovasc Surg, 19 (2007), pp. 217-224
[24.]
R.C. Rintoul, K.G. Tournoy, H. El Daly, N.R. Carroll, R.C. Buttery, K. Van Kralingen, et al.
EBUS-TBNA for the clarification of PET positive intra-thoracic lymph nodes-an international multi-centre experience.
J Thorac Oncol., 4 (2009), pp. 776
[25.]
J.E.C. Holty, W.G. Kuschner, M.K. Gould.
Accuracy of transbronchial needly aspiration in the diagnosis and staging of non-small cell lung cancer: a metaanálisis.
Thorax, 60 (2005), pp. 949-955
[26.]
M. Mateu-Navarro, R. Rami-Porta, R. Bastus-Piulats, L. Cirera-Nogueras, G. González-Pont.
Remediastinoscopy after induction chemotherapy in non-small cell lung cancer.
Ann Thorac Surg, 70 (2000), pp. 391-395
[27.]
P. Van Schil, J. Van der Schoot, J. Poniewierski, M. Pauwels, L. Carp, P. Germonpré, et al.
Remediastinoscopy after neoadjuvant therapy for non-small cell lung cancer.
LungCancer, 37 (2002), pp. 281-285
[28.]
K. Larsen, M. Krasnik, P. Vilmann, G.K. Jacobsen, J.H. Pedersen, P. Faurschou, et al.
Endoscopic ultrasound guided biopsy of mediastinal lesions has a major impact on patient management.
Thorax, 57 (2002), pp. 98-103
[29.]
J.T. Annema, M. Veselic, M.I. Versteegh, L.N. Willems, K.F. Rabe.
Mediastinal restaging: EUS-FNA offers a new perspective.
Lung Cancer, 42 (2003), pp. 311-318
[30.]
R.J. Cerfolio, B. Ojha, A.S. Bryant, V. Raghuveer, J.M. Mountz, A.A. Bartolucci.
The accuracy of integrated PET/CT compared with dedicated PET alone for the staging of patients with non-small cell lung cancer.
Ann Thorac Surg, 78 (2004), pp. 1017-1023
[31.]
P. Goldstraw.
Selection of patients for surgery after induction chemotherapy for N2 non-small-cell lung cancer.
J Clin Oncol, 24 (2006), pp. 3317-3318
[32.]
T. Watanabe, A. Okada, T. Imakiire, T. Koike, T. Hirono.
Intentional limited resection for small peripheral lung cancer based on intraoperative pathologic exploration.
Jpn J Thorac Cardiovasc Surg, 53 (2005), pp. 29-35
[33.]
B. Mondello, M. Sibilio, A. Pavone, F. Monaco, F. Nunnari, V. Micali, et al.
“Intentionally” limited pulmonary resection versus lobectomy for the treatment of peripheral stage IA non-small cell lung cancers.
G Chir, 28 (2007), pp. 7-12
[34.]
C.M. Mery, A.N. Pappas, R. Bueno, Y.L. Colson, P. Linden, D.J. Sugarbaker, et al.
Similar long-term survival of elderly patients with non-small cell lung cancer treated with lobectomy or wedge resection within the Surveillance, Epidemiology, and End Results database.
Chest, 128 (2005), pp. 237-245
[35.]
F. Gonzalez-Aragoneses, N. Moreno Mata, C. Simon Adiego, R. Peñalver Pascual, G. Gonzalez Casaurran, L. Azacarate Perea.
Lung Cancer Surgery in the Elderly.
Crit Rev Oncol Hematol, 71 (2009), pp. 266-271
[36.]
M. Okada, K. Yoshikawa, T. Hatta, N. Tsubota.
Is segmentectomy with lymph node assessment an alternative to lobectomy for non-small cell lung cancer of 2 cm or smaller?.
Ann Thorac Surg, 71 (2001), pp. 956-961
[37.]
T. Koike, Y. Yamato, K. Yoshiya, T. Shimoyama, R. Suzuki.
Intentional limited pulmonary resection for peripheral T1N0M0 small-sized lung cancer.
J Thorac Cardiovasc Surg, 125 (2003), pp. 924-928
[38.]
D.L. Miller, C.M. Rowland, C. Deschamps, M.S. Allen, V.F. Trastek, P.C. Pairolero.
Surgical treatment of non-small cell lung cancer 1 cm or less in diameter.
Ann Thorac Surg, 73 (2002), pp. 1545-1551
[39.]
W. Sienel, C. Stremmel, A. Kirschbaum, L. Hinterberger, E. Stoelben, J. Hasse, et al.
Frequency of local recurrence following segmentectomy of stage IA nonsmall cell lung cancer is influenced by segment localisation and width of resection margins implications for patient selection for segmentectomy.
Eur J Cardiothorac Surg, 31 (2007), pp. 522-528
[40.]
A. El-Sherif, H.C. Fernando, R. Santos, B. Pettiford, J.D. Luketich, J.M. Close, et al.
Margin and local recurrence after sublobar resection of non-small cell lung cancer.
Ann Surg Oncol, 14 (2007), pp. 2400-2405
[41.]
W. Sienel, S. Dango, A. Kirschbaum, B. Cucuruz, W. Hörth, C. Stremmel, et al.
Sublobar resections in stage IA non-small cell lung cancer: segmentectomies result in significantly better cancer-related survival than wedge resections.
Eur J Cardiothorac Surg, 33 (2008), pp. 728-734
[42.]
T. Takizawa, M. Haga, N. Yagi, M. Terashima, H. Uehara, A. Yokoyama, et al.
Pulmonary function after segmentectomy for small peripheral carcinoma of the lung.
J Thorac Cardiovasc Surg, 118 (1999), pp. 538-541
[43.]
G. Voynov, D.E. Heron, C.J. Lin, S. Burton, A. Chen, A. Quinn, et al.
Intraoperative 125I Vicryl mesh brachytherapy after sublobar resection for high-risk stage I non-small cell lung cancer.
Brachytherapy, 4 (2005), pp. 278-285
[44.]
T. Fukuse, E. Ogawa, F. Chen, H. Sakai, H. Wada.
Limited surgery and radiofrequency ablation for recurrent lung cancer.
Ann Thorac Surg, 82 (2006), pp. 1506-1508
[45.]
T.V. Colby, M. Noguchi, C. Henschke, M.F. Vazquez, K. Geiniger, T. Yokosa, et al.
Adenocarcinoma.
World Health Organization Classification of Tumours. Pathology and Genetics. Tumours of the Lung, Pleura, Thymus and Heart, pp. 35-44
[46.]
M. Higashiyama, K. Kodama, H. Yokouchi, K. Takami, M. Mano, S. Kido, et al.
Prognostic value of bronchiolo-alveolar carcinoma component of small lung adenocarcinoma.
Ann Thorac Surg, 68 (1999), pp. 2069-2073
[47.]
R. Rami-Porta, C. Wittekind, P. Goldstraw.
Complete resection in lung cancer surgery: proposed definition.
Lung Cancer, 49 (2005), pp. 25-33
[48.]
U. Pastorino, M. Buyse, G. Friedel, R.J. Ginsberg, P. Girard, P. Goldstraw, et al.
Longterm results of lung metastasectomy: prognostic analyses based on 5206 cases.
J Thorac Cardiovasc Surg, 113 (1997), pp. 37-49
[49.]
R. Maeda, N. Isowa, H. Onuma, H. Miura, T. Harada, H. Touge, et al.
Pulmonary resection for metastases from colorectal carcinoma.
Interact Cardiovasc Thorac Surg, 9 (2009), pp. 640-644
[50.]
J. Torres Lanzas, A. Ríos Zambudio.
La cirugía de las metástasis pulmonares.
Arch Bronconeumol, 38 (2002), pp. 403-405
[51.]
T. Treasure.
Pulmonary metastasectomy for colorectal cancer: weak evidence and no randomised trials.
Eur J Cardiothorac Surg, 33 (2008), pp. 300-302
[52.]
C. Pagés Navarrete, J. Ruiz Zafra, C. Simón Adiego, J.M. Díez Pina, A. CuetoLadrón de Guevara, A. Sánchez-Palencia Ramos.
Tratamiento quirúrgico de las metástasis pulmonares: estudio de supervivencia.
Arch Bronconeumol, 36 (2000), pp. 569-573
[53.]
J. Pfannschmidt, H. Dienemann, H. Hoffmann.
Surgical resection of pulmonary metastases from colorectal cancer: a systematic review of published series.
Ann Thorac Surg, 84 (2007), pp. 324-338
[54.]
J. Pfannschmidt, S. Bade, J. Hoheisel, T. Muley, H. Dienemann, E. Herpel.
Identification of immunohistochemical prognostic markers for survival after resection of pulmonary metastases from colorectal carcinoma.
Thorac Cardiovasc Surg, 57 (2009), pp. 403-408
[55.]
H. Wang, J. Zhang, J. Tian, B. Qu, T. Li, Y. Chen, et al.
Using dual-tracer PET to predict the biologic behavior of human colorectal cancer.
J Nucl Med, 50 (2009), pp. 1857-1864
[56.]
Y. Nie, Q. Li, F. Li, Y. Pu, D. Appelbaum, K. Doi.
Integrating PET and CT information to improve diagnostic accuracy for lung nodules: A semiautomatic computer-aided method.
J Nucl Med, 47 (2006), pp. 1075-1080
[57.]
S. Welter, J. Jacobs, T. Krbek, C. Poettgen, G. Stamatis.
Prognostic impact of lymph node involvement in pulmonary metastases from colorectal cancer.
Eur J Cardiothorac Surg, 31 (2007), pp. 167-172
[58.]
N. Barbetakis, C. Asteriou, I. Boukovinas, C. Tsilikas.
eComment: The role of lymph node dissection in pulmonary resection for metastases from colorectal cancer.
Interact Cardiovasc Thorac Surg, 9 (2009), pp. 644
[59.]
A. Muñoz Llerena, S. Carrera Revilla, A. Gil-Negrete Laborda, J. Pac Ferrer, R. Barceló Galíndez, G. López Vivanco.
Factores pronósticos de metástasis pulmonares resecables de carcinoma colorrectal.
Arch Bronconeumol, 43 (2007), pp. 309-316
[60.]
Takakura Y, Miyata Y, Okajima M, Okada M, Ohdan H. Short disease-free interval is a significant risk factor for intrapulmonary recurrence after resection of pulmonary metastases in colorectal cancer. Colorectal Dis. 2009. [En prensa]
[61.]
Y. Tanaka, Y. Maniwa, W. Nishio, M. Yoshimura, Y. Okita.
The optimal timing to resect pulmonary metastasis.
Eur J Cardiothorac Surg, 33 (2008), pp. 1135-1138
[62.]
J. Souglakos, J. Philips, R. Wang, S. Marwah, M. Silver, M. Tzardi, et al.
Prognostic and predictive value of common mutations for treatment response and survival in patients with metastatic colorectal cancer.
Br J Cancer, 101 (2009), pp. 465-472
[63.]
K. Yamakado, Y. Inoue, M. Takao, H. Takaki, A. Nakatsuka, J. Uraki, et al.
Long-term results of radiofrequency ablation in colorectal lung metastases: single center experience.
Oncol Rep, 22 (2009), pp. 885-891
[64.]
F.J. Wolf, D.J. Grand, J.T. Machan, T.A. Dipetrillo, W.W. Mayo-Smith, D.E. Dupuy.
Microwave ablation of lung malignancies: effectiveness, CT findings, and safety in 50 patients.
Radiology, 247 (2008), pp. 871-879
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