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535 pacientes fueron diagnosticados de carcinoma broncog&#233;nico no c&#233;lulas peque&#241;as &#40;CB&#41;&#44; que cumpl&#237;an criterios de operabilidad cl&#237;nica&#44; oncol&#243;gica y funcional&#44; fueron tratados en nuestra unidad&#46; Este estudio se centr&#243; principalmente en CB central con dudosa resecabilidad mediante lobectom&#237;a simple y especialmente en los pacientes con t&#233;cnicas de resecci&#243;n broncoangiopl&#225;sticas con extirpaci&#243;n de m&#225;s de un l&#243;bulo&#46; Todos los pacientes fueron evaluados oncol&#243;gica<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> y funcionalmente<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> por el Comit&#233; Oncol&#243;gico Multidisciplinar de nuestro centro&#44; seg&#250;n las gu&#237;as cl&#237;nicas de la <span class="elsevierStyleItalic">European Society Thoracic Surgeons</span>&#46; Preoperatoriamente se realiz&#243; un TAC tor&#225;cico con contraste y un 18-FDGPET-TC para estadificaci&#243;n cl&#237;nica de todos los pacientes<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> siguiendo la clasificaci&#243;n TNM 1997 y posteriormente se re-estadificaron mediante la nueva propuesta de estadificaci&#243;n de la IASCL<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; En caso de sospecha de afectaci&#243;n mediast&#237;nica ganglionar cN2 se realiz&#243; confirmaci&#243;n histopatol&#243;gica mediante la exploraci&#243;n m&#225;s conveniente y menos invasiva&#44; en cada caso &#40;EBUS&#44; EUS-FNA&#44; mediastinoscopia o extendida&#41;&#46; En caso de confirmarse la afectaci&#243;n mediast&#237;nica se les realiz&#243; tratamiento neoadjuvante y se reevalu&#243; posteriormente mediante t&#233;cnicas de imagen &#40;TAC tor&#225;cico y 18-FDGPET-TC&#41; para su rescate quir&#250;rgico&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La elecci&#243;n de la t&#233;cnica quir&#250;rgica se bas&#243; 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Se inici&#243; la lobectom&#237;a seg&#250;n t&#233;cnica quir&#250;rgica habitual&#44; hasta conseguir una exposici&#243;n correcta del bronquio y de la arteria pulmonar si era posible&#46; En ese momento se decidi&#243; sobre el tipo de resecci&#243;n quir&#250;rgica m&#225;s adecuada para cada paciente individualmente&#46; Una vez considerada la opci&#243;n de la t&#233;cnica broncoangiopl&#225;stica&#44; se aisl&#243; el tumor pulmonar y se realiz&#243; la desconexi&#243;n de las estructuras del l&#243;bulo tanto vasculares como a&#233;reas&#44; para posteriormente preparar la reconstrucci&#243;n&#46; Se realiz&#243; una secci&#243;n circunferencial del bronquio o de la arteria pulmonar o de ambos&#44; permitiendo crear el suficiente margen con la lesi&#243;n mediante bistur&#237; fr&#237;o&#46; La manipulaci&#243;n bronquial fue cuidadosa&#44; intentando mantener el aporte sangu&#237;neo y preservando las arterias bronquiales&#44; evitando la electrocoagulaci&#243;n en tejidos circundantes&#46; Los m&#225;rgenes resecados fueron evaluados intraoperatoriamente para asegurar una resecci&#243;n completa &#40;R0&#41;&#59; en caso de R1 o dudas de la viabilidad del remanente pulmonar o de la vitalidad de los tejidos perianastom&#243;ticos&#40;exceso de tensi&#243;n&#44; ausencia de flujo evidente&#44; etc&#46;&#41; se complet&#243; la neumonectom&#237;a&#46; La anastomosis bronquial se realiz&#243; mediante sutura continua de 4-0 polydioxanona &#40;PDS&#44; Ethicon Inc&#44; Somerville&#44; NJ&#41; inici&#225;ndola en la uni&#243;n membrano-cartilaginosa en la cara mediast&#237;nica del bronquio hasta la mitad del anillo cartilaginoso<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a>&#46; El resto de anastomosis se realiz&#243; mediante puntos sueltos de 4-0 polydioxanona en X&#44; que se anudaron al finalizar la anastomosis&#46; Todos los puntos fueron anudados en el exterior del bronquio&#46; Se evit&#243; la realizaci&#243;n de suturas telesc&#243;padas y las discrepancias se solucionaron mediante la correcta colocaci&#243;n de los puntos y una t&#233;cnica quir&#250;rgica cuidadosa&#46; La torsi&#243;n bronquial se evit&#243; mediante el cuidado en la t&#233;cnica<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a>&#46; Posteriormente se comprob&#243; la estanqueidad de las suturas bajo agua en todos los casos mediante una presi&#243;n en v&#237;a a&#233;rea de al menos 30 mmHg&#46; La anastomosis arterial se realiz&#243; mediante sutura continua de 5-0 Prolene &#40;Ethicon&#41; tras heparinizaci&#243;n sist&#233;mica &#40;3&#46;000-5&#46;000 UI de heparina s&#243;dica&#41; y local&#46; La reperfusi&#243;n del l&#243;bulo preservado se realiz&#243; lentamente evitando el desclampaje brusco&#44; iniciando la reperfusi&#243;n a menos de 20 mmHg de presi&#243;n y una vez que &#233;ste estaba reexpandido siempre que esto fuera posible&#46; Las suturas no se recubrieron de forma sistem&#225;tica mediante <span class="elsevierStyleItalic">flaps</span> intercostales o grasa peric&#225;rdica&#46; No se administr&#243; ni antibi&#243;ticos inhalados profil&#225;cticos ni otros f&#225;rmacos como corticoides o expectorantes&#46; Para minimizar la tensi&#243;n en la anastomosis se liber&#243; sistem&#225;ticamente el ligamento pulmonar&#44; y en caso de ser necesario&#44; se realiz&#243; una incisi&#243;n peric&#225;rdica alrededor de las venas pulmonares&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Se comprob&#243; la idoneidad de la sutura bronquial con broncoscopio flexible una vez comprobada la estanqueidad intraoperatoriamente y se realiz&#243; una limpieza de secreciones&#46; Se intent&#243; la extubaci&#243;n en todos los pacientes en quir&#243;fano&#46; El postoperatorio inmediato se realiz&#243; en la Unidad de Cuidados Intermedios durante las siguientes 24 horas y posteriormente en ausencia de complicaciones se trasladaron a la sala de hospitalizaci&#243;n de la Unidad de Cirug&#237;a Tor&#225;cica&#46; En caso de fuga a&#233;rea persistente&#44; hemoptisis o cualquier signo cl&#237;nico sospechoso de dehiscencia de sutura se realiz&#243; fibrobroncoscopia flexible inmediatamente&#44; y en ausencia de sintomatolog&#237;a se indic&#243; esta exploraci&#243;n antes del alta&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">La analgesia postoperatoria fue mediante cat&#233;ter epidural que se coloc&#243; previa intervenci&#243;n quir&#250;rgica y con el paciente despierto a nivel T7-T10&#46; Una hora antes de finalizar la cirug&#237;a se administr&#243; un bolus de ropivaca&#237;na peridural al 2&#37; &#40;5<span class="elsevierStyleHsp" style=""></span>ml&#41; y se inici&#243; una perfusi&#243;n peridural continua en modo PCA de ropivaca&#237;na al 0&#44;14&#37; m&#225;s fentanilo 2<span class="elsevierStyleHsp" style=""></span>&#956;g&#47;ml &#40;ritmo de perfusi&#243;n de 4-8<span class="elsevierStyleHsp" style=""></span>ml&#47;h con la posibilidad de autoadministrarse suplementos de 2<span class="elsevierStyleHsp" style=""></span>ml cada 30 minutos&#41; En todos los casos se paut&#243; analgesia complementaria v&#237;a sist&#233;mica dexketoprofeno 50<span class="elsevierStyleHsp" style=""></span>mg&#47;8<span class="elsevierStyleHsp" style=""></span>h&#47;iv pautado y paracetamol 1<span class="elsevierStyleHsp" style=""></span>g&#47;8<span class="elsevierStyleHsp" style=""></span>h&#47;iv si EVA &#62; 3 en reposo&#46; Antes de retirar el cat&#233;ter se administra un bolus de metadona &#40;4-6<span class="elsevierStyleHsp" style=""></span>mg&#41; y se contin&#250;a con la analgesia pautada complementaria intravenosa&#46; Se insisti&#243; en la realizaci&#243;n de fisioterapia respiratoria para evitar la retenci&#243;n de esputo y complicaciones respiratorias&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El seguimiento endosc&#243;pico de la anastomosis se llev&#243; a cabo al mes&#44; tres meses y posteriormente se realiz&#243; seguimiento mediante imagen&#44; siguiendo el protocolo de seguimiento oncol&#243;gico de la ACCP<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El an&#225;lisis estad&#237;stico se llev&#243; a cabo mediante el programa SPSS v&#46;11 &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; USA&#41;&#46; Las variables cuantitativas fueron comparadas mediante el test estadistico &#967;2 o test exacto de Fisher cuando apropiado con un nivel de significaci&#243;n de p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#46; El analisis bivariante se realiz&#243; primero con el objetivo de identificar factores de riesgo para su inclusi&#243;n en un modelo de riesgo proporcional de Cox&#46; Los resultados se expresaron como riesgo relativo estimado con su intervalo de confianza 95&#37;&#46; La supervivencia esperada fue calculada mediante las tablas de supervivencia con Kaplan-Meier y log rank para comparaci&#243;n de curvas&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0050" class="elsevierStylePara elsevierViewall">En estos 535 pacientes&#44; 95 pacientes presentaron un CBNCP central&#46; En aquellos no resecables por lobectom&#237;a simple&#44; bien por afectaci&#243;n directa del tumor o por afectaci&#243;n N1 se realizaron 58 &#40;11&#37;&#41; lobectom&#237;as broncoangiopl&#225;sticas y 22 &#40;4&#37;&#41; neumonectom&#237;as&#46; Entre las lobectom&#237;as broncoangiopl&#225;sticas se realizaron 12 lobectom&#237;as broncoangiopl&#225;sticas extendidas &#40;LBE&#41; a m&#225;s de un l&#243;bulo y 46 lobectom&#237;as broncoangiopl&#225;sticas simples &#40;LBS&#41;&#46; Las caracter&#237;sticas de ambos grupos se recogen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">En el grupo de LBS&#44; las t&#233;cnicas m&#225;s frecuentes fueron bronquiales 32 &#40;70&#37;&#41;&#44; reconstrucci&#243;n broncovascular 7 &#40;15&#37;&#41; y vascular sola 7 &#40;15&#37;&#41;&#46; Por localizaci&#243;n&#44; el m&#225;s frecuente fue el l&#243;bulo superior derecho 24 &#40;52&#37;&#41;&#44; seguido del LSI &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">En el grupo de LBE&#44; 8 &#40;66&#44;7&#37;&#41; fueron reconstrucciones bronquiales y 4 &#40;33&#44;3&#37;&#41; broncovasculares&#46; El tipo de resecci&#243;n m&#225;s frecuente &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; es la lobectom&#237;a superior derecha &#40;LSD&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>segmento 6 en 5 &#40;41&#37;&#41; casos seguido del LSD<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>l&#243;bulo medio &#40;LM&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46; Solo en 9 &#40;15&#37;&#41; casos las resecciones broncopl&#225;sticas fueron necesarias por pN1&#44; y de estos s&#243;lo 2 fueron LBE&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">La mortalidad ocurri&#243; en el grupo LBS en dos casos 2 &#40;1&#44;7&#37;&#41; &#40;f&#237;stula bronco-arterial y s&#237;ndrome distress respiratorio del adulto&#41;&#46; Las morbilidad fue similar en ambos grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; y las complicaciones m&#225;s importantes est&#225;n descritas en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; La complicaci&#243;n m&#225;s frecuente fue la retenci&#243;n de esputo en 13 &#40;22&#37;&#41; casos&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Las complicaciones anastom&#243;ticas ocurrieron s&#243;lo en 1 paciente&#46; No se detectaron complicaciones anastom&#243;ticas a largo plazo durante el seguimiento broncosc&#243;pico&#46; Se cubrieron las anastomosis 24 &#40;41&#37;&#41; sobre todo si se realiz&#243; reconstrucci&#243;n combinada bronquial y arterial sin diferencias significativas con y sin protecci&#243;n mediante <span class="elsevierStyleItalic">flap</span> &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Se consigui&#243; resecci&#243;n completa &#40;R0&#41; en todos los casos menos en uno&#44; en un borde vascular fue informado postoperatoriamente como R1&#46; D&#237;ez &#40;17&#37;&#41; pacientes fueron programados exclusivamente para LBS o LBE&#44; por motivos funcionales o por exceso de riesgo por edad avanzada &#62; 75 a&#241;os&#46; Quince pacientes recibieron tratamiento quimiorradioter&#225;pico neoadyuvante&#44; por cN2 confirmado histol&#243;gicamente&#44; sin embargo&#44; no se detect&#243; mayor n&#250;mero de complicaciones significativamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">No existieron factores de riesgo individuales en las variables estudiadas &#40;localizaci&#243;n de tumor&#44; histolog&#237;a&#44; reconstrucci&#243;n doble&#44; tratamiento neoadyuvante&#44; FEV1 bajo&#41; que afectaran a las LBE respecto a las LBS &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Sin embargo&#44; en ambos grupos los pacientes con mayor morbilidad fueron pN1&#44; localizaci&#243;n en l&#243;bulo superior izquierdo y con reconstrucci&#243;n vascular asociada &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#44; sin embargo no presentaron significativamente mayor mortalidad &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Las recurrencias sist&#233;micas ocurrieron en 16 &#40;27&#37;&#41; pacientes&#44; sin diferencias entre grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; S&#243;lo un caso de recurrencias local mediast&#237;nica apareci&#243; en el grupo de LBS&#46; No se detectaron recurrencias en la zona anastom&#243;tica&#44; salvo en el caso de R1&#44; en que no se complet&#243; neumonectom&#237;a debido al excesivo riesgo quir&#250;rgico&#44; completando tratamiento con quimiorradioterapia coadyuvante&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">La supervivencia global a los 5 a&#241;os fue del 61&#44;6&#37;&#44; LBS &#40;61&#37;&#41; y LBE &#40;68&#44;9&#37;&#41; sin diferencia entre ambos grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Los pacientes mayores de 70 a&#241;os&#44; y pN2&#44; fueron identificados como factores de riesgo en an&#225;lisis bivariante&#46; En el an&#225;lisis multivariante solo la edad<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>70 a&#241;os afect&#243; negativamente la supervivencia &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0095" class="elsevierStylePara elsevierViewall">Las t&#233;cnicas broncoangiopl&#225;sticas extendidas son igualmente efectivas en el tratamiento de tumores centrales y no a&#241;aden morbimortalidad a las t&#233;cnicas broncoangiopl&#225;sticas simples&#46; La supervivencia observada de estas t&#233;cnicas aseguran un tratamiento oncol&#243;gico &#243;ptimo con ventajas sobre la extirpaci&#243;n masiva del par&#233;nquima pulmonar&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Sin embargo&#44; la decisi&#243;n de realizar una t&#233;cnica de preservaci&#243;n o una neumonectom&#237;a depende de un dif&#237;cil balance entre calidad de vida posterior y el riesgo de recurrencia de su enfermedad y complicaciones postoperatorias<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Diversos estudios han comparado la calidad de vida<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;19</span></a> y supervivencia<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;20</span></a> de las t&#233;cnicas de preservaci&#243;n pulmonar y neumonectom&#237;as&#46; Parece claro&#44; que la calidad de vida es sensiblemente mejor en pacientes sin neumonectom&#237;a<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#44; as&#237; mismo son estos pacientes m&#225;s aptos para tratamientos quimiorradioter&#225;picos coadyuvantes con una tolerancia mayor derivada de esta mejor calidad de vida&#44; con menores efectos secundarios e interrupciones de dicho tratamiento debido de los mismos&#46; En cuanto a la supervivencia existen diversos estudios que consideran la capacidad de control oncol&#243;gico local similar a la neumonectom&#237;a y las t&#233;cnicas de preservaci&#243;n pulmonar&#44; sin embargo&#44; otros muestran una mejor&#237;a de supervivencia en pacientes sin neumonectom&#237;a<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;20</span></a>&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">La inicial utilidad de las t&#233;cnicas reconstructivas broncoarteriales se aplic&#243; en pacientes con funci&#243;n respiratoria disminuida&#44; en los que ha demostrado un efecto sobre dicha funci&#243;n mucho m&#225;s limitada que la neumonectom&#237;a<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;22</span></a>&#44; con mejor&#237;a de la capacidad respiratoria en un cierto n&#250;mero de pacientes por causas multifactoriales&#46; Entre &#233;stas se pueden destacar&#58; la optimizaci&#243;n del tratamiento m&#233;dico para la EPOC&#44; concomitante en gran n&#250;mero de pacientes<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#44; la hiperinsuflaci&#243;n de el&#47;los l&#243;bulos preservados&#44; la abstenci&#243;n del h&#225;bito tab&#225;quico despu&#233;s de la intervenci&#243;n y el posible efecto <span class="elsevierStyleItalic">shunt</span> de los l&#243;bulos extirpados&#44; frecuentemente sin capacidad de intercambio respiratorio<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46; Por estas razones&#44; y por la propia morbilidad asociada a la neumonectom&#237;a este grupo de t&#233;cnicas son muy aconsejables en pacientes a&#241;osos en que la extirpaci&#243;n masiva de par&#233;nquima pulmonar<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> acarrea un &#237;ndice de complicaciones postoperatorias<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;24</span></a> y una p&#233;rdida de calidad de vida m&#225;s acusada<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; Es en este grupo de pacientes mayores de 75 a&#241;os en los cuales pueden tener mayor significaci&#243;n la preservaci&#243;n pulmonar&#44; permitiendo ofrecer un tratamiento curativo a pacientes en los cuales&#44; por sus enfermedades asociadas el tratamiento quimiorradioter&#225;pico puede asociar gran morbilidad o estar contraindicado&#46; En nuestra serie&#44; diez pacientes fueron resecados con &#233;xito mediante LBS o LBE&#44; sin posibilidad de realizar neumonectom&#237;a por un riesgo de mortalidad precoz inaceptable&#46; As&#237; mismo&#44; 22 &#40;39&#37;&#41; casos de nuestra serie fueron realizados en mayores de 70 a&#241;os&#44; con un porcentaje similar de LBE y LBS&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">El &#237;ndice de recurrencia de estas t&#233;cnicas es similar al de las neumonectom&#237;as&#44; siendo el principal problema las recurrencias sist&#233;micas<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;10&#44;26&#44;27</span></a>&#46; Similares resultados en LBS y LBE han sido publicados en series con ligeramente mayor experiencia<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10-12</span></a>&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">La estrategia de evitaci&#243;n de la neumonectom&#237;a&#44; es hoy en d&#237;a com&#250;nmente aceptada incluso en pacientes con funci&#243;n pulmonar normal<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> y en pacientes con afectaci&#243;n ganglionar interlobar&#46; Sin embargo&#44; no siempre es f&#225;cil en tumores que afectan a m&#225;s de un l&#243;bulo por infiltraci&#243;n local&#44; por lo que&#44; peque&#241;as variaciones de estas t&#233;cnicas pueden ser &#250;tiles&#46; Johnston et al describieron por primera vez estas t&#233;cnicas con resultados interesantes<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Okada et al describieron una serie de 15 enfermos durante 13 a&#241;os&#44; representando un 9&#37; de todos los procedimientos broncopl&#225;sticos de su experiencia<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">La serie retrospectiva m&#225;s larga publicada&#44; mostr&#243; unos resultados de morbi-mortalidad similares a las LBS<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#44; con una supervivencia similar comparadas con los pacientes que sufrieron una neumonectom&#237;a en el mismo per&#237;odo&#46; Las complicaciones anastom&#243;ticas&#44; no resultaron elevadas en ninguna serie publicada&#44; como podr&#237;a esperarse debido a las grandes discrepancias de calibre bronquiales o el menor tama&#241;o de par&#233;nquima pulmonar remanente<a class="elsevierStyleCrossRefs" href="#bib0050"><span class="elsevierStyleSup">10-12</span></a>&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La morbilidad es similar en ambos grupos&#44; sin un aumento de los problemas postoperatorios por las t&#233;cnicas broncopl&#225;sticas&#44; sin embargo&#44; las complicaciones relacionadas con estas t&#233;cnicas suelen ser tan temibles como las aparecidas en la neumonectom&#237;a&#46; Estos problemas anastom&#243;ticos no est&#225;n aumentados en presencia de tratamiento de quimiorradioterapia previo&#44; sin embargo&#44; es en estos pacientes&#44; en los que un especial cuidado en la realizaci&#243;n de la anastomosis&#44; con cobertura mediante <span class="elsevierStyleItalic">flaps</span> musculares o peric&#225;rdicos y el uso de antibi&#243;ticos inhalados<a class="elsevierStyleCrossRef" href="#bib0145"><span class="elsevierStyleSup">29</span></a> debe ser tenido en cuenta&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Sin embargo&#44; la propia experiencia quir&#250;rgica en este grupo de intervenciones&#44; fuerza un sesgo individual&#58; la excesiva tensi&#243;n&#44; o un remanente pulmonar muy limitado suelen conducir a la neumonectom&#237;a&#46; Este sesgo es similar en todos los originales comparando t&#233;cnicas reconstructivas pulmonares y neumonectom&#237;as&#44; o LBS con LBE<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;11&#44;17</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">&#205;ntimamente relacionado podemos observar la relaci&#243;n de entre neumonectom&#237;as y lobectom&#237;as broncoangiopl&#225;sticas&#44; donde en la actualidad se han publicado una disminuci&#243;n dram&#225;tica de las neumonectom&#237;as cuando estas t&#233;cnicas de reconstrucci&#243;n se han aplicado agresivamente<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#46; Para esto&#44; es imprescindible disminuir el porcentaje total de LBS o LBE relacionadas con el l&#243;bulo superior derecho&#44; con inclusi&#243;n de casos en el lado izquierdo a pesar de que su realizaci&#243;n implica reconstrucci&#243;n vascular asociada en gran n&#250;mero de casos&#46; Frecuentemente&#44; con uso de materiales biol&#243;gicos para la reconstrucci&#243;n de arteria pulmonar este &#237;ndice se incrementa con facilidad<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; En pacientes con extensa afectaci&#243;n vascular&#44; arterial o venosa&#44; puede considerarse la resecci&#243;n oncol&#243;gica del tumor en cirug&#237;a de banco&#44; seguida del reimplante del l&#243;bulo remanente con reconstrucci&#243;n bronquial&#44; arterial y venosa&#46; El autotransplante&#44; por lo tanto&#44; se ha comunicado anecd&#243;ticamente&#44; sin embargo podr&#237;a ser una opci&#243;n quir&#250;rgica para evitar la neumonectom&#237;a<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">En definitiva&#44; el uso de t&#233;cnicas de preservaci&#243;n pulmonar ofrece un conjunto de ventajas con poca menor morbilidad asociada en manos expertas&#46; La consideraci&#243;n de candidatos para estas t&#233;cnicas deber&#237;a ser tenida en cuenta&#44; por m&#250;ltiples razones&#58; mayor tolerancia a los tratamientos multimodales complementarios&#44; posibilidad de recuperar quir&#250;rgicamente a pacientes que dudosamente podr&#237;an ser tratados con neumonectom&#237;a previa&#44; menor p&#233;rdida de capacidad respiratoria<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; mejor calidad de vida a largo plazo<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> y no menos importante&#44; menor incidencia de complicaciones propias de la neumonectom&#237;a como f&#237;stula bronquiales o SDRA&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">En opini&#243;n de los autores&#44; siempre que sea posible&#44; sobre todo en pacientes a&#241;osos o con tratamiento neoadyuvante es mejor cualquier t&#233;cnica broncopl&#225;stica que una neumonectom&#237;a&#46; Las t&#233;cnicas broncopl&#225;sticas extendidas son seguras&#44; t&#233;cnicamente m&#225;s demandantes y necesitan una observaci&#243;n postoperatoria muy cuidadosa&#44; sin embargo plantean inmediatamente y a largo plazo unas ventajas innegables y de gran importancia&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0160" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "clase" => "keyword"
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            0 => "Sleeve lobectomy"
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            2 => "Complications"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Determinar la morbimortalidad y supervivencia de los procedimientos broncoangiopl&#225;sticos extendidos a m&#225;s de un l&#243;bulo en comparaci&#243;n con las t&#233;cnicas broncoangiopl&#225;sticas simples&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Entre septiembre de 2005 y mayo de 2010&#44; 535 pacientes diagnosticados de carcinoma broncog&#233;nico que cumpl&#237;an criterios de operabilidad cl&#237;nica&#44; oncol&#243;gica y funcional fueron tratados en nuestra unidad&#46; Los tumores centrales&#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#41; no resecables mediante lobectom&#237;a simple fueron programados para t&#233;cnicas broncoangiopl&#225;sticas y en caso de imposibilidad&#44; neumonectom&#237;a&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se realizaron 58 &#40;11&#37;&#41; procedimientos&#44; 46 lobectom&#237;as broncoangiopl&#225;sticas simple &#40;LBS&#41; y 12 extendidas &#40;LBE&#41;&#46; En el grupo de LBS &#40;bronquiales 32 &#91;70&#37;&#93;&#44; reconstrucci&#243;n broncovascular 7 &#91;15&#37;&#93; y vascular sola 7 &#91;15&#37;&#93;&#41;&#46; En el grupo de LBE&#44; 8 &#40;66&#44;7&#37;&#41; fueron reconstrucciones bronquiales y 4 &#40;33&#44;3&#37;&#41; broncovasculares&#46; El tipo de resecci&#243;n m&#225;s frecuente es el l&#243;bulo superior derecho &#40;LSD&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>segmento 6 en 5 &#40;41&#37;&#41; casos&#44; seguido del LSD<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>l&#243;bulo medio&#46; La mortalidad fue de en 2 &#40;3&#37;&#41; casos en el grupo LBS&#46; La morbilidad ocurri&#243; en el 34&#37; LSB y en el 33&#37; LBE &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; Quince pacientes recibieron tratamiento quimiorradioter&#225;pico neoadjuvante&#44; por cN2 confirmado histol&#243;gicamente&#44; sin embargo no se detect&#243; mayor n&#250;mero de complicaciones significativamente &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; No se detectaron factores de riesgo respecto a ninguna variable estudiada que afectaran a las LBE respecto a las LBS &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; En ambos grupos&#44; los pacientes con mayor morbilidad fueron pN1&#44; localizaci&#243;n en l&#243;bulo superior izquierdo y con reconstrucci&#243;n vascular asociada &#40;p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46; La supervivencia global a los 5 a&#241;os fue 61&#44;6&#37; LBS &#40;61&#37;&#41; y LBE &#40;68&#44;9&#37;&#41; sin diferencia entre ambos grupos &#40;p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Las LBE son procedimientos t&#233;cnicamente m&#225;s demandantes pero no aumentan la morbimortalidad respecto a las t&#233;cnicas broncoangiopl&#225;sticas simples con una supervivencia similar&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To determine the morbidity&#44; mortality and survival of sleeve lobectomy procedures compared to simple broncho-angioplasty procedures&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">A total of 535 patients diagnosed with bronchogenic cancer between September 2005 and May 2010 who fulfilled the criteria of clinical&#44; oncological and functional operability were treated in our unit&#46; Unresectable central tumours &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#41; using simple lobectomy were scheduled for broncho-angioplasty techniques and a pneumonectomy in those where this was impossible&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 58 &#40;11&#37;&#41; were performed&#44; 46 simple broncho-angioplastic lobectomies &#40;SBAL&#41; and 12 extended broncho-angioplastic lobectomies &#40;EBAL&#41;&#46; In the SBAL group there were 32 bronchial &#40;70&#37;&#41; and 7 &#40;15&#37;&#41; bronchovascular reconstructions and only vascular &#40;15&#37;&#41;&#46; In the EBAL group&#44; 8 &#40;66&#46;7&#37;&#41; were bronchial and 4 &#40;33&#46;3&#37;&#41; were bronchovascular reconstructions&#46; The most common type of resection was the right upper lobe &#40;RUL&#41;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>segment 6 in five &#40;41&#37;&#41; cases&#44; followed by RUL<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>middle lobe&#46; There were 2 &#40;3&#37;&#41; deaths in the SBAL group&#46; There was 34&#37; morbidity in the SBAL and 33&#37; in the EBAL group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; Fifteen patients received neoadjuvant chemo-radiotherapy treatment&#44; due to histologically confirmed cN2&#59; however&#44; the number of complications was not significantly higher&#46; No risk factors were detected in any variable studied that would affect EBAL compared to the SBAL group &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The patients in both groups with a higher morbidity were pN1&#44; located in the left upper lobe and associated with vascular reconstruction &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46; The overall survival at 5 years was 61&#46;6&#37;&#44; SBAL &#40;61&#37;&#41; and EBAL &#40;68&#46;9&#37;&#41; with no differences between groups &#40;<span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;05&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">EBALs are technically more demanding procedures&#44; but do not increase the morbidity or mortality compared to simple broncho-angioplasty techniques&#44; and with a similar survival&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleItalic">Neoadjuvancia</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tumor lado &#40;D&#58;I&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tumor tama&#241;o &#40;media&#44; cm<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>DE&#44; rango&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;2<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;7 &#40;1&#44;2-9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;1<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>1&#44;5 &#40;1&#44;2-8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4&#44;6<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>2&#44;1 &#40;1&#44;9-9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Localizaci&#243;n &#40;n&#44;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">LSD</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;53&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">LM</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;10&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;6&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleGlyphsbnd"></span>1 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">LII</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">4 &#40;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;6&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="5" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Histolog&#237;a &#40;n&#44;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Adenocarcinoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">23 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">18 &#40;39&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;42&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Escamoso carcinoma&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">33 &#40;57&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">26 &#40;56&#44;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7 &#40;58&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Neuroendocrino carcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2 &#40;3&#44;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;4&#44;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleGlyphsbnd"></span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Estadio cl&#237;nico&#47;patol&#243;gico &#40;n&#44;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">-&#47;1 &#40;8&#44;3&#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>DLCO&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14&#44;2 &#40;49-102&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>15 &#40;49-102&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">0&#44;27&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Enfermedades asociadas&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes mellitus&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">3 &#40;25&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">IIB&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&#47;45&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#47;H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LII&#43;Lingulectomia&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escamoso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&#47;35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&#47;H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LSD&#43;LM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escamoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&#47;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">66&#47;H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LSD&#43;LM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO&#47;26&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72&#47;H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LSI&#43; segmento 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IIIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escamoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO&#47;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73&#47;H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LSD&#43;LM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IIB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escamoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NO&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&#47;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LSD&#43; segmento 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IIB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escamoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&#47;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">62&#47;H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LSD&#43; segmento 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IIIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&#47;32&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">64&#47;H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LSD&#43; segmento 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&#47;16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79&#47;H&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LSD&#43;LM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IIIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&#47;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">54&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&#47;M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">LSD&#43; segmento 6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8722;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">IIIA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Escamoso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Traqueostom&#237;a</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Complicaciones quir&#250;rgicas</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>F&#237;stula bronquial &#40;broncovascular&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Trombosis de arteria pulmonar&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Fuga a&#233;rea persistente<a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">d</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Sangrado intraoperatorio&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hemotorax&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estancia hospitalaria&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9&#44;8<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#44;3<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&#44;7<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
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                  \t\t\t\t">Sexo &#40;mujer vs hombre&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Lado tumor &#40;derecho vs izquierdo&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;27-2&#44;25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;65&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Tama&#241;o tumoral &#40;v&#46; continua&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;76-1&#44;50&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;69&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">Histolog&#237;a &#40;no-ADK&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;24-1&#44;77&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;41&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">pT &#40;T1-T2&#44; T3-T4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;21-4&#44;28&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Preoperatorio EPOC&#42;&nbsp;\t\t\t\t\t\t\n
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