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"tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "227" "paginaFinal" => "228" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Pablo A. Ordóñez Lozano, Iñigo Royo Crespo, Nadia Muñoz-González, Raúl Embún Flor" "autores" => array:4 [ 0 => array:4 [ "nombre" => "Pablo A." "apellidos" => "Ordóñez Lozano" "email" => array:1 [ 0 => "paordonnezl@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Iñigo" "apellidos" => "Royo Crespo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Nadia" "apellidos" => "Muñoz-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Raúl" "apellidos" => "Embún Flor" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, Zaragoza, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Cirugía Torácica, Hospital Universitario Miguel Servet, IIS Aragón, Zaragoza, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Segundas lobectomías pulmonares: ¿son factibles y seguras?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The diagnosis of multiple primary lung cancers (MPLC) accounts for approximately 0.2%–20% of all cases of lung cancer.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">1</span></a> The 2 presentations of MPLC, synchronous and metachronous, can manifest in 2 ways: either as a metastatic lesion of a primary lung tumor, or as multiple, unrelated lesions that can be defined as primary disease. The term MPLC is used to refer to the latter case, in which 2 or more primary malignant tumors are unrelated to each other, but present simultaneously or successively in the lung.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">2</span></a> Second lung lobectomies are very rarely described in the literature. The aim of this study was to determine postoperative morbidity and mortality in patients undergoing a second lung lobectomy. This is a descriptive study of postoperative morbidity and mortality (during hospitalization or in the first 30 days post-surgery) in a series of patients undergoing a second lung lobectomy between January 1, 2009 and December 31, 2014. Second lobectomies conducted to complete a pneumonectomy were not included in the analysis.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Of a series of 648 patients who underwent lung lobectomy, 6 (0.9%) received a second lobar resection. The study population consists of 4 men (66.6%) and 2 women (33.4%), mean age 53 years with a standard deviation (<span class="elsevierStyleItalic">σ</span>) of 7. Patient characteristics are listed in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. The final approach was most often thoracotomy, although 50% of procedures began by video-assisted thoracoscopic surgery (VATS). Contralateral lobectomies were performed in 4 patients (66.6%). The major histological type, taking into account both surgeries, was pulmonary adenocarcinoma (75%) (9 results), the most frequent disease stage according to IASLC TNM classification (7th edition, 2009) in both surgeries was IA (75%); in 4 cases (66.6%), the disease was considered second primary lung carcinoma (SPLC), according to the criteria of Martini and Melamed.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">3</span></a> Morbidity after the second intervention was 50% (3 cases), with no postoperative mortality (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>).</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">The major intraoperative findings and technical difficulties in patients undergoing ipsilateral lobectomies were associated with firm pleural adhesions and hilar fibrosis, requiring the opening of the pericardium for adequate vascular control in 2 cases.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Median time between interventions was 24 months (range 1–106). After a mean follow-up of 203 weeks (3.5 years), 2 patients (33%) died due to disease progression, while the other patients are alive with no signs of relapse.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Survival outcomes after pulmonary resection for synchronous or metachronous cancers occurring less than 4 years apart are variable, but generally poor, suggesting that many of these patients may have had pulmonary metastases instead of SPLC. This situation justifies a thorough assessment of these patients to attempt to differentiate between metastasis and SPLC, although no distinguishing criteria have yet been defined.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">4</span></a> Most SPLC are of the same histological type and few criteria, including different histologic features or DNA breakpoints by sequencing, are reliable in themselves, so a thorough histological evaluation is required for a correct prognostic classification.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The accurate assessment of these patients must also include stratification of the risk associated with pulmonary resection, focusing on the cardiologic evaluation, forced expiratory volume in one second (FEV1) diffusion capacity of the lungs for carbon monoxide, and cardiopulmonary exercise testing.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">6</span></a> In our setting, during the study period, the preoperative functional assessment protocol was based on the European Respiratory Society and European Society of Thoracic Surgeons 2009 guidelines on radical treatment of lung cancer, although 1 of our patients (case 1) did not meet the respiratory function criteria, due to limiting physical circumstances (patient with tracheostomy).</p><p id="par0035" class="elsevierStylePara elsevierViewall">Due to the scant evidence, no specific recommendations are available on the role of adjuvant treatment in patients operated for operated for MPLC. In patients with synchronous MPLC, the tumor with the most advanced staging will determine the need for adjuvant treatment; the situation is unclear when a patient has 2 synchronous or metachronous stage I lesions, since, although the prognosis is worse than in patients with a single stage I NSCLC tumor, the absolute benefit of adjuvant cisplatin-based chemotherapy has not been demonstrated.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">7</span></a> Factors that could be considered when deciding whether or not to use adjuvant chemotherapy include the time interval between the cancers, certain unfavorable histologic characteristics (degree of differentiation, vascular and lymphatic invasion, solid and micropapillary pattern), tumor size, comorbidities, and the functional assessment of the patient.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Despite the limited number of patients in our series, we believe that a second lung lobectomy is a feasible technique, with zero mortality but with significant morbidity. Of the 3 cases that developed a complication, 2 patients had Grade III postoperative complications according to the Clavien-Dindo scale<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">8</span></a> (complication that requires intervention without general anesthesia); and another had a Grade IV (life-threatening complication due to single organ dysfunction). To avoid major intraoperative bleeding in the event of an ipsilateral resection, complex dissection of the hilum should be anticipated, and intrapericardial dissection may be a surgical option to be taken into account in this group of patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Please cite this article as: Ordóñez Lozano PA, Royo Crespo I, Muñoz-González N, Embún Flor R. Segundas lobectomías pulmonares: ¿son factibles y seguras? Arch Bronconeumol. 2018;54:227–228.</p>" ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">ADC: pulmonary adenocarcinoma; AP: anatomical pathology; WR: wedge resection; ca.: carcinoma; DLCO: diffusing capacity of the lung for carbon monoxide; F: female; FEV<span class="elsevierStyleInf">1</span>: forced expiratory volume in one second; FVC: forced vital capacity; KCO: diffusion constant for carbon monoxide; LLL: left lower lobectomy; LUL: left upper lobectomy; M: male; ML: middle lobectomy; NR: not recorded; PAL: persistent air leak; RLL: right lower lobectomy; RUL; right upper lobectomy; VATS: video-assisted thoracic surgery; VO<span class="elsevierStyleInf">2 max</span>: maximal oxygen uptake.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Case \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Age \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sex \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Concomitant Disease \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FVC (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">FEV<span class="elsevierStyleInf">1</span> (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">DLCO (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">KCO (%) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">VO<span class="elsevierStyleInf">2 max</span> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">1st Surgery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AP (Stage) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Time<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a> \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">2nd Surgery \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">AP (Stage<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a>) \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Morbidity \t\t\t\t\t\t\n \t\t\t\t</th><th class="td" title="table-head " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Mortality \t\t\t\t\t\t\n \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">102 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RUL by thoracotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neuroendocrine ca. with ADC foci (IA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LLL by thoracotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ADC (IIIA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">64 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">169 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">114 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">109 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ML by VATS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ADC (IA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">33 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Intrapericardial RUL by VATS converted to thoracotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ADC (IB) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Hydropneumothorax \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">125 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">94 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">60 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">62 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">21 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RLL by thoracotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ADC (IA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">106 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LLL by thoracotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ADC (IA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">56 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">M \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">99 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">98 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">124 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LUL by thoracotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ADC (IB) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">71 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RUL by VATS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ADC (IA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">5 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">66 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">>2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">85 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">58 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">51 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">59 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">15 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RUL+RLL AR by thoracotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ADC+squamous cell ca. (IA and IA, respectively) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">24 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">ML by thoracotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Squamous cell ca. (IA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">PAL+empyema \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry " align="char" valign="top">6 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">F \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">95 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">90 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">111 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">129 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">NR \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">RLL by VATS \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Neuroendocrine ca. (IA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="char" valign="top">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">LLL by VATS converted to thoracotomy \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Typical carcinoid (IA) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">Atelectasis \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="table-entry " align="left" valign="top">No \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab1720484.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Months between first and second surgery.</p>" ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">TNM classification, 7th edition (2009).</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Age: At Second Surgery.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0045" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment outcomes for patients with synchronous multiple primary non-small cell lung cancer" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "E.J. 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Year/Month | Html | Total | |
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2024 November | 11 | 2 | 13 |
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2023 March | 34 | 3 | 37 |
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2023 January | 161 | 42 | 203 |
2022 December | 136 | 31 | 167 |
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2021 September | 62 | 41 | 103 |
2021 August | 59 | 33 | 92 |
2021 July | 73 | 22 | 95 |
2021 June | 96 | 34 | 130 |
2021 May | 92 | 38 | 130 |
2021 April | 145 | 84 | 229 |
2021 March | 88 | 26 | 114 |
2021 February | 72 | 27 | 99 |
2021 January | 62 | 9 | 71 |
2020 December | 59 | 21 | 80 |
2020 November | 53 | 10 | 63 |
2020 October | 53 | 11 | 64 |
2020 September | 50 | 11 | 61 |
2020 August | 107 | 9 | 116 |
2020 July | 44 | 22 | 66 |
2020 June | 38 | 10 | 48 |
2020 May | 44 | 8 | 52 |
2020 April | 37 | 19 | 56 |
2020 March | 23 | 7 | 30 |
2020 February | 45 | 19 | 64 |
2020 January | 26 | 11 | 37 |
2019 December | 40 | 11 | 51 |
2019 November | 25 | 23 | 48 |
2019 October | 16 | 9 | 25 |
2019 September | 16 | 9 | 25 |
2019 August | 33 | 21 | 54 |
2019 July | 18 | 18 | 36 |
2019 June | 22 | 7 | 29 |
2019 May | 41 | 17 | 58 |
2019 April | 27 | 11 | 38 |
2019 March | 37 | 15 | 52 |
2019 February | 28 | 20 | 48 |
2019 January | 28 | 18 | 46 |
2018 December | 39 | 18 | 57 |
2018 November | 42 | 24 | 66 |
2018 October | 46 | 19 | 65 |
2018 September | 3 | 0 | 3 |
2018 April | 1 | 1 | 2 |
2018 March | 0 | 2 | 2 |