array:23 [
  "pii" => "S1579212906604229"
  "issn" => "15792129"
  "doi" => "10.1016/S1579-2129(06)60422-9"
  "estado" => "S300"
  "fechaPublicacion" => "2005-04-01"
  "aid" => "60422"
  "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)"
  "copyrightAnyo" => "2005"
  "documento" => "article"
  "crossmark" => 0
  "subdocumento" => "fla"
  "cita" => "Arch Bronconeumol. 2005;41:180-4"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:2 [
    "total" => 2743
    "formatos" => array:3 [
      "EPUB" => 92
      "HTML" => 2055
      "PDF" => 596
    ]
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S1579212906604230"
    "issn" => "15792129"
    "doi" => "10.1016/S1579-2129(06)60423-0"
    "estado" => "S300"
    "fechaPublicacion" => "2005-04-01"
    "aid" => "60423"
    "copyright" => "Sociedad Española de Neumología y Cirugía Torácica (SEPAR)"
    "documento" => "article"
    "crossmark" => 0
    "subdocumento" => "fla"
    "cita" => "Arch Bronconeumol. 2005;41:185-8"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 2202
      "formatos" => array:3 [
        "EPUB" => 106
        "HTML" => 1458
        "PDF" => 638
      ]
    ]
    "en" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Articles</span>"
      "titulo" => "Prognostic Value of the Carcinoembryonic Antigen Found in Pleural Lavage Fluid From Patients With Lung Carcinoma"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "185"
          "paginaFinal" => "188"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46;M&#46; Galbis Caravajal, S&#46; Benlloch Carri&#243;n, J&#46; S&#225;nchez Pay&#225;, J&#46;J&#46; Maf&#233; Madue&#241;o, B&#46; Baschwitz G&#243;mez, J&#46;M&#46; Rodr&#237;guez Paniagua"
          "autores" => array:6 [
            0 => array:3 [
              "preGrado" => "Dr&#46;"
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Galbis Caravajal"
            ]
            1 => array:2 [
              "nombre" => "S&#46;"
              "apellidos" => "Benlloch Carri&#243;n"
            ]
            2 => array:2 [
              "nombre" => "J&#46;"
              "apellidos" => "S&#225;nchez Pay&#225;"
            ]
            3 => array:2 [
              "nombre" => "J&#46;J&#46;"
              "apellidos" => "Maf&#233; Madue&#241;o"
            ]
            4 => array:2 [
              "nombre" => "B&#46;"
              "apellidos" => "Baschwitz G&#243;mez"
            ]
            5 => array:2 [
              "nombre" => "J&#46;M&#46;"
              "apellidos" => "Rodr&#237;guez Paniagua"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906604230?idApp=UINPBA00003Z"
    "url" => "/15792129/0000004100000004/v1_201305150213/S1579212906604230/v1_201305150213/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S1579212906604217"
    "issn" => "15792129"
    "doi" => "10.1016/S1579-2129(06)60421-7"
    "estado" => "S300"
    "fechaPublicacion" => "2005-04-01"
    "aid" => "60421"
    "copyright" => "Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;SEPAR&#41;"
    "documento" => "simple-article"
    "crossmark" => 0
    "subdocumento" => "edi"
    "cita" => "Arch Bronconeumol. 2005;41:177-9"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:2 [
      "total" => 1871
      "formatos" => array:3 [
        "EPUB" => 85
        "HTML" => 1128
        "PDF" => 658
      ]
    ]
    "en" => array:8 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>"
      "titulo" => "Changes in the Surgical Treatment of Lung Cancer"
      "tienePdf" => "en"
      "tieneTextoCompleto" => 0
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "177"
          "paginaFinal" => "179"
        ]
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "J&#46; Freixinet, P&#46; Rodr&#237;guez"
          "autores" => array:2 [
            0 => array:3 [
              "preGrado" => "Dr&#46;"
              "nombre" => "J&#46;"
              "apellidos" => "Freixinet"
            ]
            1 => array:2 [
              "nombre" => "P&#46;"
              "apellidos" => "Rodr&#237;guez"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906604217?idApp=UINPBA00003Z"
    "url" => "/15792129/0000004100000004/v1_201305150213/S1579212906604217/v1_201305150213/en/main.assets"
  ]
  "en" => array:14 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Articles</span>"
    "titulo" => "Non-small Cell Lung Cancer in Stage IA&#58; Mortality Patterns After Surgery"
    "tieneTextoCompleto" => 0
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "180"
        "paginaFinal" => "184"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "J&#46; Padilla, J&#46;C&#46; Pe&#241;alver, C&#46; Jord&#225;, V&#46; Calvo, J&#46; Escriv&#225;, J&#46; Cer&#243;n, A&#46; Garc&#237;a Zarza, J&#46; Pastor, E&#46; Blasco"
        "autores" => array:9 [
          0 => array:5 [
            "preGrado" => "Dr&#46;"
            "nombre" => "J&#46;"
            "apellidos" => "Padilla"
            "email" => array:1 [
              0 => "jpadilla&#64;comv&#46;es"
            ]
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor1"
              ]
            ]
          ]
          1 => array:2 [
            "nombre" => "J&#46;C&#46;"
            "apellidos" => "Pe&#241;alver"
          ]
          2 => array:2 [
            "nombre" => "C&#46;"
            "apellidos" => "Jord&#225;"
          ]
          3 => array:2 [
            "nombre" => "V&#46;"
            "apellidos" => "Calvo"
          ]
          4 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Escriv&#225;"
          ]
          5 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Cer&#243;n"
          ]
          6 => array:2 [
            "nombre" => "A&#46;"
            "apellidos" => "Garc&#237;a Zarza"
          ]
          7 => array:2 [
            "nombre" => "J&#46;"
            "apellidos" => "Pastor"
          ]
          8 => array:2 [
            "nombre" => "E&#46;"
            "apellidos" => "Blasco"
          ]
        ]
        "afiliaciones" => array:1 [
          0 => array:1 [
            "entidad" => "Servicio de Cirug&#237;a Tor&#225;cica&#44; Hospital Universitario La Fe&#44; Valencia&#44; Spain"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor1"
            "etiqueta" => "&#42;"
            "correspondencia" => "Correspondence&#58; Dr&#46; J&#46; Padilla&#46; Servicio de Cirug&#237;a Tor&#225;cica&#46; Hospital Universitario La Fe&#46; Avda&#46; de Campanar&#44; 21&#46; 46009 Valencia&#46; Espa&#241;a"
          ]
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2004-07-14"
    "fechaAceptado" => "2004-10-04"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key Words"
          "identificador" => "xpalclavsec154009"
          "palabras" => array:5 [
            0 => "Bronchogenic carcinoma"
            1 => "Stage IA"
            2 => "Surgery"
            3 => "Lymph node excision"
            4 => "Mortality"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec154010"
          "palabras" => array:5 [
            0 => "Carcinoma broncog&#233;nico"
            1 => "Estadio IA"
            2 => "Cirug&#237;a"
            3 => "Disecci&#243;n ganglionar"
            4 => "Patr&#243;n de mortalidad"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">TO determine the causes of death in patients treated surgically for nonsmall cell lung cancer &#40;NSCLC&#41; in stage IA and to evaluate the impact on survival of not performing systematic lymph node dissection and of the number of nodes resected&#46;</p> <span class="elsevierStyleSectionTitle">Patients and methods</span><p class="elsevierStyleSimplePara elsevierViewall">The study sample consisted of 156 patients operated on for NSCLC and classified in stage IA according to TNM staging&#46; Only palpable or visible lymph nodes were dissected&#46; Kaplan-Meier survival curves were compared using a log-rank test&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">At the end of the study&#44; 85 &#40;54&#46;5&#37;&#41; patients had died&#44; 67 &#40;42&#46;9&#37;&#41; were alive&#44; and 4 &#40;2&#46;5&#37;&#41; were lost to follow up&#46; Twenty-three &#40;14&#46;7&#37;&#41; died from a recurrence of NSCLC&#58; 2 with local tumors &#40;1&#46;2&#37;&#41;&#44; 2 with mediastinal node involvement &#40;1&#46;2&#37;&#41;&#44; and 19 &#40;12&#46;1&#37;&#41; with distant metastasis&#46; The cause of death was unrelated to NSCLC in 62 &#40;39&#46;7&#37;&#41; cases&#58; 33 &#40;21&#46;1&#37;&#41; had a new tumor&#44; 18 of which were bronchogenic&#44; and 29 &#40;18&#46;5&#37;&#41; had nonmalignant disease&#46; The 5-year survival rate was 81&#46;4&#37;&#46; The rate was 88&#46;9&#37; among patients from whom no lymph nodes were excised and 79&#46;9 &#37; among those with node excision&#44; although the difference was not statistically significant &#40;<span class="elsevierStyleItalic">P</span> &#61; &#46;4073&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">Our experience suggests that neither the fact of not performing systematic lymph node dissection nor the number of nodes resected has an impact on survival&#46; A substantial number of patients died of causes unrelated to the NSCLC for which they had been treated&#46;</p>"
      ]
      "es" => array:1 [
        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">Determinar las causas de mortalidad en los pacientes operados de un carcinoma broncog&#233;nico no anapl&#225;sico de c&#233;lulas peque&#241;as &#40;CBNACP&#41; en estadio IA y el im-pacto que tiene en la supervivencia el hecho de no realizar una disecci&#243;n ganglionar sistem&#225;tica&#44; as&#237; como el n&#250;mero de ganglios resecados&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes Y M&#233;todos</span><p class="elsevierStyleSimplePara elsevierViewall">Se estudi&#243; a 156 pacientes operados de un CBNACP y clasificados en el estadio IA de acuer-do con el sistema tumor&#44; n&#243;dulo&#44; met&#225;stasis patol&#243;gico&#46; S&#243;lo se extirparon los ganglios palpables o visibles&#46; La supervivencia se analiz&#243; con el m&#233;todo de Kaplan-Meier y las cur-vas se compararon mediante el test de rangos logar&#237;tmicos&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Al finalizar el estudio&#44; 85 &#40;54&#44;5&#37;&#41; pacientes hab&#237;an fallecido&#44; 67 &#40;42&#44;9&#37;&#41; estaban vivos y 4 &#40;2&#44;5&#37;&#41; se ha-b&#237;an perdido en el seguimiento&#46; Veintitr&#233;s &#40;14&#44;7&#37;&#41; pacientes fallecieron por recidiva del CBNACP&#58; 2 por recidiva local &#40;1&#44;2&#37;&#41;&#44; otros 2 en el ganglio mediast&#237;nico &#40;1&#44;2&#37;&#41; y 19 &#40;12&#44;1&#37;&#41; por met&#225;stasis a distancia&#46; En 62 &#40;39&#44;7&#37;&#41; de los casos la causa de la muerte no estuvo relacionada con el CBNACP&#58; 33 &#40;21&#44;1&#37;&#41; fallecieron por aparici&#243;n de un nuevo c&#225;ncer&#44; 18 de los cuales fueron broncog&#233;nicos&#44; y 29 &#40;18&#44;5&#37;&#41; por enfermeda-des no tumorales&#46; La supervivencia a los 5 a&#241;os fue del 81&#44;4&#37;&#46; Cuando no se extirp&#243; ning&#250;n ganglio&#44; la supervivencia fue del 88&#44;9&#37;&#44; mientras que cuando se extirparon fue del 79&#44;9&#37;&#44; aunque la diferencia no fue significativa &#40;p &#61; 0&#44;4073&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">En nuestra experiencia&#44; ni el hecho de no realizar disecci&#243;n ganglionar sistem&#225;tica ni el n&#250;mero de ganglios extirpados han tenido una influencia en la supervivencia a los 5 a&#241;os&#46; Un n&#250;mero considerable de pacientes fa-lleci&#243; de una causa distinta del CBNACP del que se les hab&#237;a operado&#46;</p>"
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:1 [
          "bibliografiaReferencia" => array:34 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Incidence of local recurrence and second primary tumor in resected stage I lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N Martini"
                            1 => "MS Bains"
                            2 => "ME Burt"
                            3 => "MF Zakowski"
                            4 => "P McCormack"
                            5 => "VW Rusch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0022-5223(95)70427-2"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1995"
                        "volumen" => "109"
                        "paginaInicial" => "120"
                        "paginaFinal" => "129"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7815787"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognostic assessment of 1310 patients with non-small-cell lung cancer who underwent complete resection from 1980 to 1993"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K Inoue"
                            1 => "M Sato"
                            2 => "S Fujimura"
                            3 => "A Sakurada"
                            4 => "S Takahashi"
                            5 => "K Usuda"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0022-5223(98)70006-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1998"
                        "volumen" => "116"
                        "paginaInicial" => "407"
                        "paginaFinal" => "411"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9731782"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib3"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prognosis and survival after resection for bronchogenic carcinoma based on the 1997 TNM-staging classification&#58; the Japanese experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "T Naruke"
                            1 => "R Tsuchiya"
                            2 => "H Kondo"
                            3 => "H Asamura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg&#46;"
                        "fecha" => "2001"
                        "volumen" => "71"
                        "paginaInicial" => "1759"
                        "paginaFinal" => "1764"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11426744"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib4"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of comorbidity on survival after surgical resection in patients with stage I non-small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "RJ Battafarano"
                            1 => "JF Piccirillo"
                            2 => "BF Meyers"
                            3 => "H-S Hsu"
                            4 => "TJ Guthrie"
                            5 => "JD Cooper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "2002"
                        "volumen" => "123"
                        "paginaInicial" => "280"
                        "paginaFinal" => "287"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11828287"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib5"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preoperative pulmonary function as a prognostic factor for stage I non-small cell lung carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T Iizasa"
                            1 => "M Suzuki"
                            2 => "K Yusufuku"
                            3 => "A Iyoda"
                            4 => "M Otsuji"
                            5 => "S Yoshida"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.athoracsur.2003.10.014"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg&#46;"
                        "fecha" => "2004"
                        "volumen" => "77"
                        "paginaInicial" => "1896"
                        "paginaFinal" => "1903"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15172232"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib6"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The risk of second primary tumors after resection of stage I nonsmall cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D Rice"
                            1 => "HV Kim"
                            2 => "A Sabichi"
                            3 => "S Lippman"
                            4 => "JJ Lee"
                            5 => "B Williams"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg&#46;"
                        "fecha" => "2003"
                        "volumen" => "76"
                        "paginaInicial" => "1001"
                        "paginaFinal" => "1008"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14529975"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib7"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lymph node involvement&#44; recurrence&#44; and prognosis in resected small&#44; peripheral&#44; non-small-cell lung carcinomas&#58; are these carcinomas candidates for video-assisted lobectomy&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H Asamura"
                            1 => "H Nakayama"
                            2 => "H Kondo"
                            3 => "R Tsuchiya"
                            4 => "Y Shimosato"
                            5 => "T Naruke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1996"
                        "volumen" => "111"
                        "paginaInicial" => "1125"
                        "paginaFinal" => "1134"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8642812"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib8"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K Sugi"
                            1 => "K Nawata"
                            2 => "N Fujita"
                            3 => "K Ueda"
                            4 => "T Tanaka"
                            5 => "T Matsuoka"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Surg&#46;"
                        "fecha" => "1998"
                        "volumen" => "22"
                        "paginaInicial" => "290"
                        "paginaFinal" => "294"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9494422"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib9"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Extent of mediastinal node metastasis in clinical stage I nonsmall-cell lung cancer&#58; the role of systematic nodal dissection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M Oda"
                            1 => "Y Watanabe"
                            2 => "J Shimizu"
                            3 => "S Murakami"
                            4 => "Y Ohta"
                            5 => "N Sekido"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lung Cancer"
                        "fecha" => "1998"
                        "volumen" => "22"
                        "paginaInicial" => "23"
                        "paginaFinal" => "30"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9869104"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib10"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical analysis of small-sized peripheral lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T Koike"
                            1 => "M Terahima"
                            2 => "T Takizawa"
                            3 => "Y Kurita"
                            4 => "A Yokoyama"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0022-5223(98)70399-X"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1998"
                        "volumen" => "115"
                        "paginaInicial" => "1015"
                        "paginaFinal" => "1020"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9605069"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib11"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lymph node sampling in lung cancer&#58; how should it be done&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "T Naruke"
                            1 => "R Tsuchiya"
                            2 => "H Kondo"
                            3 => "H Nakayama"
                            4 => "H Asamura"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eur J Cardiothorac Surg&#46;"
                        "fecha" => "1999"
                        "volumen" => "19"
                        "paginaInicial" => "17"
                        "paginaFinal" => "24"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib12"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term results of pathological stage I non-small cell lung cancer&#58; validation of using the number of totally removed lymph nodes as a staging control"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "Y-C Wu"
                            1 => "C-F Jeff Lin"
                            2 => "W-H Hsu"
                            3 => "B-S Huang"
                            4 => "M-H Huang"
                            5 => "L-S Wang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur J Cardiothorac Surg&#46;"
                        "fecha" => "2003"
                        "volumen" => "24"
                        "paginaInicial" => "994"
                        "paginaFinal" => "1001"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14643819"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib13"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A Gajra"
                            1 => "N Newman"
                            2 => "GP Gamble"
                            3 => "LJ Kohman"
                            4 => "SL Graziano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2003.07.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2003"
                        "volumen" => "21"
                        "paginaInicial" => "1029"
                        "paginaFinal" => "1034"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12637467"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib14"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Normativa actualizada &#40;1998&#41; sobre diagn&#243;stico y estadificaci&#243;n del carcinoma broncog&#233;nico"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Grupo de Trabajo de la SEPAR"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol&#46;"
                        "fecha" => "1998"
                        "volumen" => "34"
                        "paginaInicial" => "437"
                        "paginaFinal" => "452"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9842457"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib15"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Multiple primary lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "N Martini"
                            1 => "MR Melamed"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1975"
                        "volumen" => "70"
                        "paginaInicial" => "606"
                        "paginaFinal" => "611"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/170482"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib16"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lung cancer mortality in the Mayo Lung Project&#58; impact of extended follow-up"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P Marcus"
                            1 => "E Bergstralh"
                            2 => "R Fagerstrom"
                            3 => "D Williams"
                            4 => "R Fontana"
                            5 => "W Taylor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Natl Cancer Inst&#46;"
                        "fecha" => "2000"
                        "volumen" => "92"
                        "paginaInicial" => "1308"
                        "paginaFinal" => "1316"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10944552"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib17"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mediastinal lymph node dissection in resected lung cancer&#58; morbidity and accuracy of staging"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "EC Bollen"
                            1 => "CJ van Duin"
                            2 => "PH Theunissen"
                            3 => "BE Vt Hof-Grootenboer"
                            4 => "GH Blijham"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg&#46;"
                        "fecha" => "1993"
                        "volumen" => "55"
                        "paginaInicial" => "961"
                        "paginaFinal" => "966"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8385446"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib18"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Estadificaci&#243;n ganglionar intraoperatoria en la cirug&#237;a del carcinoma broncog&#233;nico&#46; Documento de consenso"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Grupo Cooperativo de Carcinoma Broncog&#233;nico de la Sociedad Espa&#241;ola de Neumolog&#237;a y Cirug&#237;a Tor&#225;cica &#40;GCCB-S&#41;"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Arch Bronconeumol&#46;"
                        "fecha" => "2001"
                        "volumen" => "37"
                        "paginaInicial" => "495"
                        "paginaFinal" => "503"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11734139"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib19"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Complete mediastinal lymph node dissection-does it make a difference&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "SM Keller"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lung Cancer"
                        "fecha" => "2002"
                        "volumen" => "36"
                        "paginaInicial" => "7"
                        "paginaFinal" => "8"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11891026"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib20"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mediastinal lymph node dissection improves survival in patients with stage II and IIIa non-small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:3 [
                          "colaboracion" => "Eastern Cooperative Oncology Group"
                          "etal" => false
                          "autores" => array:4 [
                            0 => "SM Keller"
                            1 => "S Adak"
                            2 => "H Wagner"
                            3 => "DH Johnson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg&#46;"
                        "fecha" => "2000"
                        "volumen" => "70"
                        "paginaInicial" => "358"
                        "paginaFinal" => "365"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10969645"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib21"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Impact of radical systematic mediastinal lymphadenectomy on tumor staging in lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "JR Izbicki"
                            1 => "B Passlick"
                            2 => "O Karg"
                            3 => "C Bloechle"
                            4 => "K Pantel"
                            5 => "WT Knoefel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0003-4975(94)00717-L"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Thorac Surg&#46;"
                        "fecha" => "1995"
                        "volumen" => "59"
                        "paginaInicial" => "209"
                        "paginaFinal" => "214"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7818326"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib22"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus report&#58; Staging Classification Committee"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "R Ginsberg"
                            1 => "J Cox"
                            2 => "M Green"
                            3 => "H Bulzebruck"
                            4 => "D Grunewald"
                            5 => "P Harper"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Lung Cancer"
                        "fecha" => "1997"
                        "volumen" => "17"
                        "paginaInicial" => "11S"
                        "paginaFinal" => "13S"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib23"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Clinical tumour size and prognosis in lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery &#40;GCCB-S&#41;"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J&#46;"
                        "fecha" => "1999"
                        "volumen" => "14"
                        "paginaInicial" => "812"
                        "paginaFinal" => "816"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10573226"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib24"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Mediastinal lymph node metastasis in patients with clinical stage I peripheral non-small-cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T Takizawa"
                            1 => "M Terashima"
                            2 => "T Koike"
                            3 => "H Akamatsu"
                            4 => "Y Kurita"
                            5 => "A Yokoyama"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0022-5223(97)70320-9"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1997"
                        "volumen" => "113"
                        "paginaInicial" => "248"
                        "paginaFinal" => "252"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9040617"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib25"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Systematic nodal dissection in the intrathoracic staging of patients with non-small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "AN Graham"
                            1 => "KJ Chan"
                            2 => "U Pastorino"
                            3 => "P Goldstraw"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0022-5223(99)70419-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1999"
                        "volumen" => "117"
                        "paginaInicial" => "246"
                        "paginaFinal" => "251"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9918964"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib26"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lymph node mapping and curability at various levels of metastasis in resected lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "T Naruke"
                            1 => "K Suemasu"
                            2 => "S Ishikawa"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1978"
                        "volumen" => "76"
                        "paginaInicial" => "832"
                        "paginaFinal" => "839"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/713589"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib27"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas&#58; role of subcarinal nodes in selective dissection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M Okada"
                            1 => "N Tsubota"
                            2 => "M Yoshimura"
                            3 => "Y Miyamoto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/S0022-5223(98)70045-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1998"
                        "volumen" => "116"
                        "paginaInicial" => "949"
                        "paginaFinal" => "953"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9832685"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib28"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "H Asamura"
                            1 => "H Nakayama"
                            2 => "H Kondo"
                            3 => "R Tsuchiya"
                            4 => "T Naruke"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1999"
                        "volumen" => "117"
                        "paginaInicial" => "1102"
                        "paginaFinal" => "1111"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/10343258"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib29"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Local recurrence after complete resection for non-small-cell cancer of the lung&#46; Significance of local control by radiation treatment"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "T Yano"
                            1 => "N Hara"
                            2 => "Y Ichinose"
                            3 => "H Asoh"
                            4 => "H Yokohama"
                            5 => "M Otha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1994"
                        "volumen" => "107"
                        "paginaInicial" => "8"
                        "paginaFinal" => "12"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8283923"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib30"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "JR Izbicki"
                            1 => "B Passlick"
                            2 => "K Pantel"
                            3 => "U Pichlmeier"
                            4 => "SB Hosch"
                            5 => "O Karg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Ann Surg&#46;"
                        "fecha" => "1998"
                        "volumen" => "227"
                        "paginaInicial" => "138"
                        "paginaFinal" => "144"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9445122"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            30 => array:3 [
              "identificador" => "bib31"
              "etiqueta" => "31"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "Y Wu"
                            1 => "Z Huang"
                            2 => "S Wang"
                            3 => "X Yang"
                            4 => "W Ou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lung Cancer"
                        "fecha" => "2002"
                        "volumen" => "36"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11891025"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            31 => array:3 [
              "identificador" => "bib32"
              "etiqueta" => "32"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Preoperative mediastinoscopic assessment of N factors and the need for mediastinal lymph node dissection in T1 lung cancer"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "T Funatsu"
                            1 => "Y Matsubara"
                            2 => "S Ikeda"
                            3 => "R Hatakenaka"
                            4 => "T Hanawa"
                            5 => "H Ishida"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Thorac Cardiovasc Surg&#46;"
                        "fecha" => "1994"
                        "volumen" => "1994"
                        "paginaInicial" => "321"
                        "paginaFinal" => "328"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            32 => array:3 [
              "identificador" => "bib33"
              "etiqueta" => "33"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Lymph node dissection&#58; is it diagnostic or therapeutic&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "ER Sigurdson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1200/JCO.2003.11.944"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Clin Oncol&#46;"
                        "fecha" => "2003"
                        "volumen" => "21"
                        "paginaInicial" => "965"
                        "paginaFinal" => "967"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12637458"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            33 => array:3 [
              "identificador" => "bib34"
              "etiqueta" => "34"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 &#40;less than hilar&#41; non-small cell lung carcinoma"
                      "autores" => array:1 [
                        0 => array:2 [
                          "colaboracion" => "American College of Surgeons Oncology Group"
                          "etal" => false
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "WWW" => array:1 [
                        "link" => "Available from&#58; http&#58;&#47;&#47;www&#46;acosog&#46;org"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/15792129/0000004100000004/v1_201305150213/S1579212906604229/v1_201305150213/en/main.assets"
  "Apartado" => null
  "PDF" => "https://static.elsevier.es/multimedia/15792129/0000004100000004/v1_201305150213/S1579212906604229/v1_201305150213/en/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1579212906604229?idApp=UINPBA00003Z"
]
Share
Journal Information
Vol. 41. Issue 4.
Pages 180-184 (April 2005)
Share
Share
Download PDF
More article options
Vol. 41. Issue 4.
Pages 180-184 (April 2005)
Original Articles
Full text access
Non-small Cell Lung Cancer in Stage IA: Mortality Patterns After Surgery
Visits
4805
J. Padilla
Corresponding author
jpadilla@comv.es

Correspondence: Dr. J. Padilla. Servicio de Cirugía Torácica. Hospital Universitario La Fe. Avda. de Campanar, 21. 46009 Valencia. España
, J.C. Peñalver, C. Jordá, V. Calvo, J. Escrivá, J. Cerón, A. García Zarza, J. Pastor, E. Blasco
Servicio de Cirugía Torácica, Hospital Universitario La Fe, Valencia, Spain
This item has received
Article information
Objective

TO determine the causes of death in patients treated surgically for nonsmall cell lung cancer (NSCLC) in stage IA and to evaluate the impact on survival of not performing systematic lymph node dissection and of the number of nodes resected.

Patients and methods

The study sample consisted of 156 patients operated on for NSCLC and classified in stage IA according to TNM staging. Only palpable or visible lymph nodes were dissected. Kaplan-Meier survival curves were compared using a log-rank test.

Results

At the end of the study, 85 (54.5%) patients had died, 67 (42.9%) were alive, and 4 (2.5%) were lost to follow up. Twenty-three (14.7%) died from a recurrence of NSCLC: 2 with local tumors (1.2%), 2 with mediastinal node involvement (1.2%), and 19 (12.1%) with distant metastasis. The cause of death was unrelated to NSCLC in 62 (39.7%) cases: 33 (21.1%) had a new tumor, 18 of which were bronchogenic, and 29 (18.5%) had nonmalignant disease. The 5-year survival rate was 81.4%. The rate was 88.9% among patients from whom no lymph nodes were excised and 79.9 % among those with node excision, although the difference was not statistically significant (P = .4073).

Conclusions

Our experience suggests that neither the fact of not performing systematic lymph node dissection nor the number of nodes resected has an impact on survival. A substantial number of patients died of causes unrelated to the NSCLC for which they had been treated.

Key Words:
Bronchogenic carcinoma
Stage IA
Surgery
Lymph node excision
Mortality
Objetivo

Determinar las causas de mortalidad en los pacientes operados de un carcinoma broncogénico no anaplásico de células pequeñas (CBNACP) en estadio IA y el im-pacto que tiene en la supervivencia el hecho de no realizar una disección ganglionar sistemática, así como el número de ganglios resecados.

Pacientes Y Métodos

Se estudió a 156 pacientes operados de un CBNACP y clasificados en el estadio IA de acuer-do con el sistema tumor, nódulo, metástasis patológico. Sólo se extirparon los ganglios palpables o visibles. La supervivencia se analizó con el método de Kaplan-Meier y las cur-vas se compararon mediante el test de rangos logarítmicos.

Resultados

Al finalizar el estudio, 85 (54,5%) pacientes habían fallecido, 67 (42,9%) estaban vivos y 4 (2,5%) se ha-bían perdido en el seguimiento. Veintitrés (14,7%) pacientes fallecieron por recidiva del CBNACP: 2 por recidiva local (1,2%), otros 2 en el ganglio mediastínico (1,2%) y 19 (12,1%) por metástasis a distancia. En 62 (39,7%) de los casos la causa de la muerte no estuvo relacionada con el CBNACP: 33 (21,1%) fallecieron por aparición de un nuevo cáncer, 18 de los cuales fueron broncogénicos, y 29 (18,5%) por enfermeda-des no tumorales. La supervivencia a los 5 años fue del 81,4%. Cuando no se extirpó ningún ganglio, la supervivencia fue del 88,9%, mientras que cuando se extirparon fue del 79,9%, aunque la diferencia no fue significativa (p = 0,4073).

Conclusiones

En nuestra experiencia, ni el hecho de no realizar disección ganglionar sistemática ni el número de ganglios extirpados han tenido una influencia en la supervivencia a los 5 años. Un número considerable de pacientes fa-lleció de una causa distinta del CBNACP del que se les había operado.

Palabras clave:
Carcinoma broncogénico
Estadio IA
Cirugía
Disección ganglionar
Patrón de mortalidad
Full text is only aviable in PDF
REFERENCES
[1]
N Martini, MS Bains, ME Burt, MF Zakowski, P McCormack, VW Rusch, et al.
Incidence of local recurrence and second primary tumor in resected stage I lung cancer.
J Thorac Cardiovasc Surg., 109 (1995), pp. 120-129
[2]
K Inoue, M Sato, S Fujimura, A Sakurada, S Takahashi, K Usuda, et al.
Prognostic assessment of 1310 patients with non-small-cell lung cancer who underwent complete resection from 1980 to 1993.
J Thorac Cardiovasc Surg., 116 (1998), pp. 407-411
[3]
T Naruke, R Tsuchiya, H Kondo, H Asamura.
Prognosis and survival after resection for bronchogenic carcinoma based on the 1997 TNM-staging classification: the Japanese experience.
Ann Thorac Surg., 71 (2001), pp. 1759-1764
[4]
RJ Battafarano, JF Piccirillo, BF Meyers, H-S Hsu, TJ Guthrie, JD Cooper, et al.
Impact of comorbidity on survival after surgical resection in patients with stage I non-small cell lung cancer.
J Thorac Cardiovasc Surg., 123 (2002), pp. 280-287
[5]
T Iizasa, M Suzuki, K Yusufuku, A Iyoda, M Otsuji, S Yoshida, et al.
Preoperative pulmonary function as a prognostic factor for stage I non-small cell lung carcinoma.
Ann Thorac Surg., 77 (2004), pp. 1896-1903
[6]
D Rice, HV Kim, A Sabichi, S Lippman, JJ Lee, B Williams, et al.
The risk of second primary tumors after resection of stage I nonsmall cell lung cancer.
Ann Thorac Surg., 76 (2003), pp. 1001-1008
[7]
H Asamura, H Nakayama, H Kondo, R Tsuchiya, Y Shimosato, T Naruke.
Lymph node involvement, recurrence, and prognosis in resected small, peripheral, non-small-cell lung carcinomas: are these carcinomas candidates for video-assisted lobectomy?.
J Thorac Cardiovasc Surg., 111 (1996), pp. 1125-1134
[8]
K Sugi, K Nawata, N Fujita, K Ueda, T Tanaka, T Matsuoka, et al.
Systematic lymph node dissection for clinically diagnosed peripheral non-small-cell lung cancer less than 2 cm in diameter.
World J Surg., 22 (1998), pp. 290-294
[9]
M Oda, Y Watanabe, J Shimizu, S Murakami, Y Ohta, N Sekido, et al.
Extent of mediastinal node metastasis in clinical stage I nonsmall-cell lung cancer: the role of systematic nodal dissection.
Lung Cancer, 22 (1998), pp. 23-30
[10]
T Koike, M Terahima, T Takizawa, Y Kurita, A Yokoyama.
Clinical analysis of small-sized peripheral lung cancer.
J Thorac Cardiovasc Surg., 115 (1998), pp. 1015-1020
[11]
T Naruke, R Tsuchiya, H Kondo, H Nakayama, H Asamura.
Lymph node sampling in lung cancer: how should it be done?.
Eur J Cardiothorac Surg., 19 (1999), pp. 17-24
[12]
Y-C Wu, C-F Jeff Lin, W-H Hsu, B-S Huang, M-H Huang, L-S Wang.
Long-term results of pathological stage I non-small cell lung cancer: validation of using the number of totally removed lymph nodes as a staging control.
Eur J Cardiothorac Surg., 24 (2003), pp. 994-1001
[13]
A Gajra, N Newman, GP Gamble, LJ Kohman, SL Graziano.
Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer.
J Clin Oncol., 21 (2003), pp. 1029-1034
[14]
Grupo de Trabajo de la SEPAR.
Normativa actualizada (1998) sobre diagnóstico y estadificación del carcinoma broncogénico.
Arch Bronconeumol., 34 (1998), pp. 437-452
[15]
N Martini, MR Melamed.
Multiple primary lung cancer.
J Thorac Cardiovasc Surg., 70 (1975), pp. 606-611
[16]
P Marcus, E Bergstralh, R Fagerstrom, D Williams, R Fontana, W Taylor, et al.
Lung cancer mortality in the Mayo Lung Project: impact of extended follow-up.
J Natl Cancer Inst., 92 (2000), pp. 1308-1316
[17]
EC Bollen, CJ van Duin, PH Theunissen, BE Vt Hof-Grootenboer, GH Blijham.
Mediastinal lymph node dissection in resected lung cancer: morbidity and accuracy of staging.
Ann Thorac Surg., 55 (1993), pp. 961-966
[18]
Grupo Cooperativo de Carcinoma Broncogénico de la Sociedad Española de Neumología y Cirugía Torácica (GCCB-S).
Estadificación ganglionar intraoperatoria en la cirugía del carcinoma broncogénico. Documento de consenso.
Arch Bronconeumol., 37 (2001), pp. 495-503
[19]
SM Keller.
Complete mediastinal lymph node dissection-does it make a difference?.
Lung Cancer, 36 (2002), pp. 7-8
[20]
SM Keller, S Adak, H Wagner, DH Johnson, Eastern Cooperative Oncology Group.
Mediastinal lymph node dissection improves survival in patients with stage II and IIIa non-small cell lung cancer.
Ann Thorac Surg., 70 (2000), pp. 358-365
[21]
JR Izbicki, B Passlick, O Karg, C Bloechle, K Pantel, WT Knoefel, et al.
Impact of radical systematic mediastinal lymphadenectomy on tumor staging in lung cancer.
Ann Thorac Surg., 59 (1995), pp. 209-214
[22]
R Ginsberg, J Cox, M Green, H Bulzebruck, D Grunewald, P Harper, et al.
Consensus report: Staging Classification Committee.
Lung Cancer, 17 (1997), pp. 11S-13S
[23]
Bronchogenic Carcinoma Cooperative Group of the Spanish Society of Pneumology and Thoracic Surgery (GCCB-S).
Clinical tumour size and prognosis in lung cancer.
Eur Respir J., 14 (1999), pp. 812-816
[24]
T Takizawa, M Terashima, T Koike, H Akamatsu, Y Kurita, A Yokoyama.
Mediastinal lymph node metastasis in patients with clinical stage I peripheral non-small-cell lung cancer.
J Thorac Cardiovasc Surg., 113 (1997), pp. 248-252
[25]
AN Graham, KJ Chan, U Pastorino, P Goldstraw.
Systematic nodal dissection in the intrathoracic staging of patients with non-small cell lung cancer.
J Thorac Cardiovasc Surg., 117 (1999), pp. 246-251
[26]
T Naruke, K Suemasu, S Ishikawa.
Lymph node mapping and curability at various levels of metastasis in resected lung cancer.
J Thorac Cardiovasc Surg., 76 (1978), pp. 832-839
[27]
M Okada, N Tsubota, M Yoshimura, Y Miyamoto.
Proposal for reasonable mediastinal lymphadenectomy in bronchogenic carcinomas: role of subcarinal nodes in selective dissection.
J Thorac Cardiovasc Surg., 116 (1998), pp. 949-953
[28]
H Asamura, H Nakayama, H Kondo, R Tsuchiya, T Naruke.
Lobe-specific extent of systematic lymph node dissection for non-small cell lung carcinomas according to a retrospective study of metastasis and prognosis.
J Thorac Cardiovasc Surg., 117 (1999), pp. 1102-1111
[29]
T Yano, N Hara, Y Ichinose, H Asoh, H Yokohama, M Otha, et al.
Local recurrence after complete resection for non-small-cell cancer of the lung. Significance of local control by radiation treatment.
J Thorac Cardiovasc Surg., 107 (1994), pp. 8-12
[30]
JR Izbicki, B Passlick, K Pantel, U Pichlmeier, SB Hosch, O Karg, et al.
Effectiveness of radical systematic mediastinal lymphadenectomy in patients with resectable non-small cell lung cancer.
Ann Surg., 227 (1998), pp. 138-144
[31]
Y Wu, Z Huang, S Wang, X Yang, W Ou.
A randomized trial of systematic nodal dissection in resectable non-small cell lung cancer.
Lung Cancer, 36 (2002), pp. 1-6
[32]
T Funatsu, Y Matsubara, S Ikeda, R Hatakenaka, T Hanawa, H Ishida.
Preoperative mediastinoscopic assessment of N factors and the need for mediastinal lymph node dissection in T1 lung cancer.
J Thorac Cardiovasc Surg., 1994 (1994), pp. 321-328
[33]
ER Sigurdson.
Lymph node dissection: is it diagnostic or therapeutic?.
J Clin Oncol., 21 (2003), pp. 965-967
[34]
American College of Surgeons Oncology Group.
Randomized trial of mediastinal lymph node sampling versus complete lymphadenectomy during pulmonary resection in the patient with N0 or N1 (less than hilar) non-small cell lung carcinoma.
Copyright © 2005. Sociedad Española de Neumología y Cirugía Torácica (SEPAR)
Archivos de Bronconeumología
Article options
Tools

Are you a health professional able to prescribe or dispense drugs?