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Vol. 34. Issue 5.
Pages 250-255 (May 1998)
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Vol. 34. Issue 5.
Pages 250-255 (May 1998)
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Resultados del tratamiento quirúrgico del carcinoma broncopulmonar no microcítico en estadio III-A
Results of surgical treatment of stage III-A non-small cell bronchopulmonary carcinoma
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A.I. Blanco*, A. Alvarado, J. Vázquez, M. Torres Cansino
Servicio de Cirugía Torácica. Hospital Universitario Virgen del Rocío. Sevilla
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Los objetivos de este estudio han sido analizar los resultados y la supervivencia del tratamiento quirúrgico en los distintos subgrupos del estadio III-A.

Desde enero de 1970 a diciembre de 1991, se revisaron 748 historias clínicas de pacientes con carcinoma broncopulmonar no microcítico. Seleccionamos 121 correspondientes a enfermos resecados que se encontraban en estadio III-A, según el informe anatomopatológico de la pieza.

La supervivencia global a los 3, 5 y 10 años fue de un 26, 16 y 12%, respectivamente. El subgrupo que mejor respondió al tratamiento fueron los T-3 (periféricos), N-0, con supervivencias a los 5 años del 21%. Si existía afectación de ganglios peribronquiales y/o hiliares (N-l), la supervivencia fue ligeramente inferior, alcanzando un 16%, y si se acompañaban de adenopatías mediastínicas (N-2) no se obtuvieron supervivientes a los 3 años. En este mismo subgrupo T-3, pero con invasión neoplásica de pericardio, pleura mediastínica o bronquios principales, no obtuvimos supervivencia alguna a los 3 años. La supervivencia obtenida en los pacientes T-3 periféricos que fueron sometidos a una resección en bloque fue del 27, 20 y 17% a los 3, 5 y 10 años, respectivamente, y del 16% a los 2 años y de 0% a los cinco en aquellos en los que se realizó una resección extrapleural.

Los enfermos que peor respondieron al tratamiento fueron aquellos con afectación de ganglios mediastínicos (N-2), en los que la supervivencia fue de un 17,12 y 8% a los 3, 5 y 10 años, respectivamente. En 34 de estos pacientes que fueron irradiados postoperatoriamente sobre el mediastino, la supervivencia aumentó discretamente al 16%.

En nuestra serie, la supervivencia obtenida a los 5 años para los carcinomas epidermoides fue similar a la de los adenocarcinomas, el 18 y el 14% a los 5 años, respectivamente.

Los resultados del tratamiento quirúrgico son variables y dependen de una serie de factores: extensión y localización extrapulmonar de las lesiones, técnica quirúrgica utilizada en los T-3 y tipo histológico tumoral.

Palabras clave:
Tratamiento quirúrgico
Carcinoma broncopulmonar no microcítico
Estadio III-A

To analyze results and survival after surgical treatment of various stage III-a subgroups.

We reviewed 748 case histories of patients with non-small cell bronchopulmonary carcinoma between January 1970 and December 1991, selecting 121 patients who underwent resection of stage III-a tumors, according to the pathologist's report.

Overall survival at 3, 5 and 10 years was 26, 16 and 12%, respectively. The subgroup with better response to treatment was that of patients with T-3 tumors (peripheral), N-0, with survival of 21% at five years. If peribronchial and/or hilar (N-1) nodes were affected, survival was slightly less (16%). If mediastinal adenopathy (N-2) was present, there were no survivors after 3 years. In this same T-3 group, but with neoplastic invasion of the pericardium, mediastinal pleura or principal bronchi, survival after 3 years was nil. The survival rates of peripheral T-3 patients undergoing block resections were 27, 20 and 17% at 3, 5 and 10 years, respectively, 16% at 2 years and 0% at 5, for those with extrapleural resection.

Patients with the poorest response to treatment were those with mediastinal nodes (N-2), in whom survival was 17, 12 and 8% at 3, 5 and 10 years, respectively. In the 34 patients received postoperative irradiation of the mediastinum, survival was 16% higher.

The survival rates after 5 years were similar for epidermoid carcinoma (18%) and adenocarcinoma (14%).

The results of surgical treatment are variable and depend on several factors: extension and extrapulmonary location of lesions, surgical technique used for T-3 tumors and histological type.

Key words:
Surgical treatment
Non-small cell bronchopulmonary carcinoma
Stage III-A
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Copyright © 1998. Sociedad Española de Neumología y Cirugía Torácica
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