Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT +...
Transcript of Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT +...
![Page 1: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/1.jpg)
Cirugía tras tratamiento neoadyuvante
Josep Belda. Cirujano Torácico
![Page 2: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/2.jpg)
No tengo ningún conflictode interésrelacionadocon el temade esta presentación.
![Page 3: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/3.jpg)
![Page 4: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/4.jpg)
1. Selección de pacientes para cirugía.
2. Cirugía en pacientes con ycN2 residual
3. Resultados tratamiento trimodal tras una VAMLA
4. Complicaciones quirúrgicas tras inducción. Factores de riesgo.
5. Neumonectomía tras inducción
![Page 5: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/5.jpg)
Resecable. R0
Paciente operable
Riesgo quirúrgico / beneficio terapéutico
Complete resection in LC. Rami-Porta R. IASLC Staging Committee. LC. 2005
Infiltrative and discreteN2/N3 involvement. Ramnath. ACCP guidelines. Chest 2013
ERS/ESTS guidelines on fitness for radical therapy in LC patients (surgery and CT/RT). BrunelliERJ 2009
![Page 6: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/6.jpg)
Median
(mo)
5-Year
estimate OS
CT/RT/Surgery 23.6 27.2%
CT/RT 22.2 20.3%
p=0.10p=0.24HR 0.87
(95%CI 0.70-1.10)
Overall survival of
intention-to-treat .
T1-3pN2M0
Radiotherapy plus chemotherapy with or without surgical resection for stage
III NSCLC: a phase III RCT. Albain K. Lancet 2019. Intergroup Trial 0139
![Page 7: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/7.jpg)
CT/RT CT/RT Log Rank
Mediana sv 34 m 22 m p=0,002
OS 5 a. 36% 18%
Lobectomía
CT/RT CT/RT Log rank
Mediana sv 19 m 29 m p=ns
OS 5 a. 22% 24%
Neumonectomía
OS matching analysis (any ypT/ypN)
Albain. Lancet 2019. Intergroup trial 0139
![Page 8: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/8.jpg)
Any T Median sv 5yr OS
pN0 34,4 m 41%
pN1-3
pN unknown26,4 m 24%
No surgery 7,9 m 8%
ypT0N0 (RPC) 39,8 m 42%
Albain. Lancet 2019. Intergroup trial 0139
![Page 9: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/9.jpg)
Repeat mediastinoscopy in all its indications: experience with 96patients and 101 procedures. Call S. EJCTS. 2011.
P<0.0001
cN2 confirmados, inducción (CRT/CT) más cirugía
Repeat mediastinoscopy:
S 0.74, NPV 0.79, A 0.87
![Page 10: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/10.jpg)
Prognostic factors in neoadjuvant treatment followed by surgery in stage IIIA-N2 NSCLC: a multi-institutional study. Oncologic Group
for the Study of Lung Cancer (SEOR). Couñago F, et al. Clin Trans Oncol 2019
![Page 11: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/11.jpg)
Thomas et al. Lancet Oncol 2008Carreta et al. World J Surg 2008Albain et al. Lancet 2009Li et al. Clin Lung Cancer 2009Decaluwé et al. EJCTS 2009Higgins et al. Int J Rad Oncol Biol Phys 2009Krasna et al. Ann Thorac Surg 2010Call et al. EJCTS 2011;Paul et al. J Thorac Cardiovasc Surg 2011Pataer et al. JTO 2012Steger et al. ICVTS 2012;Loccoco et al. EJCTS 2013;Yang et al. EJCTS 2016. Couñago et al. Clin Transl Oncol 2019
Strauss et al. J Clin Oncol 1992Albain et al. J Clin Oncol 1995Rice et al. Ann Thorac Surg 1998Stamatis et al. Ann Thorac Surg 1999Okada et al. Chest 2000Bueno et al. Ann Thorac Surg 2000Voltolini et al. EJCTS 2001Cyjon et al. ATS 2002Betticher et al. J Clin Oncol 2003Rusch et al. Lung Cancer 2005Van Meerbeeck et al. Lung Cancer 2005Van Meerbeeck et al. J Natl Cancer Inst 2007Garrido et al. J Clin Oncol 2007
![Page 12: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/12.jpg)
Initial results of pulmonary resection after neoadjuvant nivolumab in patients
with resectable NSCLC. Bott MJ. JTCVS 2019
Major pathologic response/CPR
– 24% LCMC3
– 24% NEOSTAR
– 45% Bott (MSKCC & JH)
– 80% NADIM
sin mas complicaciones ni mortalidad perioperatorias…
![Page 13: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/13.jpg)
Probablemente… NO deben
hacerse resecciones mayores
que una lobectomía
o Rice et al. Ann Thorac Surg 1998o Stamatis et al. Ann Thorac Surg 1999o Okada et al. Chest 2000o Bueno et al. Ann Thorac Surg 2000o Betticher et al. J Clin Oncol 2003o Albain et al. J Clin Oncol 2005o Van Meerbeeck et al. J Natl Cancer Inst 2007o Uy KL, et al J Thorac Cardiovasc Surg 2007o Decaluwe H, et al. Eur J Cardiothorac Surg 2009o Yang ChF, et al. Eur J Cardiothorac Surg 2016. o Couñago F, eat al. Clin Transl Oncol 2019
![Page 14: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/14.jpg)
Probablemente… SOLO
deberían operarse ycN0-1
…el problema de la
reestadificación
![Page 15: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/15.jpg)
The accuracy of clinical staging of stage I-IIIa NSCLC: An analysis based
on individual participant data. Navani. Chest 2019.
![Page 16: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/16.jpg)
A systematic review of restaging after induction therapy for
stage IIIa LC: Prediction of p-stage. de Cabanyes C. JTO 2010
![Page 17: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/17.jpg)
Postinduction PET assessment of N2 nodes is not associated with ypN2
or overall survival in stage IIIA NSCLC. Ripley RT. JTCVS 2016 MSKCC
43% PET N2 negative
39% PET N2-avid disease.
N=100 IIIA-N2 confirmado patol.
CT + Cirugia
62% ypN2
S E PD
Postinduction
PET for ypN2
59% 55% 57%
P =0.251
![Page 18: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/18.jpg)
SUVmax decrease on PET/TC after neoadjuvant CT is a prognostic
classifier for long-term outcome after multimodality treatment: Secondary analysis of
a randomized trial for resectable stage IIIA/B NSCLC. Pöttgen Ch, et al. JCO 2016
ESPATUE trial
Phase III. Surgery vs
definitive concurrent CRT
boost in patients with
resectable stage IIIA-N2
and selected IIIB NSCLC
after induction CT and
concurrent CRT
![Page 19: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/19.jpg)
1. Selección de pacientes para cirugía.
2. Cirugía en pacientes con ycN2 residual
3. Resultados tratamiento trimodal tras una VAMLA
4. Complicaciones quirúrgicas tras inducción. Factores de riesgo.
5. Neumonectomía tras inducción
![Page 20: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/20.jpg)
Kaplan–Meier estimated OS according to the LNR for pN2
Porque hay “pocos” ganglios afectos
Mediastinal downstaging after induction is not a significant prognostic factor to select patients who would benefit from surgery: the clinical value of the lymph node ratio. Renaud, et al. ICVTS 2015
• SV pN2 con LNR bajo = pN1 con LNR alto
• Downstaging mediastínico NO seria un
factor pronóstico suficiente para
contraindicar la cirugia tras la inducción
![Page 21: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/21.jpg)
“Poco N2” porque es “solo” microscópico
Surgery for patients with persistent pathological N2 IIIA NSCLC after induction
RCT: the microscopic seed of doubt. Meacci E. EJCTS 2011
• 161 IIIA-N2
• Induction CRT
• 40 pN2 (26%)
Microscopic (---) and macroscopic ( ) LN involvement survival functions.
![Page 22: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/22.jpg)
The impact of residual multi-level N2 disease after induction therapy
for NSCLC. Sawabata, et al. LC 2003
“Poco N2” porque hay pocos niveles afectos
![Page 23: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/23.jpg)
1. Selección de pacientes para cirugía.
2. Cirugía en pacientes con ycN2 residual
3. Resultados tratamiento trimodal tras una VAMLA
4. Complicaciones quirúrgicas tras inducción. Factores de riesgo.
5. Neumonectomía tras inducción
![Page 24: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/24.jpg)
Resultados tratamiento trimodal tras una VAMLA
![Page 25: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/25.jpg)
CentralN1 > 3cm
• Vilmann. ERJ 2015. ESGE/ERS/ESTS
• Majem. Clin Transl Oncol 2019. GECP,
SECT, SEPAR, SEOM, SERAM, SEOR, SEMNIM
• Eberhartdt. AO 2015. ESMO
• De Leyn. EJCTS 2014. ESTS/ERS
• Darling. Curr Oncol 2011. Ontario Guidelines
• Silvestri. Chest 2013. ACCP.
• Ramnath. Chest 2013. ACCP
Mediastino normal en PET/TC: recomendaciones EBUS
y/o mediastinoscopia
![Page 26: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/26.jpg)
VideoAssisted Mediastinoscopic Lymphadenectomy for staging NSCLC. Call S. Ann Thorac Surg 2016.
n= 32
uN2= 13 (40.7%)
cN1
T >3cm
cN0
n= 63
uN2= 14 (22.2%) n= 31
uN2= 2 (6.4%)
cN0
T ≤ 3cm
![Page 27: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/27.jpg)
cN1 based on:
Watanabe. ATS 2005 CT
Hishida. Thorax 2007 CT
Cerfolio. ATS 2015 PET/CT
Al.Sarraf. EJCTS 2008 PET/CT
Kim TCS 2014 PET/CT
Dooms (ASTER 2). Chest 2015
PET/CT + EBUS + Mediastinoscopy + surgery if all negative
Call. ATS 2016 PET/CT+ VAMLA + surgery if neg.
c/pN2
44%
28%
26%
24% RL8% LL
19%
16%
41%
![Page 28: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/28.jpg)
Nuestra experiencia con pacientes cN2 diagnosticados con VAMLA
![Page 29: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/29.jpg)
2010-17
250 cN0-1
35 N2(14.5%)
QT+ RT(>60Gy)
7 casos no candidatos
tratamiento trimodal
ReestadificaciónPET-CT
✓ Tumor estable✓Ausencia enf.
extratorácica
28 cN2Reestadificar quirúrgicamente el
mediastino después de una VAMLA no es posible
Resultados tratamiento trimodal tras una VAMLA
![Page 30: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/30.jpg)
Progresion8 cases
Estabilidad / Respuesta20 cases
Inoperable7 casos
Resección13 casos (46%)
7% RPC.1 neumonect.
Resultados tratamiento trimodal tras una VAMLA
![Page 31: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/31.jpg)
3-y Sv 5-y Sv
CT + RT + C 85% 74%
C+ RT 25% 0%
Unfit for C+RT 14.3% 0%
p=0.0001
CT+RT+C
CT + RT
Unfit for C+RT
Survival – all N2 cases (n=35)
![Page 32: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/32.jpg)
1. Selección de pacientes para cirugía.
2. Cirugía en pacientes con ycN2 residual
3. Resultados tratamiento trimodal tras una VAMLA
4. Complicaciones quirúrgicas tras inducción. Factores de riesgo.
5. Neumonectomía tras inducción
![Page 33: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/33.jpg)
1. Edad2. Lado derecho3. DLCO pre post inducción4. Dosis (altas) de radioterapia5. Albúmina6. Pérdida de sangre
Factores de riesgo
![Page 34: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/34.jpg)
Is pulmonary function damaged by neoadjuvant lung cancer therapy?
A comprehensive serial time-trend analysis of pulmonary function after
induction radiochemotherapy plus surgery. Margaritora S, et al. JTCVS 2010
23% caída 4 semanas tras inducción
![Page 35: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/35.jpg)
Mortalidad de la neumonectomía tras inducción
Trat. 30/90 (%) D(%) I (%)
Doddoli JTCVS 05 11/21 16/25 7/15
Alan JSO 06 QT 9 12,5 10
Daly ATS 06 QT/RT (59,4 Gy) 13
Cerfolio ATS 05 QT/RT (<60 vs. ≥60 Gy) 2 vs. 3,7
Van Schil ERJ 05 EORTC 08941 QT 7 6 9
Mansour EJCTS 07 QT 7/12
Albain Lancet 2009 INT 0139 09 QT/RT 26
D’Amato ATS 09 QT 9/12 11 7
Weder JTCVS 10 QT±RT /3
Broderick JTCVS 16 QT/RT 8
Cashiragi CLC 18 2,6/8,6
Yamaguchi ST 19 QT/RT 0/3
![Page 36: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/36.jpg)
An analysis, systematic review, and meta-analysis of the perioperative
mortality after neoadjuvant therapy and pneumonectomy for NSCLC
Kim AW, et al JTCVS 2012
![Page 37: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/37.jpg)
Postoperative complications after induction CRT in patients
with NSCLC. Fujita S. EJCTS 2006
• 124 patients with NSCLC
• Induction CRT + surgery
• Only RT> 45 Gy predicted postop.
complications (p<0.021)
![Page 38: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/38.jpg)
1. DLCO pre y postinducción!
2. Cirugía entre 6-8 semanas tras la inducción.
3. La mortalidad a los 90 días, es el doble que a los 30!
4. La neumonectomía, es un procedimiento de alto riesgo.
5. Hay que cubrir el muñón bronquial con cualquier plastia.
![Page 39: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/39.jpg)
Tanto como puedan…
1. formen un buen equipo (MDT)
2. eviten operar pacientes cyN2
3. eviten la neumonectomía
4. miren la mortalidad a 90 días
![Page 40: Josep Belda. Cirujano Torácico€¦ · Kim TCS 2014 PET/CT Dooms (ASTER 2). Chest 2015 PET/CT + EBUS + Mediastinoscopy + surgery if all negative Call. ATS 2016 PET/CT+ VAMLA + surgery](https://reader036.fdocuments.co/reader036/viewer/2022062606/5fff5c9a8534424ac73d59e7/html5/thumbnails/40.jpg)