LXXI Congreso Nacional de Neumologia y Cirugia de Torax
Yesterday was such a flurry of activity – I didn’t get a chance to post Wednesday’s Conference highlights until now.
After sitting thru some lackluster presentations for most of Tuesday, today was definitely the best day of the conference so far; as the topics become more and more thoracic surgery related (versus Asthma, and other strictly pulmonary medicine topics). There were so many enjoyable and informative lectures today that is was hard to choose, even after deciding to pick more than one – I feel like apologizing to all the other great speakers – but I’ve narrowed it down to a trifecta of great speakers, with Dr. Raimundo Santolaya, Dr. Rafael Andrade, and Dr. Enrique Guzman de Alba.
Dr. Ramundi Santolaya, MD a Chilean thoracic surgeon gave a thoroughly enjoyable overview of the diagnosis and management of pneumothoraces. Whether it was due to innate charisma, a lively discussion and multi-media presentation on one of my favorite topics, or due to that fact that with his clear, unaccented Spanish – I didn’t miss a word – he was a standout star of the day – so much so that I chased him down later for a full interview.
Dr. Rafael Andrade, from the University of Minnesota was also very informative, yet entertaining during his talk on the use of ultrasound for mediastinal evaluation (cancer staging). He explained that while mediastinoscopy remains the gold standard for staging lung cancer, that the new(er) ultrasound techniques including endobronchial (EBUS) and endoesophageal (EUS) ultrasound allow for tissue sampling (and biopsy) of lymph nodes that are normally inaccessible during mediastinoscopy including many of the more distal stations. These techniques do not replace mediastinoscopy, or mediastinotomy (Chamberlain) but offer complimentary information to assist in the staging of cancers to help determine the extent of disease when PET results may be inconclusive, or appear to show more extensive disease.
I had just finished reading some of his recent papers for another article I was working on, so it was both a surprise and a pleasure to see him and speak with him, in person. He sure didn’t seem to mind my questions (despite my chronically impaired Spanish.)
Of course, his English is impeccable but when in Rome, etc. so I did my best. Luckily for me, and all the readers here at Cirugia de Torax – my understanding of ‘surgical Spanish’ tends to be spot – on, particularly when there are overhead slides to assist with translation.
Dr. Enrique Guzman de Alba, a cardiothoracic surgeon gave two lectures, more of a part I and a part II on the current literature regarding the surgical treatment of lung cancers by staging as well as a review of the literature surrounding clinical outcomes comparing lobectomy versus segmentectomy (aka wedge resections.) As he explained, lobectomy remains the gold standard for any patient who is able to tolerate surgery, (including patients that are believed to be marginal candidates and would otherwise be relegated to wedge resection.) He reports that despite common beliefs regarding segmentectomies as ‘lung -sparing’ for patients with marginal baseline respiratory (or other functional) status – there has been no data to demonstrate that these patients perform better/ or better tolerate a wedge resection versus the more complete lobectomy. Therefore, given the increased incidence of cancer reoccurrence with segmentectomies – he advocates for the larger, but more effective lobectomy.
There was also some interesting discussion on managing malignant pleural effusions and limitations of PleurX catheter use in Mexico due to prohibitive costs for many patients.