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Clinical Science
Surgical Resection of Lung Metastases: Results from 529 Patients
Riad N. YounesI,II,
Corresponding author
rnyounes@yahoo.com

Tel: 55 11 3257-2808
, Jefferson L. GrossI, Andrea M. TairaI, Andrea Aparecida C. MartinsI, Giuliana Sigolo NevesI
I Department of Thoracic Surgery, Hospital do Cancer AC Camargo - São Paulo/SP, Brazil
II LIM-62, Faculdade de Medicina da Universidade de São Paulo - São Paulo, Brazil
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="cesec10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle60">INTRODUCTION</span><p id="para10" class="elsevierStylePara elsevierViewall">The presence of metastases in patients with malignant tumors is a sign of advanced systemic disease<a class="elsevierStyleCrossRef" href="#bib1">1</a>&#46; Consequently&#44; few patients survive more than one year after diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a> However&#44; over 20&#37; of patients with solid tumors&#44; including colorectal adenocarcinoma&#44; may have metastases exclusively in the pulmonary parenchyma&#44; with no detectable involvement of other organs&#46; In these patients&#44; surgical resection of lung metastases may significantly impact long-term survival&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a> We have recently reported on metastatic lung cancer in Brazil<a class="elsevierStyleCrossRef" href="#bib4">4</a> and reviewed possible sources of new anti-tumoral drugs from Brazilian plant extracts&#46;<a class="elsevierStyleCrossRef" href="#bib5">5</a></p><p id="para20" class="elsevierStylePara elsevierViewall">Pulmonary metastasectomy is currently indicated for patients with the following criteria&#58; primary tumor controlled&#59; no evidence of metastases outside lung parenchyma&#59; possibility of complete resection as verified by chest imaging&#59; pulmonary function compatible with the proposed lung resection procedure&#59; and lack of another available treatment that would be more effective than metastasectomy&#46;<a class="elsevierStyleCrossRef" href="#bib6">6</a> Using these criteria for metastasectomy&#44; several retrospective series have reported five-year survival rates ranging from 30&#37; to 40&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a></p><p id="para30" class="elsevierStylePara elsevierViewall">These results are encouraging considering that all of the patients included presented with metastatic disease&#46; However&#44; there is a clear need to refine these criteria to better identify patients who would benefit from surgical resection of lung metastases&#46; More accurate criteria may eventually improve long-term survival rates and avoid unnecessary surgical procedures&#46; In order to define the selection factors&#44; many authors have reviewed their experience with lung metastasectomy in an effort to identify variables associated with better survival&#46; The majority of these series included a limited number of patients treated over a long period of time&#44; and the heterogeneity of the studied population did not allow for definitive conclusions&#46; Today&#44; complete surgical resection&#44; long disease-free intervals&#44; and a suitably low number of metastases are considered the most important variables associated with better survival rates&#46;<a class="elsevierStyleCrossRef" href="#bib8">8</a></p><p id="para40" class="elsevierStylePara elsevierViewall">Since the early 1990s&#44; our institution has employed a continuous protocol-oriented approach to treat patients with resectable lung metastases&#46; Our goal was to define factors related to outcome following lung metastasectomy in our patient population&#46; All patients in the studied population underwent similar preoperative imaging&#44; together with clinical and surgical evaluations&#46; This was done to generate a more homogeneous and comparable group of patients&#44; each of whom had detailed information registered in their individual records&#46;</p><p id="para50" class="elsevierStylePara elsevierViewall">The goal of this study is to evaluate outcomes following the surgical treatment of lung metastases in patients treated at a single institution&#44; as well as to identify prognostic factors that may significantly impact long-term overall survival&#46; Our results will allow us to more precisely define the subgroups of patients who may benefit from surgical therapy&#46;</p></span><span id="cesec20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle70">METHODS</span><p id="para60" class="elsevierStylePara elsevierViewall">This is a retrospective analysis of patients previously diagnosed with primary malignant solid tumors and who subsequently underwent surgical resection of lung nodules in the context of suspected or diagnosed metastatic lesions&#46; All patients were admitted and treated in the Department of Thoracic Surgery of AC Camargo Hospital from 1990 to 2006&#46; This study was approved by the ethics committee at our institution&#46;</p><p id="para70" class="elsevierStylePara elsevierViewall">Data were collected from medical record reviews of individual patients&#46; The following characteristics of the primary tumor were recorded&#58; primary site&#44; date of surgical resection&#44; histological type&#44; and adjuvant or neoadjuvant treatment associated with the resection&#46;</p><p id="para80" class="elsevierStylePara elsevierViewall">All patients were evaluated for lung nodules during the pretreatment evaluation and staging of a neoplasm or during routine follow-up after the treatment of various primary tumors&#46; Disease-free interval was defined as the time period between the treatment of the primary tumor and the diagnosis of pulmonary metastases&#46;</p><p id="para90" class="elsevierStylePara elsevierViewall">Patients were considered eligible for pulmonary metastasectomy if they presented with the following characteristics&#58; 1&#41; primary tumor controlled or controllable&#44; 2&#41; nodules confined to the lung parenchyma&#44; 3&#41; nodules that were amenable to surgical resection&#44; 4&#41; pulmonary function and clinical condition that were compatible with the planned operation&#44; 5&#41; predictable remaining lung function after resection that would allow for adequate postoperative quality of life&#44; and 6&#41; non-availability of a more suitable treatment option for the metastases&#46;</p><p id="para100" class="elsevierStylePara elsevierViewall">All patients underwent a chest CT scan in order to evaluate the resectability of their pulmonary nodules&#46; Radiology reports were reviewed in each patient file&#44; and the following characteristics were recorded&#58; number of pulmonary nodules&#44; size of the largest nodule&#44; and laterality&#46; The preoperative evaluation of the nodules was routinely performed by the radiologist and the surgeon&#46; In cases of significant discrepancies between the number of nodules identified by the surgeon and by the radiologist&#44; the evidence was discussed with a specialist&#46; The number of nodules included in this retrospective study was the final number confirmed by the surgeon after complete preoperative evaluation&#46;</p><p id="para110" class="elsevierStylePara elsevierViewall">In the case of bilateral nodules on admission&#44; a staged thoracotomy was performed starting on the side with the lowest likelihood of a complete resection&#46; Several factors determined which side to start with&#44; including the number of nodules identified by chest CT&#44; the anatomical position of one or more nodules relative to the pulmonary hilum&#44; and the potential need for a more complex and extensive lung resection&#46;</p><p id="para120" class="elsevierStylePara elsevierViewall">Patients were placed under general anesthesia with selective single lung ventilation&#46; Surgical access to the thorax was performed by lateral thoracotomy even for patients with bilateral metastases&#46; In all cases&#44; we attempted to completely resect all lung nodules&#44; preserving lung parenchyma by resecting the tumor with a small margin &#40;5 mm to 10 mm&#41;&#46; We did not routinely perform mediastinal lymph node dissection or sampling&#46; In the presence of a single pulmonary nodule&#44; frozen section analysis was mandatory&#46; If histological evidence suggested a possible primary lung tumor&#44; the patient underwent pulmonary lobectomy with radical mediastinal lymph-node dissection when possible&#46; Lung nodules were identified individually according to the site of resection and sent for histopathological analysis&#46;</p><p id="para130" class="elsevierStylePara elsevierViewall">Date of surgery&#44; type of resection &#40;complete or incomplete&#41;&#44; number of malignant and benign resected nodules&#44; size of the largest nodule&#44; and type of lung resection &#40;wedge&#44; segmentectomy&#44; lobectomy or pneumonectomy&#41; were registered according to the surgical report in individual patient records&#46;</p><p id="para140" class="elsevierStylePara elsevierViewall">Some patients received chemotherapy&#44; based on the medical oncologist&#8217;s opinion&#44; before or after a surgical resection of lung nodules&#46; The type of treatment and radiological response &#40;complete&#44; partial&#44; stable or progression of disease&#44; as defined by RECIST<a class="elsevierStyleCrossRef" href="#bib9">9</a>&#41; were collected&#46;</p><p id="para150" class="elsevierStylePara elsevierViewall">Patients were discharged from the hospital following chest tube removal&#46; Postoperative complications included&#58; fever&#62;38&#176;C&#44; bleeding&#44; air leakage for more than three days&#44; Intensive Care Unit stay for more than two days&#44; cardiac complications &#40;arrhythmia&#44; ischemia&#44; infarction&#41;&#44; pulmonary atelectasis&#44; embolism or respiratory failure&#44; renal failure&#44; neurological complications &#40;coma&#44; stroke&#44; motor and sensitive dysfunctions&#41;&#44; and infection &#40;bacterioscopy or culture confirming the presence of a bacterial infection&#41;&#46;</p><p id="para160" class="elsevierStylePara elsevierViewall">Beyond hospital discharge&#44; patients were followed-up by clinical examination&#44; with radiological evaluations &#40;chest X-rays and CT scans&#41; every three months during the first two years post-resection and every six months subsequently until the fifth year&#46; Annual radiological follow-up was performed thereafter&#46; Other ancillary tests were performed consistent with symptoms or clinical suspicion of recurrence in organs other than the lungs&#46; We recorded recurrence when new lesions were identified in the lungs or in other organs&#46; When necessary&#44; we performed a histological confirmation of a new tumor&#46; When recurrence was again limited to the lung parenchyma&#44; and if the disease was considered resectable by the attending thoracic surgeon&#44; the patient underwent additional metastasectomies as needed&#46;</p><p id="para170" class="elsevierStylePara elsevierViewall">After complete surgical resection&#44; all patients were evaluated in the department of clinical oncology&#44; and systemic treatment was administered by the clinical oncologist&#46;</p><p id="para180" class="elsevierStylePara elsevierViewall">The characteristics of the patients included in this study are shown in <a class="elsevierStyleCrossRef" href="#tbl1">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl1"></elsevierMultimedia><span id="cesec30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle80">Statistical Analyses</span><p id="para190" class="elsevierStylePara elsevierViewall">Continuous data are presented as medians&#44; and categorical data are presented as percentages&#46; Overall and disease-free survival rates were estimated using Kaplan-Meier analysis<a class="elsevierStyleCrossRef" href="#bib10">10</a>&#46; Log-rank and Breslow analyses were used to compare differences between variables&#46; Overall survival was estimated from the date of surgery to the date of last follow-up or until death from any cause&#46; The influence of each variable on overall and disease-free survival was calculated&#46;</p><p id="para200" class="elsevierStylePara elsevierViewall">Multivariate analysis to determine the independent prognostic factors for overall survival was determined by the Cox proportional hazard model&#46;<a class="elsevierStyleCrossRef" href="#bib11">11</a> Whenever more than one procedure was performed&#44; survival time was determined&#44; with time zero denoting the first thoracotomy&#46;</p><p id="para210" class="elsevierStylePara elsevierViewall">Statistical analyses were performed using SPSS 11&#46;5 for Windows&#46; Significant differences were defined as p&#60;0&#46;05&#46;</p></span></span><span id="cesec40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle90">RESULTS</span><p id="para220" class="elsevierStylePara elsevierViewall">The patients included in this retrospective study &#40;n &#61; 529&#41; underwent a total of 776 thoracotomies&#46; The average follow-up time for all patients was 40 months&#44; with a median of 21&#46;6 months &#40;range&#58; 0&#8211;192 months&#41;&#44; and eight patients &#40;1&#46;5&#37;&#41; were lost to follow up&#46; Most patients were discharged by the fifth postoperative day &#40;length of stay in hospital ranged from two days to 27 days&#44; with a median of four days&#41;&#46; The postoperative complication rate was 9&#46;3&#37; for the 776 thoracotomies&#46; More than one complication occurred in some patients &#40;infection n&#61;19&#44; atelectasis n&#61;29&#44; cardiac arrhythmia n&#61;18&#44; stroke n&#61;2&#44; myocardial infarction n&#61;3&#44; prolonged air leak n&#61;28&#41;&#44; and the 30-day mortality rate was 0&#46;2&#37; &#40;n&#61;2&#44; due to respiratory failure and stroke&#41;&#46;</p><p id="para230" class="elsevierStylePara elsevierViewall">The ninety-month overall survival rate for all patients was 30&#46;4&#37; &#40;<a class="elsevierStyleCrossRef" href="#fig1">Figure 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig1"></elsevierMultimedia><p id="para240" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRefs" href="#fig2">Figures 2&#8211;7</a> show the significant prognostic factors for overall survival&#44; as identified by univariate analyses&#46;</p><elsevierMultimedia ident="fig2"></elsevierMultimedia><elsevierMultimedia ident="fig3"></elsevierMultimedia><elsevierMultimedia ident="fig4"></elsevierMultimedia><elsevierMultimedia ident="fig5"></elsevierMultimedia><elsevierMultimedia ident="fig6"></elsevierMultimedia><elsevierMultimedia ident="fig7"></elsevierMultimedia><p id="para250" class="elsevierStylePara elsevierViewall">All other factors evaluated in the univariate analyses&#44; including type of resection&#44; response to preoperative chemotherapy&#44; number of resected nodules&#44; and the total number of thoracotomies in an individual patient&#44; were not statistically significant &#40;p&#62;0&#46;05&#41;&#46;</p><p id="para260" class="elsevierStylePara elsevierViewall">Multivariate analysis identified the number of pulmonary nodules &#40;p&#60;0&#46;001&#41;&#44; the number of malignant nodules resected &#40;p&#61;0&#46;001&#41;&#44; and complete resection &#40;p&#60;0&#46;001&#41; as the independent prognostic factors for overall survival &#40;<a class="elsevierStyleCrossRef" href="#tbl2">Table 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl2"></elsevierMultimedia></span><span id="cesec50" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle100">DISCUSSION</span><p id="para270" class="elsevierStylePara elsevierViewall">Thirty to 40&#37; of all extrathoracic cancers lead to secondary pulmonary lesions during the course of the disease&#44; and approximately 20&#37; of these cases feature metastases that are confined to the lungs&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a>&#44;<a class="elsevierStyleCrossRef" href="#bib7">7</a>&#44;<a class="elsevierStyleCrossRefs" href="#bib12">12&#8211;14</a> Improved survival following resection of lung metastases has broadened the surgical indications for these lesions&#46; It is likely that surgery itself impacts the outcome of patients who are candidates for a complete resection of nodules that are confined to the lungs&#46; Therefore&#44; resectability should be evaluated preoperatively with great care&#46; The recent introduction of positron emission tomography using 18F- fluorodeoxyglucose &#40;FDG PET-CT&#41; has proven to be of clinical value for the proper staging of cancer patients&#46; The use of this technology during the preoperative evaluation of candidates for lung metastasectomy has been shown to eliminate 21&#37; of patients otherwise deemed resectable&#46;<a class="elsevierStyleCrossRef" href="#bib15">15</a> Unfortunately&#44; our study population did not routinely undergo this imaging evaluation because the method was not available in our institution for most patients&#46;</p><p id="para280" class="elsevierStylePara elsevierViewall">The 529 patients included in this study underwent 776 thoracotomies for the treatment of lung metastases&#46; The overall survival of patients at 90 months in our study was 30&#46;4&#37;&#44; with average follow-up of 40 months&#46; Eight patients &#40;1&#46;5&#37;&#41; were lost to follow-up&#46;</p><p id="para290" class="elsevierStylePara elsevierViewall">The histological type of a primary malignant tumor has been shown to influence the results of metastasectomy in previous studies&#46;<a class="elsevierStyleCrossRef" href="#bib1">1</a> In this study&#44; survival rates were significantly better for patients with adenocarcinoma&#46; Multivariate analysis&#44; however&#44; did not identify this variable as an independent prognostic factor&#46; Better systemic therapy for patients with metastatic colorectal adenocarcinoma might explain the apparently favorable long-term outcome&#46; Our study failed to provide sufficient evidence to support this observation&#46;</p><p id="para300" class="elsevierStylePara elsevierViewall">On the basis of our univariate analysis&#44; patients with synchronous metastases &#40;DFI&#60;12 months&#41; exhibited significantly lower survival rates&#44; compared to patients with metachronous disease&#44; than reported in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a>&#44;<a class="elsevierStyleCrossRef" href="#bib7">7</a> On the other hand&#44; this factor was not significant in our multivariate analysis&#46;</p><p id="para310" class="elsevierStylePara elsevierViewall">Several reports have demonstrated the prognostic importance of the number of nodules&#46;<a class="elsevierStyleCrossRef" href="#bib7">7</a> The sensitivity of preoperative imaging examinations of pulmonary metastases varies depending on the technique used&#46; Dellai et al<a class="elsevierStyleCrossRef" href="#bib16">16</a> evaluated the precision of the diagnosis and the exact quantification of lung nodules using computerized tomography&#46; All of the nodules were subsequently resected&#44; revealing a diagnostic accuracy of 51&#37;&#46; In a prospective study involving 182 patients in Brazil&#44; the CT scan identified the exact number of nodules resected in 47&#37; of all cases&#46; However&#44; the CT scan underestimated the actual number of lung nodules found during surgery in 28&#37; of cases and overestimated the number in 24&#37;&#46;<a class="elsevierStyleCrossRef" href="#bib2">2</a></p><p id="para320" class="elsevierStylePara elsevierViewall">A recently published study by Cerfolio et al <a class="elsevierStyleCrossRef" href="#bib17">17</a> showed that in 37&#37; of patients who were candidates for video-assisted thoracic surgery &#40;VATS&#41;&#44; intraoperative palpation during a formal thoracotomy detected more nodules than had been identified using preoperative imaging &#40;CT scans&#41;&#46; VATS has a definitive role in the management of solitary pulmonary lesions that are suspected to be metastatic&#44; but the use of thoracoscopic techniques for pulmonary metastasectomy is controversial because small metastatic foci may be missed without thorough finger palpation of the lung&#46; Prospective studies are currently evaluating this issue in several centers&#46;</p><p id="para330" class="elsevierStylePara elsevierViewall">In our study&#44; the number of nodules exerted a significant impact on long-term overall survival using both univariate and multivariate analyses&#46; Similar observations have been previously reported in other publications<a class="elsevierStyleCrossRef" href="#bib7">7</a>&#44;<a class="elsevierStyleCrossRef" href="#bib18">18</a></p><p id="para340" class="elsevierStylePara elsevierViewall">In most studies published to date&#44; there has been no significant difference in survival of patients with metastases confined to one lung compared to bilateral lesions&#46;<a class="elsevierStyleCrossRefs" href="#bib19">19&#8211;22</a> However&#44; univariate analysis in this study suggested a significant difference in survival rates between patients presenting with unilateral or bilateral disease&#46; However&#44; this factor was found not to be significant under multivariate analysis&#46;</p><p id="para350" class="elsevierStylePara elsevierViewall">Preoperative or postoperative systemic therapy had no significant impact on long-term survival rate in this patient population&#44; consistent with data published elsewhere&#46;<a class="elsevierStyleCrossRef" href="#bib3">3</a>&#44;<a class="elsevierStyleCrossRef" href="#bib7">7</a>&#44;<a class="elsevierStyleCrossRef" href="#bib8">8</a>&#44;<a class="elsevierStyleCrossRefs" href="#bib23">23&#8211;26</a></p><p id="para360" class="elsevierStylePara elsevierViewall">Complete resection was the most significant prognostic factor associated with long-term overall survival&#44; both in univariate and multivariate analyses&#44; as has been consistently reported elsewhere&#46;<a class="elsevierStyleCrossRefs" href="#bib27">27&#8211;35</a> The 90-month overall survival rate for patients who underwent complete resection in the context of metastatic disease was 35&#46;1&#37;&#44; compared to 10&#46;2&#37; in the group who underwent incomplete resection&#46;</p><p id="para370" class="elsevierStylePara elsevierViewall">Type of surgical resection and the total number of thoracotomies failed to influence the outcome of the patients&#44; provided that complete resection was accomplished&#46; Thus&#44; we conclude that repeated resection may be beneficial in patients with relapses that are confined to the lung&#46;<a class="elsevierStyleCrossRef" href="#bib36">36</a> As reported elsewhere&#44; limited resection with lung parenchyma preservation is adequate to achieve clear margins and local control of the disease&#46;<a class="elsevierStyleCrossRef" href="#bib8">8</a> Recently&#44; alternative options like radiofrequency ablation have been evaluated for the management of lung metastases&#46; Although promising&#44; such methods are still considered experimental&#44; since they are indicated only in limited numbers of patients&#44; and they are usually considered clinically inappropriate for patients who can undergo a conventional resection&#46;<a class="elsevierStyleCrossRef" href="#bib37">37</a></p></span><span id="cesec60" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle110">CONCLUSIONS</span><p id="para380" class="elsevierStylePara elsevierViewall">This study identified a group of patients who may benefit from pulmonary metastasectomy&#46; Irrespective of other factors&#44; all patients who present with fewer than four lung nodules should be considered candidates for surgical resection&#44; after selection using the currently established inclusion criteria&#46; Other patients should be individually evaluated in order to assess the impact of surgical resection on survival and long-term outcomes&#46; Additional studies are needed to determine the role of adjuvant systemic therapy in patients stratified according to the histology of their primary tumors&#46;</p></span></span>"
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          "titulo" => "KEYWORDS"
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        1 => array:2 [
          "identificador" => "cesec10"
          "titulo" => "INTRODUCTION"
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        2 => array:3 [
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          "titulo" => "METHODS"
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            0 => array:2 [
              "identificador" => "cesec30"
              "titulo" => "Statistical Analyses"
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        3 => array:2 [
          "identificador" => "cesec40"
          "titulo" => "RESULTS"
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        4 => array:2 [
          "identificador" => "cesec50"
          "titulo" => "DISCUSSION"
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        5 => array:2 [
          "identificador" => "cesec60"
          "titulo" => "CONCLUSIONS"
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        6 => array:1 [
          "titulo" => "REFERENCES"
        ]
      ]
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2009-01-26"
    "fechaAceptado" => "2009-03-13"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "KEYWORDS"
          "identificador" => "xpalclavsec1584859"
          "palabras" => array:5 [
            0 => "Lung"
            1 => "Metastases"
            2 => "Resection"
            3 => "Metastasectomy"
            4 => "Prognostic factors"
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    "tieneResumen" => true
    "resumen" => array:1 [
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        "resumen" => "<span id="ceabs10" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle10">OBJECTIVE&#58;</span><p id="spara100" class="elsevierStyleSimplePara elsevierViewall">The aim of this study is to determine clinical&#44; pathological&#44; and treatment-relevant variables associated with long-term &#40;90-month&#41; overall survival in patients with lung metastases undergoing pulmonary metastasectomy&#46;</p></span> <span id="ceabs20" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle20">METHODS&#58;</span><p id="spara110" class="elsevierStyleSimplePara elsevierViewall">A retrospective review was performed of patients who were admitted with lung metastases&#44; and who underwent thoracotomy for resection&#44; after treatment of a primary tumor&#46; Data were collected regarding demographics&#44; tumor features&#44; treatment&#44; and outcome&#46;</p></span> <span id="ceabs30" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle30">RESULTS&#58;</span><p id="spara120" class="elsevierStyleSimplePara elsevierViewall">Patients &#40;n &#61; 529&#41; were submitted to a total of 776 thoracotomies&#46; Median follow-up time across all patients was 21&#46;6 months &#40;range&#58; 0&#8211;192 months&#41;&#46; The postoperative complication rate was 9&#46;3&#37;&#44; and the 30-day mortality rate was 0&#46;2&#37;&#46; The ninety-month overall survival rate for all patients was 30&#46;4&#37;&#46; Multivariate analysis identified the number of pulmonary nodules detected on preoperative CT-scan&#44; the number of malignant nodules resected&#44; and complete resection as the independent prognostic factors for overall survival&#46;</p></span> <span id="ceabs40" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="cestitle40">CONCLUSION&#58;</span><p id="spara130" class="elsevierStyleSimplePara elsevierViewall">These results confirm that lung metastasectomy is a safe and potentially curative procedure for patients with treated primary tumors&#46; A select group of patients can achieve long-term survival after resection&#46;</p></span>"
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          "en" => "<p id="spara30" class="elsevierStyleSimplePara elsevierViewall">Overall survival according to disease-free interval &#40;DFI&#41;</p>"
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          "en" => "<p id="spara40" class="elsevierStyleSimplePara elsevierViewall">Overall survival rates according to the number of nodules identified using CT Scans</p>"
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="middle" scope="col">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="middle" scope="col">n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="middle" scope="col">&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Age &#40;mean&#58; 45&#46;7 years&#44; median&#58; 50&#46;1&#44; range&#58; 3&#46;7&#8211;89&#46;2 years&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Age subgroups &#40;years&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>0&#8211;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;38&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">7&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>13&#8211;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;155&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">29&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;231&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">43&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">19&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Gender</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Male &#40;n&#61;267&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Female &#40;n&#61;262&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">50&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Primary tumor site</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bone&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;105&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">19&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Head-Neck&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;101&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">19&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Soft tissue&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;72&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">13&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Breast&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;69&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">13&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Colorectal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">9&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Skin&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">7&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Uterus&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Kidney&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Stomach&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">1&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bladder&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">8&#46;4&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Histology of the primary tumor</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Adenocarcinoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;154&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">29&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Osteosarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">16&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Squamous cell&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">15&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Soft tissue sarcoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">14&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Malignant melanoma&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;48&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">9&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">15&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Disease-free interval &#40;months&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;227&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">42&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;302&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">57&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Number of nodules on CT scan</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804; 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;301&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">56&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&#8211;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">14&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;149&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">28&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Laterality of the nodules</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Right lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;185&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">35&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Left lung&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;123&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">23&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Bilateral&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;220&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">41&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Type of resection</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Pneumonectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Lobectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">12&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Segmentectomy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">34&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Wedge resection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;260&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">49&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Biopsy&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">3&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Number of resected nodules&#58; median 1 &#40;0-multiple&#41;</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Number of malignant nodules resected</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;180&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">44&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&#8211;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;164&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">40&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">14&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Number unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;125&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Diameter of greater nodule</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#8804;1 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;163&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">31&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&#46;1&#8211;3 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;256&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">48&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;3 cm&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;107&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">20&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Number of thoracotomies</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;331&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">62&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;134&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">25&#46;3&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">7&#46;6&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">4&#46;5&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Complete resection at last thoracotomy</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;408&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">77&#46;1&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;120&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">22&#46;7&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="3" align="left" valign="top">Adjuvant chemotherapy after lung resection</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;354&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">66&#46;9&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Yes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;160&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">30&#46;2&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">n&#61;15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">2&#46;8&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara80" class="elsevierStyleSimplePara elsevierViewall">Patient characteristics</p>"
        ]
      ]
      8 => array:7 [
        "identificador" => "tbl2"
        "etiqueta" => "Table 2 -"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:1 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="bottom" scope="col">Variables included in the model&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="center" valign="bottom" scope="col">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Primary tumor site&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;091&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Histology of the primary tumor&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;086&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Disease-free interval &#40;months&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;063&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Number of nodules identified on the CT scan&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Laterality of the nodules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Number of resected nodules&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;069&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Number of malignant nodules resected&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Diameter of greater nodule&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;319&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Complete resection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="top">Adjuvant chemotherapy after lung resection&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="center" valign="top">0&#46;772&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spara90" class="elsevierStyleSimplePara elsevierViewall">Multivariate analysis for overall survival</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "REFERENCES"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "cebibsec10"
          "bibliografiaReferencia" => array:37 [
            0 => array:3 [
              "identificador" => "bib1"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The contribution of surgery to the management of carcinomatous pulmonary metastases"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              CF Mountain \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              KG Khalil \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              KE Hermes \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              OH Frazier \n
                              \t\t\t\t\t\t\t\t
                              """
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/1097-0142(197803)41:3<833::aid-cncr2820410309>3.0.co;2-4"
                      "Revista" => array:6 [
                        "tituloSerie" => "Cancer"
                        "fecha" => "1978"
                        "volumen" => "41"
                        "paginaInicial" => "833"
                        "paginaFinal" => "840"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/638972"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib2"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Surgical removal of pulmonary metastasis&#58; prospective study in 182 patients"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => """
                              RN Younes \n
                              \t\t\t\t\t\t\t\t
                              """
                            1 => """
                              F Haddad \n
                              \t\t\t\t\t\t\t\t
                              """
                            2 => """
                              F Ferreira \n
                              \t\t\t\t\t\t\t\t
                              """
                            3 => """
                              JL Gross \n
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es en pt

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