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Background: Lung cancer surgery may be required for patients with a history of coronary artery bypass graft (CABG). In this study, we evaluated the general characteristics of patients, the difficulties experienced during and after lung cancer surgery and complications and mortality rates., Method: Patients who were operated on for primary lung cancer between January 2012 and July 2017 in the participating centres were analysed retrospectively (n=7,530). Patients with a history of CABG (n=220) were examined in detail. This special group was analysed and compared with other patients operated on for lung cancer who did not have CABG (n=7,310) in terms of 30-day mortality and revision for haemorrhage., Results: Of the 7,530 patients operated on for primary lung cancer, 2.9% were found to have undergone CABG. Surgical revision was required in the early postoperative period for 6.8% of those who had CABG and 3.5% in those who did not have CABG (p=0.009). Thirty-day (30-day) mortality was 4.5% in those who had CABG and 2.9% in those who did not have CABG (p=0.143). Further analysis of patients who had undergone CABG demonstrated that video-assisted thoracoscopic surgery (VATS) resulted in fewer complications (p=0.015). Patients with a left-sided left internal mammary artery (LIMA) graft had a higher number of postoperative complications (p=0.30)., Conclusions: Patients who had CABG suffered postoperative haemorrhage requiring a revision twice as often, and a tendency towards higher mortality (non-statistically significant). In patients with a history of CABG, VATS was demonstrated to have fewer complications. Patients with a LIMA graft who had a left-sided resection had more postoperative complications., (Copyright © 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)

Objectives: The right sleeve lower lobectomy is the least used of the bronchial sleeve operations. There are only case-based studies in the literature. In this study, we compared this technique to those used in patients who underwent a right lower bilobectomy., Methods: We retrospectively reviewed the data of patients who had been operated on due to non-small cell lung cancer (NSCLC) from January 2005 to December 2015 from a dataset that was formed prospectively. Of the 4,166 patients who underwent resections due to NSCLC, the files of those who had a right sleeve lower lobectomy (group S) and those who had a right lower bilobectomy (group B) were evaluated. The remaining 25 patients in group B and 18 patients in group S were compared in terms of demographic data, morbidity, hospitalization time, mortality, histopathology, recurrence, and total survival., Results: No significant differences in the demographic or clinical characteristics were observed between the two groups, except that group S had more female patients. Postoperative complications developed in 52% of the patients in group B and 11.1% of the patients in group S ( p  = 0.006). Mean hospitalization time was 9.6 ± 3.6 (range, 6-19) days in group B and 6.72 ± 1.5 (range, 4-9) days in group S ( p  = 0.001). All patients received complete resections. The mean patient follow-up time was 42.9 months. No significant difference was found between local and distant recurrences ( p  = 1, p  = 0.432). Mean survival time was 89.6 months (5-year rate = 73%), which was 90.6 months (5-year rate = 75.3%) in group B and 63.1 months (5-year rate = 69.3%) in group S ( p  = 0.82)., Conclusion: This technique allows for reduced filling of the thoracic cavity by a prolonged air leak and a reduced prevalence of complications. Additionally, the hospitalization time is shortened. It does not produce any additional mortality burden, and total survival and oncological outcomes are reliable. This technique can be used in selected patients at experienced centers., Competing Interests: The author(s) declare no potential conflict of interest with respect to the research, authorship, and/or publication of this article., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Carinal resections for non-small cell lung cancer (NSCLC) invading the carina are challenging cases that require a therapeutic strategy. The aim of this study was to compare the oncologic outcomes and complications of patients who underwent carinal resection., Methods: Sixty-four patients who underwent carinal resection between 2005 and 2016 were evaluated. Data were retrospectively reviewed for indications, complications, and factors influencing long-term survival., Results: The study included 51 patients (79.7%) who underwent sleeve pneumonectomy (sP) and 13 patients who underwent carinal sleeve lobectomy (csL) as a curative therapy. Nine patients (14.1%) received induction chemotherapy. Complications were observed in 31 patients (48.8%), including 24 patients (47.1%) in the sP group and 7 patients (53.8%) in the csL group ( p  = 0.662). Six patients (9.4%) developed bronchopleural fistula. The 30-day mortality rate was 10.9% ( n  = 7). The 5- and 10-year survival rates were 42.2 and 23.1%, respectively. N2 and R1 were identified as factors affecting survival ( p  = 0.029 and p  = 0.047)., Conclusion: Carinal resections have acceptable morbidity, mortality, and long-term survival outcomes in central NSCLC. The main factors affecting survival are complete resection and nodal status. The results of csL were similar to those of sP. Therefore, we believe that csL should be performed in all eligible patients., Competing Interests: The authors declared no potential conflict of interest in this article., (Georg Thieme Verlag KG Stuttgart · New York.)

Objectives: Cervical mediastinoscopy may become essential in patients with pathological lymph nodes at mediastinum after laryngectomy. However, having had a previous tracheostomy has been reported to be a contraindication for cervical mediastinoscopy., Methods: Between January 2010 and December 2017, cervical mediastinoscopy was performed for lung cancer staging in 1985 patients at the Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Education and Research Hospital, Istanbul, Turkey. Eighteen of these patients (1%) had a permanent tracheostomy after total laryngectomy and cervical radiotherapy due to laryngeal carcinoma., Results: Cervical mediastinoscopy was performed in 18 patients with a permanent tracheostomy after total laryngectomy. The negative predictive value of cervical mediastinoscopy was 13/14 (93%). The average operative time was 63 min (SD 12.0, range 50-90 min). The negative predictive value of endobronchial ultrasonography was 4/7 (57%). Positron emission tomography-computed tomography had a positive predictive value of 3/15 (20%) and a negative predictive value of 2/3 (67%)., Conclusions: Contrary to the claims of 2 textbooks, cervical mediastinoscopy is a viable method for patients with a tracheostomy after laryngectomy. The negative predictive values of standard cervical mediastinoscopy and mediastinoscopy for patients with a tracheostomy after total laryngectomy are approximately equivalent. Our results indicate that cervical mediastinoscopy is a feasible method in patients with a permanent tracheostomy when applied by experienced thoracic surgeons in specialized hospitals., (© The Author(s) 2019. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Background: The aim of this study was to discuss indications and outcomes for conversion to thoracotomy during thoracoscopic lobectomy., Materials and Methods: Patients who underwent lobectomy for non-small cell lung cancer between January 2012 and December 2016 were evaluated retrospectively. The study included 129 patients who underwent video-assisted thoracoscopic lobectomy (group-V) and 18 patients converted from thoracoscopic lobectomy to thoracotomy due to unexpected intraoperative complications (group-T)., Results: The two patient groups showed no statistical differences in terms of demographic characteristics. Causes of unexpected conversions to thoracotomy were hemorrhage in six patients, dense pleural adhesions in seven patients, fused fissure in one patient, and fibrocalcified lymph nodes around the vascular structures in four patients. Operative time was 180.37 ± 68.6 min in group-V and 235 ± 72.6 min in group-T (p = 0.003). Intraoperative blood loss was 263.9 ± 180.6 mL in group-V, compared to 562.7 ± 296.2 mL in group-T (p < 0.001). Patient age ≥ 70 years was a significant risk factor for conversion to thoracotomy (p = 0.015, odds ratio 4.73). The 5-year survival rate in group-V was 71.4% {mean: 65.2 months [95% confidence interval (CI) 59.6-70.8]}, while that in group-T was 80% [mean 54.9 months (95% CI 45.9-63.8)] (p = 0.548)., Conclusion: Advanced age was identified as the main risk factor for conversion to thoracotomy. However, early- and long-term outcomes were similar in the two groups, indicating that video-assisted thoracoscopic surgery is a safe and applicable method.

Background: Completion pneumonectomy (CP) is the removal of remaining lung tissue after initial resection. Our aim in this study was to investigate the factors affecting mortality, morbidity, and survival after CP. Methods: Patients who underwent CP in our clinic between January 2000 and December 2015 were evaluated retrospectively. The patients' demographic information, morbidity, mortality, histopathological characteristics, and 2-, 5-, and 10-year survival were evaluated. Results: Of the 32 non-small cell lung cancer patients in the study, 31 (96.9%) were male and one (3.1%) was female. The postoperative mortality rate was 9.4% and the morbidity rate was 46.9%. The most common complication was atrial fibrillation (31.3%). Median survival time was 67 ± 10.3 months; 5- and 10-year survival rates were 50.3 and 31.2%, respectively. Conclusion: Completion pneumonectomy involves an acceptable mortality rate but high morbidity rate. Based on the results of this study, the interval between initial resection and CP does not affect survival time.

Purpose: Lung cancer is one of the major sources of mortality in the elderly. This study was undertaken to assess the early and long-term results of surgical resection in patients older than 70 years of age by comparing the results of patients aged 70-79 years (group 1) with patients older than 80 years of age (group 2)., Methods: Data on patient age, gender, spirometry values, side, size, histology and stage of the tumor, surgical procedures, postoperative complications, Charlson comorbidity scores (CCS), and survival were collected., Results: After 1-2 propensity score matching group 1 (70-79 years) included 84 and group 2 (age over 80) 42 cases. The multivariate analysis showed that CCS was the only significant factor affecting the development of complications (p = 0.003). The overall median and 5-year survival of all patients were 55 months and 42.5%, respectively. Although the survival of the elderly group 2 was higher than the first group, the difference did not reach significance (50 vs. 49 months, respectively)., Conclusion: The outcomes of surgery in terms of morbidity and mortality rates do not differ between the two age groups. The safety of pulmonary resections in the elderly group is comparable to patients under 70 years if the comorbidities are appropriately controlled. In addition, surgery provides satisfactory survival rates in both age groups.

Purpose: The purpose of this study was to evaluate the following parameters after complete resection in established lung cancer patients: the frequency of bronchial stump recurrence (BSR), the effect of the distance between the tumor and bronchial resection margin (DBTM) on BSR, the survival of patients with BSR, and the effect of the DBTM on survival., Patients and Methods: We retrospectively evaluated 553 consecutive lung cancer patients who underwent complete lung resection. The patients were classified as DBTM: ≤ 10 mm (group 1), 11 to 20 mm (group 2), and > 20 mm (group 3)., Results: We found BSR in eight (1.5%) patients. Six patients were in group 1, and two were in group 2. The difference was found to be statistically significant ( p  = 0004; groups 1 vs. 3). In multivariable analysis, we observed a trend toward significance for the effect of a DBTM on BSR development ( p  = 0.1). The DBTM did not significantly affect survival ( p  = 0.61). The survival of patients who developed BSR was significantly poor compared with those who did not develop BSR ( p  = 0.001)., Conclusion: BSR can develop even after complete resection of lung cancer. The DBTM is associated with BSR risk, and the survival of patients who develop BSR is poor., Competing Interests: The authors declare no conflict of interest; the authors have no any financial relationship with a biotechnology manufacturer, pharmaceutical company, or other commercial entity that has an interest in the subject matter or materials discussed in the article., (Georg Thieme Verlag KG Stuttgart · New York.)

Background: Squamous cell carcinomas confined to the bronchial wall (SCC-CBW) exhibit two distinct patterns of growth: superficially spreading and endobronchial mass lesions. We examined whether differences exist in the histopathological features and prognosis of SCC-CBW exhibiting different growth patterns., Materials and Methods: In this study, 37 cases with SCC-CBW were included. Tumors were classified into two groups: superficially spreading squamous cell carcinoma (s-SCC) and nodular squamous cell carcinoma (n-SCC). For each case, the growth pattern, T and N status, lymphovascular and perineural invasions, immunohistochemical expressions of p53 and Ki-67, and survival rates were analyzed., Results: Twenty cases were classified as s-SCC, and 17 cases were classified as n-SCC. There was a significant relationship and correlation between the length of s-SCC in the longitudinal axis and the depth of invasion (p = 0.01, R = 0.557). There was a statistically significant positive relationship between the depth of invasion and the nodal status (N1 involvement) (p < 0.0001, R = 0.71)., Conclusions: SCC-CBW exhibits variable growth patterns. However, despite this variability, there are no biological or histological differences between tumors of different growth patterns, and this variability has very little, if any, effect on survival., (Georg Thieme Verlag KG Stuttgart · New York.)

Purpose: Lung adenocarcinoma (AC) demonstrates various histological subtypes within the tumour tissue. A panel established jointly by the IASLC, ATS and ERS classified invasive lung ACs based on the predominant histological subtype. We examined the distribution of tumours in lung AC patients according to histological subtype and analysed the effects of this classification on survival., Methods: The records of patients who had pulmonary resection for lung cancer between January 2000 and December 2009 were reviewed and 226 lung AC patients who fulfilled the inclusion criteria were identified. Histological subtypes of the ACs and their ratios in the tumour tissue were determined. Tumours were classified according to the predominant histological subtype and subsequently graded. The relationship between the predominant histological subtype, grade and survival were analysed., Results: Tumours were predominantly acinar in 99 cases (43.8%), solid in 89 (39.3%), lepidic in 20 (8.8%), and papillary in 11 (4.8%), whereas 7 tumours (3%) were variants of AC. Stage significantly affected survival (p = 0.001); however, the predominant histological subtype had no significant effect. The 5-year survival rate for patients with histologically grade II tumours was 48.6%, whereas that in patients with grade III tumours was 56%. (p = 0.69)., Conclusion: Invasive lung ACs may be defined by their predominant histological subtype. However, it is not yet possible to conclude that this classification is related to survival.

Objective: The presence of synchronous multiple primary non-small-cell lung cancers (SMPLC) is a rare condition and the optimal treatment remains unclear. In this study, the survival of surgically treated SMPLC patients and the factors affecting survival were analyzed., Methods: Between 2001 and 2008, 26 consecutive patients diagnosed with SMPLC, who had all of their tumors resected, were retrospectively evaluated. Patients, who had bronchoalveolar carcinoma or carcinoid tumors and satellite nodules, were excluded. Prognostic factors were analyzed using univariate and multivariate analyses., Results: The tumors were unilateral in 14 and bilateral in 12 patients. In total, 38 procedures were performed. A complete resection was achieved in 35 (92.1%) procedures. The in-hospital mortality rate was 7.6% (two patients). The overall 5-year survival rate was 49.7%, and the median survival time was 40 months. The 5-year survival rate was 40.6% for unilateral and 62.8% for bilateral SMPLC patients (p = 0.47). Histopathologic tumor type, N1 nodal disease, tumor (T) status, and older age did not influence survival. There was no survival disadvantage for patients, upon whom a sublobar resection had been performed. There was a trend toward poorer survival in patients upon whom a pneumonectomy had been performed (p = 0.12). The 3-year survival rate for patients, who received adjuvant chemotherapy and/or radiotherapy (66.7%), was better than other patients (56.3%). In the multivariate analysis, we found a trend toward poor survival in patients, who received a pneumonectomy, and a trend toward better survival in patients, who received adjuvant therapy (p = 0.05 and p = 0.06)., Conclusions: The survival of SMPLC patients, who were treated surgically, was satisfactory. Pneumonectomy was a poor prognostic factor, whereas adjuvant therapy was a good prognostic factor., (Copyright © 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)

Objective: Complete resection is the therapy of choice in non-small-cell lung cancer (NSCLC). There is no agreement on the type of resection, especially when interlobar N1 disease is present. The present study explored the effect of the type of resection on survival in the presence of N1 disease., Method: Medical records of 195 patients with NSCLC who underwent resection between 1998 and 2006 and whose histopathological examination showed N1 disease were reviewed retrospectively. This study included 162 patients with T status of T1, T2 or T3, who had complete resection (excluding superior sulcus tumours). The patients were divided into three groups, namely hilar N1 (n=15, 9.3%), interlobar N1 (N1-i) (n=54, 33.3%) and lobar N1 (n=93, 57.4%). Frequency comparisons were carried out by chi-square test. Survival rates were calculated by the Kaplan-Meier method and compared by log-rank test after patients who had operative mortality (n=10, 6.2%) were excluded., Results: Seventy-seven patients (47.5%) had lobectomy, 14 (8.6%) had bilobectomy (BL) and 71 (43.8%) had pneumonectomy (PN). Twenty-one of these patients (13.0%) had sleeve lobectomy and 19 had (11.7%) additional interventions (such as resection of the diaphragm or thoracic wall). Among all N1 patients, 5-year survival rate was 56.9% in patients who had BL or PN and 46.8% in patients who had lobectomy, a difference not statistically significant (p=0.09). Similarly, there was no significant difference between patients who had sleeve resection and PN (p=0.58). The type of resection was not found related to survival in the presence of interlobar (p=0.75). Similarly, type of resection was not significantly associated with survival in patients with hilar N1 (p=0.86)., Conclusion: Those who had PN or BL had a higher survival rate, which was statistically insignificant. Further studies are required to determine whether or not the type of resection should be changed as a result of N1 only., (Copyright 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.)