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Amaç: Akciğer kanseri için en etkili tedavi cerrahidir. Morbidite oranları, yıllar içinde mortalite dışında hemen hemen aynı kalmıştır. Morbidite oranları da perioperatif ve postoperatif prosedürlerin iyi yönetimi ile azalmaya başlamıştır. Rezeksiyon cerrahisinden sonra, yıllara göre postoperatif morbidite ve mortalite nedenlerini ve sonuçlarını incelemektir. Yöntemler: Ocak 2013’ten Aralık 2017’ye kadar, anatomik akciğer rezeksiyonları retrospektif olarak gözden geçirildi. Bilateral akciğer rezeksiyonu uygulanan, apse ve tüberküloz gibi enfeksiyonlara eşlik eden hastalar çalışmaya dahil edilmedi. Bulgular: Çalışmaya 907 hasta dahil edildi. Hastaların %79’u erkek ve yaş ortanca değeri 56 olarak bulundu. Malign pulmoner rezeksiyon oranlarındaki artış istatistiksel olarak anlamlıydı (p

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.

Background: Histology represents the major source of information to define a usual interstitial pneumonia (UIP) pattern. However, the procedure is associated with significant morbidity and mortality. The aim of this study was to evaluate morbidity and mortality of surgical lung biopsy (SLB) in diagnosing UIP. Methods: Patients undergoing SLB with the ultimate diagnosis of UIP were studied. Clinical data concerning medical history, histology, pulmonary functions, radiology, length of hospital stay (LOS), morbidity and mortality status were retrospectively recruited from four hospitals. Results: The study included consecutive 93 patients with a SLB diagnosis of UIP. Mean age was 61 ± 8 years, with one third of the patients were ≥65 years. In 58 cases (62.4%), the biopsy was performed by video-assisted thoracoscopic surgery, in 35 (37.7%) by limited thoracotomy. Eighty patients (86%) had possible UIP, 12 (12.9%) had inconsistent with UIP and one (1.1%) had UIP pattern on high-resolution computed tomography. The mean LOS was 5.47 ± 3.16 days. LOS was associated with smoking status (P = 0.024), type of biopsy (P = 0.00), 6-min walk test (P = 0.00) and number of biopsy (P = 0.00). There was no in-hospital and 30-day mortality in our cohort, and 90-day mortality rate was 1.1%. In seven patients (7.5%), we observed postoperative morbidities, predominantly prolonged air leakage (7.5% of all cases). Postoperative morbidity was only associated with the type of SLB. Patients with limited thoracotomy showed greater morbidity rates (17.1% versus 1.7%, P = 0.011). Conclusion: SLB is a relatively safe procedure in the diagnosis of UIP and can be performed in suitable patients with suspected UIP/idiopathic pulmonary fibrosis. WOS:000623102700001 33645001 Q3

Background: Pulmonary artery reconstruction can be preferred as an alternative to pneumonectomy, to spare the functional lung parenchyma in lung cancer. This study aimed to evaluate the morbidity, mortality and survival rates of the patients who had undergone pulmonary artery reconstruction due to central non-small cell lung cancer (NSCLC) and also to compare their data with those of the patients who had undergone pneumonectomy. Materials and Methods: In this study, 88 patients who underwent pneumonectomy (group PN) and 20 patients who underwent standard or sleeve lobectomy (double sleeve) with pulmonary artery reconstruction (group PAR) for NSCLC with stages I-IIIA between January 2005 and December 2010 were evaluated retrospectively. The morbidity and mortality rates, durations of the hospital and intensive care unit stay, 5-year and mean survival rates of the homogenous patient groups were analyzed comparatively. Results: The postoperative morbidity rate was 30% in the PAR group and 53% in the PN group (p = 0.77). The bronchial complication rate was 0% in the PAR group and 15% in the PN group (p = 0.04). The 30-day mortality rate was 5% in the PAR group and 5.6% in the PN group (p = 1). The median follow-up period for all patients was 31.5 months (range: 0-84 months) and total 5-year survival was 56.2%. In early-stage tumors (stage I + stage II), total 5-year survival rate was 64% in the PAR group and 60% in the PN group (p = 0.7). In late-stage tumors (stage III), total 5-year survival rate was 52% in the PAR group and 30% in the PN group (p = 0.04). No local recurrence was observed in either group during the follow-up period. Conclusions: In central lung tumors, to avoid pneumonectomy, major anatomical lung resection with pulmonary artery reconstructions can safely be performed with acceptable morbidity and mortality rates. Oncological outcomes of pulmonary angioplasty procedures regarding survival and local recurrence are not worse than those of pneumonectomy. Even in advanced stage lung tumors, these procedures can be an alternative to more radical operations such as pneumonectomy.

Background The discussions at the surgical levels (sympathectomy levels) about endoscopic thoracic sympathectomy (ETS) method, which is applied in hyperhidrosis treatment in the present day and acknowledged as the golden treatment method, continue. Mainly, most of the studies evaluates postoperative early period results. Our aim in this study is to compare the long-term quality of life depending on the different surgical levels (sympathectomy levels) and evaluate the postoperative complications. Methods 165 patients operated due to palmar hyperhidrosis between January 2012 and July 2017 were evaluated. Sympathectomy was performed either by clipping or cauterization and sympathetic nerves included were T2-4, T3-4, or T3 levels. Data were retrospectively reviewed for complications, factors affecting the postoperative quality of life. Results Ninety of the patients were male (54.5%) and 75 (45.5%) were female. The level of ganglion block was T2-T4 in 62 patients (37.6%), T3-T4 in 46 patients (27.9%), and T3 in 57 patients (34.5%). Early complications were observed in 27 patients (16.4%). Compensatory hyperhidrosis (CH) was observed in 62 patients (37.6%). There was a significant difference in the postoperative quality of life according to ETS level (p < 0.001). Patients who underwent T2-T4 sympathectomy had a lower quality of life than patients who underwent isolated T3 or T3-T4 sympathectomy. Conclusion Based on our results, we recommend performing lower level resections to increase the long-term quality of life in palmar hyperhidrosis patients. The lower risk of CH and comparable quality of life suggest that T3 sympathectomy is more effective. WOS:000515006000010 Q4

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.

Ozpolat, Berkant/0000-0002-6203-7306 WOS: 000492824600021 PubMed: 32082924 Background: This study aims to compare the safety and diagnostic accuracy of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases. Methods: This prospective randomized study was conducted between October 2016 and April 2018 and included 293 patients (201 males, 92 females; mean age 53.59 years; range, 18 to 90 years) from five medical centers experienced in video-assisted thoracoscopic surgery. The patients were randomized into two groups as awake video-assisted thoracoscopic surgery with sedoanalgesia (non-intubated) and video-assisted thoracoscopic surgery with general anesthesia (intubated). Patients with undiagnosed pleural effusions and pleural pathologies such as nodules and masses were included. Conditions such as pain, agitation, and hypoxia were indications for intubation. The groups were compared in terms of demographic data, postoperative pain, operative time, complications, diagnostic accuracy of the procedures, and cost. All patients completed a follow-up period of at least 12 months for samples that were non-specific, suspicious for malignancy or inadequate. Results: Awake video-assisted thoracoscopic surgery was performed in 145 and intubated video-assisted thoracoscopic surgery was performed in 148 patients. Pleural disease was unilateral in 83% (243/293) and bilateral in 17% (50/293) of the patients. There was no difference between the groups in terms of presence of comorbidity (p=0.149). One patient in the awake video-assisted thoracoscopic surgery group (0.6%) was converted to general anesthesia due to refractory pain and agitation. As postoperative complications, fluid drainage and pneumonia were observed in one patient in the awake video-assisted thoracoscopic surgery group (0.6%) and fluid drainage was detected in one patient in the video-assisted thoracoscopic surgery group (0.6%). There were no differences in pain intensity measured with visual analog scale at postoperative 4, 8, 12, or 24 hours (p>0.05). Distribution and rates of postoperative pathological diagnoses were also similar (p=0.171). Both operative cost and total hospital cost were lower in the awake video-assisted thoracoscopic surgery group (p

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. WOS:000491087000009 31004316 Q4

Congenital pulmonary airway malformation (CPAM) is the most common congenital lesion of the lung. A 21-year-old man presented with complaints of frequent cough and sputum. Computed tomography of the chest revealed a 7 x 5-cm lesion in the upper lobe of the left lung. Because the cyst originated in the left upper lobe bronchus and was compressing the surrounding parenchyma, a left upper lobectomy was performed. The pathology report indicated adenocarcinoma arising from congenital cystic adenomatoid malformation. WOS:000531154500023 Q4