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The term radiologic subsolid lung nodule (SLN) represents a heterogeneous group of non-neoplastic and neoplastic lesions. Intraoperative evaluation (IO) is often required to differentiate and diagnose. The current study aims to investigate the feasibility and reliability of scrape cytology (SC) and radiologic solid size correlation for the IO diagnosis of SLNs.Sixty-eight patients with SLN signs were eligible to take part in the study due to intraoperatively prepared SC slides. We managed to complete the blind radiologic solid size measurement and cytologic evaluation retrospectively. Cases were grouped into three categories based on their cytological features: Group-0 (Benign), Group-1 (mild atypical features), and Group-2 (severe atypical features/unequivocally carcinoma). IO diagnoses were given by combining the radiologic solid size and cytological findings.Cytological features of Group-1 were observed in 100%, 93%, 32.5%, and 17% of the AIS, MIA, IA, and benign lesions, respectively. Cytological features of Group-2 were observed in 67.5%, and 7% of the IA and MIA, respectively. By combining cytology with radiologic solid size, 100%, 85%, 71%, and 83% of the AIS, IA, MIA, and benign lesions respectively were diagnosed correctly. Fifteen (15%) percent of the IA cases were underdiagnosed as MIA since their radiological solid sizes were less than 0.5 cm with cytological features of Group-1. Conversely, 29% of the MIA cases were overdiagnosed as IA since their radiological solid sizes were greater than 0.5 cm.SLNs should be handled with caution in terms of IO management. SC and radiologic solid size correlation both provide a practical and tissue-protecting approach for the IO evaluation of SLNs, ensuring a high consistency between IO and definitive diagnosis.

Background/aim: programmed death ligand-1 (PD-L1) is a predictive marker for immunotherapeutic agents. However, heterogeneous staining of PD-L1 can cause false-negative results. The aim of this study is to evaluate the importance of histological patterns on PD-L1 staining heterogeneity in lung adenocarcinomas (LAC). Materials and methods: PD-L1 immunohistochemistry (IHC) stain was performed to two different tissue cores of 128 LAC cases, and cut-off values are given for grouping the cases according to the percentage of staining (1%-10%, 11%-49%, 50%-100%). Staining rates between cores were compared and analyzed by their histological patterns. Also, the relation of the PD-L1 expression with the clinicopathological characteristics of the cases was analyzed. Results: overall, PD-L1 expression was observed in 53 of 128 cases (41.4%, 1% cut-off), 23.5% of them were positive at 10% cut-off and 14.1% at 50% cut-off. PD-L1 expression was significantly related to the high grade micropapillary and solid patterns of adenocarcinomas (p:0.01). Staining cut-offs were mostly similar between cores (43/50, 86%) (k:0.843). However, 14% of them were positive only in one core (7 of 50). This false negativity was mostly related to the histological patterns. Conclusion: our data reveal the heterogeneous staining of PD-L1 expression, also micropapillary and solid patterns show higher rates of PDL expression. Therewithal, these findings also highlight the importance of taking into consideration of histological patterns, when choosing a paraffin block for the PDL1., NA

Background: we aimed to assess the feasibility and short-term clinical outcomes of surgical procedures for cancer at an institution using a coronavirus disease 2019 (COVID-19)-free surgical pathway during the peak phase of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Materials and methods: this was a single-center study, including cancer patients from all surgical departments, who underwent elective surgical procedures during the first peak phase between March 10 and June 30, 2020. The primary outcomes were the rate of postoperative SARS-CoV-2 infection and 30-day pulmonary or non-pulmonary related morbidity and mortality associated with SARS-CoV-2 disease. Results: four hundred and four cancer patients fulfilling inclusion criteria were analyzed. The rate of patients who underwent open and minimally invasive procedures was 61.9% and 38.1%, respectively. Only one (0.2%) patient died during the study period due to postoperative SARS-CoV2 infection because of acute respiratory distress syndrome. The overall non-SARS-CoV2 related 30-day morbidity and mortality rates were 19.3% and 1.7%, respectively; whereas the overall SARS-CoV2 related 30-day morbidity and mortality rates were 0.2% and 0.2%, respectively. Conclusions: under strict institutional policies and measures to establish a COVID-19-free surgical pathway, elective and emergency cancer operations can be performed with acceptable perioperative and postoperative morbidity and mortality., NA

What is known and objective Erlotinib is a small molecule tyrosine kinase inhibitor which blocks the activation of epidermal growth factor receptor (EGFR), a transmembrane receptor that is upregulated in many cancer types. Inhibition of angiogenesis with consequent impairments in intratumoral microcirculation is one of the mechanisms through which EGFR inhibition halts the progression of cancer. A consequence of impaired microcirculation is intratumoral hypoxia, which results in increases in serum uric acid levels. The goal of this study was to investigate the relationship between serum uric acid levels and response to erlotinib in metastatic non-small-cell lung cancer (NSCLC). Methods A total of 56 patients with metastatic non-small-cell lung cancer who received erlotinib for a duration of at least 3 months were included in this retrospective cohort study. Demographic characteristics, progression status, baseline serum uric levels and 3-month serum uric acid levels were recorded and analysed. Results and discussion Of the study population, 21 (37.5%) were female and 35 (62.5%) were male patients. No significant difference in above demographic characteristics was observed among exitus, survivor with progression and survivor without progression groups. Patients who responded favourably to erlotinib with no progression of their disease had significantly increased uric acid levels at 3-month follow-up (P = .01). Such a correlation was not observed if the patient was exitus (P = .47) or had progressed on erlotinib therapy (P = .19). What is new and conclusion In conclusion, this study is the first to demonstrate significant increases in serum uric acid levels in patients with metastatic NSCLC who responded favourably to erlotinib and had no progression under erlotinib therapy. Further studies are required to confirm and characterize serum uric acid as a novel biomarker in predicting the outcome in those with metastatic NSCLC. Türkiye Cumhuriyeti Kalkınma Bakanlığı

PURPOSE In lung adenocarcinoma cases, 'spread through air spaces' (STAS) is a new indicator of invasion and directly related to disease survival. The aim of our study is to establish whether a preoperatively performed 18F-Fluorodeoxyglucose (FDG) PET/computed tomography (CT) imaging data can predict the presence of STAS in cases with lung adenocarcinoma and thus predict the decision for the type of surgery and adjuvant chemotherapy. MATERIALS AND METHODS Between 2000 and 2019, we retrospectively analyzed 63 patients with lung adenocarcinoma cases that had undergone lobectomy or pneumonectomy. Semiquantitative parameters were calculated and metabolic tumor volume (MTV)/CT volume (CTV) ratio was recorded from FDG PET/CT data. The pathological samples from these patients were evaluated for STAS. All these values were evaluated for their correlation with the alveolar spread. RESULTS There was no statistically significant correlation to be found between CTV, MTV, total lesion glycolysis (TLG), standardized uptake value (SUV)max, SUVmean and STAS (P > 0.05). However, MTV/CTV ratio above 1 had statistically more alveolar spread. In the group with an MTV ratio above 1, STAS positivity was 27 (75%), and 9 (25%) did not have STAS, whereas these were 6 (22.2%) patients who had STAS, and 21 (77.8%) did not have STAS in the group with below 1 (P

Objectives: Whether acute phase and immune responses are minimally affected following minimally invasive lung surgery needs further investigation. We performed a pilot study to evaluate the immune profile of patients who underwent video-assisted thoracoscopic surgery or robot-assisted thoracic surgery lobectomies for the treatment of suspicious or known stage I non-small-cell lung cancer. Methods: blood samples were taken preoperatively and 3 and 24 h postoperatively were analysed for C-reactive protein, glucose, cortisol, tumour necrosis factor alpha (TNF-α), interleukin 8 (IL-8) and interleukin 10 (IL-10) levels. TNF-α, IL-8 and IL-10 were also measured in lung tissues. T (CD4, CD8), B (CD19) and natural killer (CD56, CD16) cell counts and natural killer cell functions were analysed using a flow cytometry-based assay before and after surgery. Results: minimally invasive surgery (robot-assisted thoracic surgery + video-assisted thoracoscopic surgery) significantly decreased IL-10 (P = 0.016) levels after surgery. No significant differences were detected in TNF-α (P = 0.48) and IL-8 (P = 0.15) levels before and after surgery. C-reactive protein (P < 0.001), cortisol (P < 0.001) and glucose levels (P < 0.001) increased significantly after surgery. Lymphocyte, total T cell, CD3+CD4+ and CD3+CD8+ CD16+CD56+ cell counts were significantly lower on postoperative day 1. Conclusion: there seems to be a dynamic balance between pro- and anti-inflammatory cytokines and immune cells following minimally invasive lobectomy., Scientific and Technological Research Council of Turkey (TÜBİTAK)

One of the key immune cells involved in the pathogenesis of lung cancer is natural killer (NK) cells and these cells are novel targets for therapeutic applications in lung cancer. The purpose of this review is to summarize the current literature on lung cancer pathogenesis with a focus on the interaction between NK cells and smoking, how these factors are related to the pathogenesis of lung cancer and how NK cell-based immunotherapy effect lung cancer survival. The relevant literature from PubMed and Medline databases is reviewed in this article. The cytolytic potential of NK cells are reduced in lung cancer and increasing evidence suggests that improving NK cell functioning may induce tumor regression. Recent clinical trials on NK cell-based novel therapies such as cytokines including interleukin (IL)-15, IL-12 and IL-2, NK-92 cell lines and allogenic NK cell immunotherapy showed promising results with less adverse effects on the lung cancer survival. The NK cell targeting strategy has not yet been approved for lung cancer treatment. More clinical studies focusing on the role of NK cells in lung cancer pathogenesis are warranted to develop novel NK cell-based therapeutic approaches for the treatment of lung cancer.

Ovarian cancer is the leading cause of death among gynecological malignancies. Primary maximal cytoreduction is associated with significantly improved survival.[1 2][1] The aim of this video is to present a primary extended maximal cytoreductive surgery. A 37-year-old woman was admitted with

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) or hyperthermic intrapleural chemotherapy (HIC) has been established as the new treatment modality for selected patients with peritoneal and pleural malignancies. The purpose of the study was to compare the development of acute kidney injury (AKI) in patients who received intravenous cisplatin alone, HIPEC and underwent surgery.This retrospective study included 104 patients who underwent different therapeutic procedures including systemic cisplatin, surgery and HIPEC or HIC using cisplatin for the treatment of peritoneal carcinomatosis from a variety of primary tumors at Koc University Hospital and American Hospital between January 2015 to December 2017.AKI developed in 18 (17.3%) patients. Baseline creatinine was significantly increased in 3 groups after therapies. The development of AKI was highest in patients treated with HIPEC compared to patients treated with intravenous cisplatin and patients who underwent surgery. AKI developed 31.2% in the HIPEC group (10 of 32 patients), 11.7% in the surgery group (4 of 34 patients) and 10.5% in intravenous cisplatin group (4 of 38 patients), respectively (p 0.04).HIPEC may not be so safe with regard to kidney function. Every attempt should be taken to decrease kidney damage during this procedure.

Objective: To analyze the extent of visceral pleural invasion (VPI) and its effect on survival along with its place in determining the T descriptor in TNM staging in our patients. Methods: A total of 233 patients underwent lung resection. The data were retrospectively analyzed in terms of sex, age, histopathologic type, stage of the tumor, extent of VPI, and survival. Patients who had neoadjuvant chemotherapy or chemoradiotherapy, distant metastasis, parietal pleural invasion, and operative mortality were excluded. Results: The median follow-up was 59 months (range 4–126). The extent of VPI was PL0 in 119 (65.7%) patients, PL1 in 47 (26%) patients, and PL2 in 15 (8%) patients. The median survival rates were 65 (range 43–96) months for PL0, 54 (range 37–72) months for PL1, and 39 (range 12–69) months for PL2. The 5-year overall survival rates were 74.7% for PL0, 77.8% for PL1, and 53.3% for PL2. There were statistically significant differences in overall survival among PL0, PL1, and PL2 ( p = 0.03). In subgroup analysis, the difference was insignificant in PL0 vs PL1 ( p = 0.81), but significant in PL0 vs PL2 ( p = 0.02) and PL1 vs PL2 ( p = 0.04) groups. Conclusions: This study emphasizes that the presence of VPI is related with poor prognosis independent of lymph node positivity, histologic subtypes, and tumor size. As the study shows, PL0 and PL1 have similar survival rates and these two groups may be considered as VPI (−) patients whereas PL2 disease affects survival outcomes.

A 23-year-old pregnant patient was evaluated with a mass lesion located on the right sided chest wall. A MRI of the chest showed a lesion of approximately 18 × 16 × 17.5 cm originating from ribs. A tru-cut biopsy revealed the diagnosis of chondrosarcoma. The patient underwent an extended chest wall resection, reconstruction and right pneumonectomy operation in the 24th gestation week. After the recovery period, two cycles of chemotherapy were administrated. The patient delivered a healthy baby in 34th week of her pregnancy.

Introduction: Patients with inadequately controlled or uncontrolled asthma are at a greater risk of attacks for asthma requiring emergency room visits or hospital admissions. There is a significant correlation between the severity of the disease and the severity of exacerbations. Patients with poorly controlled asthma are at a higher risk for complications. Case study: We present a 24-year-old aspirin-intolerant, uncontrolled asthma patient with the complication of pneumomediastinum. Results: Severe symptoms persisted after the resolution of the pneumomediastinum despite intense anti-inflammatory and anti-obstructive therapy. A bronchoscopy revealed an endobronchial lesion and she was diagnosed with a carcinoid tumor. Conclusion: This case is an example of the importance of re-evaluating asthma patients who do not respond to standard medical treatment. Clinicians should be aware of the complications associated with asthma attacks such as pneumomediastinum and the possibility of a differential diag...

OZ Amac: Bu calismada gunumuzde akciger kanseri tedavisinde nadir olarak uygulanmakta olan pulmoner artere (PA) yama veya uc uca anastomoz yontemleri ile rezeksiyon ve rekonstruksiyon ameliyatlarinin sonuclari bildirildi. Ca­lis­ma­pla­ni:­Ocak 2005 Ocak 2012 tarihleri arasinda kucuk hucreli disi akciger kanseri nedeniyle ameliyat edilen 712 hastanin 32’sine (26 erkek, 6 kadin; ort. yas 62±8 yil; dagilim 39-80 yil) lobektomi ve PA major rekonstruksiyon cerrahisi (dordu otolog perikard yama, 10’u da politetrafloroetilen greft ile yama olmak uzere 14’une parsiyel ve 18’ine sirkumferensiyal rezeksiyon) uygulandi. Bul gu lar: Medyan sagkalim 48±8 ay idi. Bes ve yedi yillik sagkalim oranlari sirasiyla %27 ve %9 idi. Ameliyata bagli mortalite gorulmedi. Morbidite orani %41 (minor %31 ve major %10) idi. Sag tarafli ameliyat olan hastalarin tumunde bronsiyal sleeve rezeksiyon da uygulanir iken, sol tarafta bu oran %59 idi (p=0.03). ‘Double sleeve’ rezeksiyon orani %47 idi. Pulmoner artere yama cerrahisi yapilan hastalarda medyan sagkalim orani 60±36 ay, bes yillik sagkalim orani ise %37 iken, sirkumferensiyal rezeksiyon ve uc uca anastomoz yapilan hastalarda medyan sagkalim 43±13 ay, bes yillik sagkalim orani ise %22 bulundu (p=0.38). Yama uygulamasi ile sirkumferensiyel rezeksiyon ve uc uca anastomoz grubu arasinda komplikasyon acisindan istatistiksel olarak anlamli fark yoktu (p=0.808). ‘Double sleeve’ rezeksiyon uygulanan hastalarda bes yillik sagkalim orani %16 iken, digerlerinde bu oran %48 idi (p=0.282). Ayrica sagkalimin tek degiskenli analizinde yas (p=0.185), taraf (p=0.527), neoadjuvan tedavi (p=279), N durumu (p=0.878), adjuvant tedavi secimi (p=0.978) ve metastaz gelisimi (p=0.471) acisindan anlamli bir fark gorulmedi. Kadin cinsiyeti (p=0.05), adjuvan tedavi (p=0.001) ve ameliyat sonrasi komplikasyon gelisimi (p=0.038) uzun donem sagkalim icin pozitif ongorduruculer olarak bulundu. So­nuc:­Pnomonektomiden sakinmak icin uygulanan PA rezeksiyonlari ve rekonstruksiyonlari, dusuk morbidite ve mortalite oranlari ile uygulanabilen uygun ve etkili cerrahi islemlerdir. Kadin cinsiyeti, ameliyat sonrasi adjuvan onkolojik tedavi ve ameliyat sonrasi surecte komplikasyon gelismemesinin uzun donem sagkalimi etkileyebilecegi gorunmektedir. Anah­tar­soz­cuk­ler: Lobektomi; akciger kanseri; pulmoner arter; sleeve rezeksiyon. ABSTRACT Background:­ This study aims to report the results of pulmonary arterial (PA) resections and reconstructions with either a patch or end-to-end anastomosis for lung cancer which are currently rarely used. Methods: Between January 2005 and January 2012, 712 non-small cell lung cancer patients underwent surgery of which 32 (26 males, 6 females; mean age 62±8 years; range 39 to 80 years) had lobectomy and major reconstructive surgery for PA (14 partial, including four PA reconstructions with an autologous pericardial patch and 10 PA reconstructions with a polytetraflouroethylene graft and 18 circumferential). Results:­The median survival was 48±8 months. Five and seven-year survival rates were 27% and 9% respectively. No operative mortality was seen. Morbidity rates were 41% (minor 31% and major 10%). All patients with a right-sided resection had also a bronchial sleeve resections with a rate of 59% in the left lung (p=0.03). The rate of double sleeve resection was 47%. The median and five-year survival rates were 60±36 months and 37% in the arterial patch plasty operations respectively, whereas it was 43±13 months and 22% in circumferential resections and end-to-end anastomosis patients, respectively (p=0.38). There was no statistically significant difference in the complication rate between the circumferential resections with patch plasty operations and end-to-end anastomosis (p=0.808). Five-year survival rate was 16% in double sleeve resections and 48% in others (p=0.282). Univariate analysis of survival demonstrated no significant differences in terms of age (p=0.185), side (p=0.527), neoadjuvant treatment (p=279), N status (p=0.878), type of adjuvant treatment (p=0.978) and metastasis development (p=0.471). Female gender (p=0.05), adjuvant treatment (p=0.001) and development of postoperative complications (p=0.038) were identified as positive predictors for long-term survival. Conclusion:­ Pulmonary arterial resections and reconstructions to prevent pneumonectomy are feasible and effective surgical procedures with acceptable morbidity and mortality rates. Female gender, postoperative adjuvant oncological treatment and non-complicated postoperative course appear to be potential influencing factors on long-term survival.

With the progress of the technology, video-assisted surgeries have been developed in thoracic surgery as well as the other branches. With the widespread use in the 2000’s, robotic surgical systems had also found a place within the field of thoracic surgery. First in benign diseases and then in parallel with the increasing experience, it started to be used in cancer surgery which requires more technical skill. It was shown in various articles that it can be used in a wide area from wedge resections to pneumonectomy.

Objectives The aim of this prospective study was to compare the effects of axillary thoracotomy (AT) and video-assisted thoracoscopic surgery (VATS) on acute-phase responses, pain, performance status and quality of life in patients undergoing pulmonary resection. Methods Fifty-five patients with peripherally located lung lesions were enrolled into this study. Surgery was done by VATS or AT. Forced expiratory volume, smoking habits, complications, Charlson comorbidity index, sex, age, length of incision, length of operation, length of hospital stay, length of drainage, length of air leakage, preoperative and postoperative C-reactive protein (CRP) values, visual analogue scale, quality of life and performance status of the patients were measured and compared. Results Twenty-five patients had lung resection with VATS and 30 patients had lung resection with AT. The demographic variables were similar. The differences between the two groups' postoperative serum CRP levels were significantly lower for the VATS group. The length of postoperative stay was significantly shorter for the VATS group. There were no other statistical significance between the two groups in terms of operative variables, complications, pain, quality of life and performance status. Conclusions AT is a technique equivalent to VATS in terms of early complications, pain, performance status and quality of life; VATS provided a shorter postoperative stay.

Amac: Bu calismada, pediatrik hastalarda pulmoner sublober rezeksiyonun sonuclari degerlendirildi. Ca­lis­ma­pla­ni:­Ocak 2001 Haziran 2011 tarihleri arasinda Istanbul Universitesi Istanbul Tip Fakultesi Gogus Cerrahisi Kliniginde ameliyat edilen 405 cocugun tibbi kayitlari geriye donuk olarak incelendi. Yalnizca pulmoner sublober rezeksiyon uygulanan 43 hasta (20 kiz, 23 erkek; ort. yas 11.4±0.5 yil; dagilim 0-16 yil) calismaya dahil edildi. Hastalar yas, cinsiyet, basvuru yakinmalari, gecirilmis hastalik oykusu, tani yontemleri, ameliyat endikasyonlari, cerrahi yontemler, komplikasyonlar, hastanede kalis sureleri ve islemin sonuclari yonunden degerlendirildi. Bul gu lar: Cerrahi rezeksiyon endikasyonlari onkolojik (n=29), non-onkolojik (n=9) ve dogustan patolojiler (n=5) idi. Cerrahi islem sonrasi ortalama hastanede yatis suresi 3.6 gun idi. Ameliyat sonrasi iki hastada morbidite gorulur iken, mortalite gorulmedi. So­nuc:­ Pulmoner sublober rezeksiyonlarin cocuk hastalardaki endikasyonlari yetiskinlere gore farklilik gosterir. Fonksiyonel akciger dokusu kaybinin ve ameliyat sonrasi komplikasyonlarin daha az olmasi nedeni ile, pulmoner sublober rezeksiyon cocuklar icin iyi bir secenektir. Ayrica, lobektomiden daha kolay ve hizli yapilabilir cerrahi bir yontemdir.

The purpose of this study was to investigate the effects of diagnostic and surgical developments in the complete resection of the mediastinal masses. Of 313 patients, 236 underwent therapeutic or diagnostic complete resections. We analyzed age, gender, diagnostic interventions, neoadjuvant treatment, type of surgical intervention (sternotomy, video-assisted thoracic surgery [VATS], thoracotomy), pathology, duration of hospital stay, complications, mortality, and associated diseases. Patients were divided into two groups according to the period of operation: group A included patients who were operated on between January 2002 and January 2007; group B included patients who were operated on between January 2007 and January 2012. Resection with VATS increased significantly after 2007, from 17.7 to 35 % (p = 0.03). The rate of complications increased after 2007 (p = 0.03), which was apparent in non-VATS patients (p = 0.03). The use of magnetic resonance imaging (MRI) decreased from 29 to 15.5 % (p = 0.02) and positron emission tomography (PET)–computed tomography (CT) use increased from 1.6 to 25.2 % (p

In the case of a pulmonary nodule on preoperative examination or during postoperative follow-up of breast cancer patients, it can be difficult to distinguish between primary lung cancer, a metastatic pulmonary tumor, and a benign pulmonary lesion. The size, morphology, and number of nodules are helpful parameters for differential diagnoses in many cases, whereas more interventional methods are required to clarify the etiology of progression at follow-up. Benign lesions such as atypical pneumonia, tuberculosis, atypical mycobacteria, inflammatory granuloma, rheumatoid nodules, and atypical bronchoalveolar hyperplasia are also common in immunocompromised patients who underwent multiple cycles of chemotherapy.

Thymoma and thymic carcinoma are the most frequent anterior mediastinal neoplasms that originates from epithelial tissue of the thymic gland. Histologic classification of thymomas has been under debate for many years until the World Health Organization (WHO) published and updated the histologic classification of thymomas in 1999 and 2004, respectively [1, 2]. In updated version, type C thymomas were classified in to separate type of thymic tumors as thymic carcinomas (Table 17.1). The widely used staging system, Masaoka classification published in 1981 and further refined with little modifications as the Masaoka-Koga staging system in 1994 (Table 17.2), was proved to be a significant factor for survival [3, 4].

A 70-year-old female patient, who did not have any symptoms, was admitted to the hospital for routine health checkup. She had no significant past medical history other than a 40 pack-year history of smoking. Systematic physical examination was normal. Chest X-ray revealed a suspected opacity in the left upper zone. Thoracic computerized tomography showed peripheral solitary pulmonary nodule in the left lung upper lobe. FDG PET/CT demonstrated high FDG uptake in the left upper lobe nodule with maximal standard uptake value (SUVmax) 7,4 (Fig. 11.1). There was no FDG uptake in the other systems. Cranial MRI did not reveal any metastatic lesion. The patient was clinically staged as cT1aN0M0. Minimally invasive surgery was recommended to patient for diagnosis and treatment.

Lung cancer, a major health problem affecting the epithelial lining of the lower respiratory tract, is considered to be one of the deadliest types of cancer in males and females and it is well-known that smoking is the chief cause of lung cancer. In addition to smoking and environmental factors, genetic susceptibility may also contribute to the development of lung cancer. Previous studies have shown that certain non-small cell lung cancer (NSCLC) patients harbor gain-of-function mutations in the epidermal growth factor receptor gene (EGFR). Phosphorylated EGFR triggers the activation of intracellular signal transduction pathways, including the RAS-MAPK, PI3K-Akt and STAT pathways. However, K-Ras gene point mutations in codons 12, 13 or 61 cause the inactivation of GTPase activity which results in overstimulation of cellular growth and gives rise to neoplastic development. Our aim was to investigate the presence and association of EGFR and K-Ras mutations in 50 primary NSCLC patients with a smoking history by using real-time PCR and sequencing. EGFR mutations were detected in four patients (8%). Two of these mutations were L858R mutations and the remaining two were deletion mutations spanning between codons 746 and 750. The L858R mutation was significantly associated with smoking status (P=0.003). K-Ras codon 12 and 61 mutations were also observed in four patients. However, no association was observed between K-Ras mutations and the tumor staging, gender, histology and smoking status of the patients.

This study aimed to analyze surgeons' learning curve for thymoma resection with video-assisted thoracoscopic surgery (VATS). Two hundred and eleven myasthenia gravis patients had VATS thymic resections, including 25 patients with a thymoma. Three groups of surgeries, according to the order of operations, were analyzed: Group A comprised the first 70 thymectomies, Group B comprised the second 70 thymectomies, and Group C comprised the final 71 thymectomies. We compared the groups on a set of preoperative (age, gender, body mass index, and Osserman stage), operative (number in each group, size, and Masaoka stage), and postoperative (complications and length of stay) variables. A significant difference was observed in the number of thymoma operations (Group A: four patients, Group B: seven patients, and Group C: 14 patients; P: 0.031) and the duration of operation (Group A: 66 min, Group B: 52 min, and Group C: 48 min; P: 0.024). A strong correlation was found between the duration of operation and order of patients (Pearson r: -0.554, P: 0.000). We recommend the start of a program for the resection of thymoma with VATS after surgical staff have performed 70 VATS thymectomy operations.

BACKGROUND: The aim of the study was to compare the effects of conventional posterolateral thoracotomy and muscle-sparing posterolateral thoracotomy on pulmonary and muscle strength. METHODS: From January 2003 to December 2004, 50 randomized patients with a diagnosis of primary lung cancer underwent pulmonary resection. The patients were divided into two groups: Group I (n = 25) underwent conventional posterolateral thoracotomy, while Group II (n = 25) had muscle-sparing thoracotomy. The groups were compared in terms of shoulder abduction/adduction isokinetic muscle strength and respiratory muscle strength. RESULTS: A comparison of maximal expiratory pressure and maximal inspiratory pressure preoperatively and postoperatively and of maximal expiratory pressure and maximal inspiratory pressure preoperatively and at 3 months postoperatively showed statistically significant differences ( P < 0.05). CONCLUSION: For the preservation of muscle strength, especially in patients whose jobs involved manual work, muscle-sparing posterolateral thoracotomy should be the first choice rather than conventional thoracotomy. Moreover, if necessary, the latissimus dorsi muscle can be used more extensively as a flap after muscle-sparing posterolateral thoracotomy procedures.

Lung cancer is the most common cause of cancer-related death worldwide and, like many other cancers, is affected by different genetic, epigenetic, and environmental factors. The WW domain-containing oxidoreductase (WWOX) gene is a tumor-suppressor gene located on chromosome 16q23.3-24.1, and it has been shown that it loses its function due to alterations in genetic and epigenetic mechanisms. The aim of this study is to investigate the relationship between lung cancer and WWOX gene. Tumor tissue samples, corresponding normal tissues, and blood samples obtained from 50 lung cancer patients were involved in the study. We analyzed methylation profile by methylation-specific PCR and mutations and polymorphisms by DNA sequencing. Methylation analysis showed that promoter hypermethylation was present in 38 of 50 (76%) patients. In addition, promoter region of WWOX gene of younger patients was more frequently methylated than older patients. Using DNA sequencing, we found four genetic alterations in WWOX gene. Two of them were germline mutations (Exon 4 and 7), and two of them were polymorphic (Exon 6 and 8). We found a new mutation in exon 7 (Arg-254--Cys) which has not been described previously. The changes in the short-chain dehydrogenase domain of the protein caused by the genetic alterations may affect the function of the gene. We conclude that hypermethylation of WWOX gene promoter region and mutations in the gene might be related to lung carcinogenesis.

Extended resections may be necessary to achieve tumor-free borders for secondary pulmonary malignancies. This study was performed to analyze the outcomes that result from extended resections of pulmonary metastases. Between February 1991 and December 2008, a total of 25 extended pulmonary resections (resection of the chest wall and diaphragm, vascular procedures, sleeve resections, pneumonectomies, atrial resections, and completion pneumonectomies) were performed on 250 patients undergoing 319 metastasectomy procedures. The extended resection group was analyzed in terms of disease-free interval, type of resection, operative morbidity, mortality, and survival and was then compared with patients who underwent lobar or sublobar resections. The extended resection group consisted of 14 male and 11 female patients. The mean disease-free interval was 36.02 (minimum 6, maximum 132) months. The extended resection rate was 10%. After 30 days, all patients were alive. For all extended metastasectomy groups, actuarial 5-year survival rates from the time of the extended metastasectomy were 16.3%. Mean survival times of patients who underwent extended resection and lobar or sublobar resection were 40 months (SD = 11) (95% confidence interval, 19–61) and 20 months (SD = 3) (95% confidence interval, 14–26), respectively. This difference was not statistically significant (P = 0.09) (Fig. 2). In the subgroup analysis, survival in the extended resections and lobar or sublobar resections groups was not statistically significant (osteosarcoma, P = 0.758; epithelial tumor, P = 0.11). Extended resections, which can be performed during pulmonary metastasectomies of patients with tumor-free surgical borders, may establish curative benefits, with low rates of mortality and morbidity.

It is accepted that cardiopulmonary exercise testing is one of the most valuable parameters, especially peak oxygen uptake (VO(2)), for the evaluation of risk assessment in lung cancer surgery. It therefore represents an attractive way of identifying a patient at high risk for postoperative complications. However, many patients do not achieve the maximal or predictive level during an incremental exercise testing. The purpose of the current investigation was to study the value of the oxygen uptake efficiency slope (OUES), which shows exercise capacity during submaximal testing, in predicting postoperative mortality in patients with bronchogenic carcinoma scheduled for lung resection. Forty-nine patients with bronchogenic carcinoma participated in studies with exercise tests as a preoperative evaluation. The peak VO(2) was calculated for each subject by averaging values obtained during the final 10s of exercise. The following equation was used to determine OUES: VO(2)/log(10)VE. Peak VO(2) without postoperative complication was 22.8+/-3.3 ml/(kg min), however, peak VO(2) in patients with present complications was 19.1+/-4.2 ml/(kg min) (p=0.001). In addition, although the mean OUES in patients with present complications was 11.1+/-1.2, the mean OUES in the absent group was 13.3+/-2.1 (p

The aims of this study are to present the results of videothoracoscopic thymectomy in patients with myasthenia gravis (MG) and to predict the factors affecting the next morning discharge (NMD). This is a retrospective analysis of the prospectively recorded data of 181 consecutive myasthenic patients who underwent videothoracoscopic thymectomy from June 2002 to September 2009. Sixty-one patients (33.7%) were discharged on the next morning. Univariate and multivariate analyses were evaluated to determine the predictors for NMD. Mean calculated variables were: age (29.8 years), duration of symptoms (22.5 months), duration of surgery (51.3 min), postoperative stay (2.1) days, and visual analogue scale (2.1). No mortality occurred. Four patients were required to stay in intensive care unit (ICU) with a mean of 18.6 h. With logistic regression analysis, duration of operation (DoO) was calculated to be the only predictive factor for NMD (P=0.006). Video-assisted thoracoscopic thymectomy (VAT thymectomy) is a safe surgery procedure with a smooth postoperative period for MG. Although a detailed analysis was performed, only DoO was found to be a predictive factor for NMD in MG patients.

Amaç: Bu çalışmanın amacı neoadjuvan kemoterapi ve kemoradyoterapi sonrası cerrahi tedavi uygulanan primer akciğer tümörlü hastaların nüks, sağkalım, komplikasyon, morbidite ve mortalite açısından incelenmesidir.Gereç ve Yöntem: Haziran 2001-Aralık 2008 tarihleri arasında 59’u neoadjuvan kemoterapi, 31’i ise neoadjuvan kemoradyoterapi sonrası opere edilen toplam 90 hasta retrospektif olarak 3 gruba ayrılarak incelendi: 47 klinik T3/N2, 23 T4(N0-1), 20 histopatolojik olarak pozitif N2 (T1-3) hasta mevcuttu. Olguların yaşları, cinsiyetleri, tümör patolojileri, rezeksiyon tipleri, komplikasyonları, mortalite ve sağkalım oranları incelendi.Bulgular: Hastaların 76’sı erkek, 14’ü kadındı. Yaş ortalaması 55.3±8.5 (36-75) idi. Olguların 36’sına lobektomi, 11’ine lobektomiyle birlikte genişletilmiş rezeksiyon, 13’üne sleeve lobektomi, 30’una pnömonektomi uygulandı. Tüm olguların major komplikasyon oranı %14.4, mortalite %2.2 idi. Minimal takip süresi 24 ay, ortalama takip süresi ise 27±18 aydı. Ortalama sağkalım oranı 25±4.6 ay; (patolojik evre I:35±9.7 ay, evre II:33±8.5 ay, evre IIIa:24±9.7 ay ve evre IIIb:14±10.9 ay) olarak hesaplandı. Ortalama sağkalım klinik T3/N2 grubunda 26±6.7 ay, T4 grubunda 14±2.2 ay ve histopatolojik N2 grubunda 41±3.7 aydı. Klinik T3/N2 grubu ile histopatolojik N2 grubunun sağkalım süreleri arasında istatistiksel olarak anlamlı fark saptandı (p, Objective: In this study, we aimed to analyse the non-small celllung carcinoma patients who have undergone surgery after neoadjuvantchemo/chemoradiotherapy in regardsto recurrences, survival, complication, morbidity, and mortality.Materials and Methods: The data of 90 patients who had surgeries between June2001 and December 2008 were retropectively evaluated. Fifty nine of those 90patients had neoadjuvant chemotherapy and 31 patients had neoadjuvantchemoradiotherapy. Patients were divided into 3 groups; 47 patients wereclinical T3/N2, 23 patients were clinical T4(N0-1), 20 patients werehistopatologically proven N2(T1-3). Age, gender, tumor pathology, resectiontype, complications, mortality and survival rates of the patients wereevaluated.Results: There were 76 male, 14 female patients in our studygroup. Mean age was 55.3±8.5 (36-75) years. Thirty six patients had lobectomy,11 patients had extended resections with lobectomy, 13 patients had sleevelobectomy, and 30 patients had pneumonectomy operations. Major complication andmortality rates were 14.4% and 2.2% respectively. Minimal and mean follow-upperiods were 24 and 27±18 monthsrespectively. Mean survival was calculated as 25±4.6 months (pathological stageI: 35±9.7 months, stage II: 33±8.5 months, stage IIIa: 24±9.7 months, and stageIIIb: 14±10.9 months). Mean survival was 26±6.7 months in clinical T3/N2 group,14±2.2 months in T4 group, 41±3.7 months in histopathological N2 group. Therewas a statisticaly significant difference in survival times between clinicalT3/N2 and histopathological N2 groups (p

Large cell carcinoma of the lung with a rhabdoid phenotype is very rare. We present a 55-year-old man with multiple nodules in his lung. He had an emergency operation because of abundant hemoptysis. The microscopic appearance was a large cell carcinoma with a pure rhabdoid phenotype. There were no foci of any other carcinomatous components. Tumor cells had abundant eosinophilic cytoplasmic globules and eccentric nuclei and did not adhere to each other. Histochemically, these cells were periodic acid-Schiff-negative. Immunohistochemically, vimentin and neuron-specific enolase were positive. Epithelial membrane antigen was focally and weakly positive, p53 was positive in 60% of tumoral cells, and Ki-67 (MIB-1 labeling index) was 50%. The patient died of disseminated disease 2 months after the operation.

BACKGROUND The aim of this study was to compare the early postoperative results of thymectomy operations after partial sternotomy and videothoracoscopy for myasthenia gravis. METHODS A total of 51 thymectomy operations were reviewed. The surgical procedure was simple thymectomy with partial sternotomy in the first 19 patients (Group I) and videothoracoscopic thymectomy (Group II) in the remaining patients. Both groups were compared in terms of preoperative data (age, gender, classification, duration of disease, medications), operative data (operation time, the mean amount of drainage, the duration of chest tube drainage), and postoperative data (duration of hospital stay, complications and pain). RESULTS Groups were statistically uniform in terms of preoperative and operative data. Statistically significant differences were noted for the duration of chest tube drainage (48.8 vs. 29.8 hours, p < 0.001), the amount of drainage (264.4 vs. 178.6 ml, p = 0.001), the length of hospital stay (5.6 vs. 2.3 days, p = 0.000), and the visual analogue scale score (4.8 vs. 3.1, p < 0.001). CONCLUSIONS Thymectomy with videothoracoscopic surgery demonstrated a more comfortable and faster recovery period without deterioration in myasthenic status.

Objectives: Some of the lung cancer patients who are treated surgically with curative intent ultimately die in the early postoperative period. The aim of this study is to analyze the causes of death within 1 year of resection for lung cancer in our patients. Methods: Six hundred and twenty patients, who underwent resection for lung cancer with a curative intent were reviewed retrospectively. Eighteen patients (2.9%) died due to postoperative complications or within the first month and 51 (8.4%) patients (group 1) died within the first year after operation. Fifty-one patients (group 1) were compared with the survivors (group 2) in terms of age, gender, preoperative FEV 1, pathological tumor node metastasis (TNM), histopathological subtypes, type of resection, completeness of the resection, preoperative Karnofsky performance status and application of postoperative radiotherapy. Results: Pathological TNM ðP , 0:001Þ; type of resection ðP , 0:01Þ; histopathological subtype ðP , 0:001Þ; completeness of the resection ðP , 0:05Þ and postoperative radiotherapy ðP , 0:001Þ were determined to be significant factors in mortality within 1 year after resection for lung cancer. Conclusions: The patients with pathological stage 3 disease, with large cell histology or who had undergone pneumonectomy have a higher risk of mortality within 1 year. These patients require detailed preoperative work up in terms of metastatic disease and cardiopulmonary physiological status. q 2004 Elsevier B.V. All rights reserved.

This prospective study was done between February 2001 and December 2002 on 84 non-small cell lung cancer patients who were apparently operable. We selectively performed mediastinoscopy to 46 patients (54.76%, group 1) with the following indications: clinical T4 tumor, high operative risk, radiologically enlarged mediastinal lymph nodes, clinical T3 tumors with central location, radiologically identified mediastinal lymph nodes of any size with adeno or large cell carcinoma histology. Other 38 patients (45.23%, group 2) underwent thoracotomy without mediastinoscopy. Sensitivity, specificity, negative predictive value and positive predictive value of the indications were calculated. Cost analysis was done in the 84 patients and the results were compared with alternative mediastinal staging strategies (vs. routine, and vs. selectively to patients with radiologically positive mediastinal lymph nodes) if they had been applied to our population. Group 1 had higher selectivity to differentiate N2 patients (p=0.02). Sensitivity, specificity, negative predictive value and positive predictive value of indications were calculated as: 0.85, 0.54, 0.92 and 0.36, respectively. Our approach was most economical in terms of total cost per patient and money spent unnecessarily per patient. Mediastinal evaluation in operable lung cancer patients should decrease the number of surgical procedures, N2 disease found at thoracotomy and cost.

BACKGROUND The aim of this study is to identify the effectiveness of perioperative pneumoperitoneum to prevent air leak after the lobectomy-bilobectomy operations for lung cancer. METHODS A prospective study was designed on consecutive 50 patients who had lobectomy-bilobectomy operations for lung cancer and whose remnant lung had failed to fill the half of the hemithoracic cavity under 30 cm H(2)O positive pressure ventilation during the operation with totally relaxed diaphragm. The patients were divided into two groups: group 1 (25 patients) with perioperative pneumoperitoneum, group 2 (25 patients) without perioperative pneumoperitoneum. RESULTS The statistical analysis between the two groups did not show any significant difference in terms of age, preoperative FEV1, and the type of resection. Perioperative pneumoperitoneum significantly reduced the duration of postoperative air leak (2.2 +/- 1.15 days vs. 6.04 +/- 3.27 days p < 0.0001) and total chest tube drainage time (3.84 +/- 0.98 days vs. 7.88 +/- 3.16 days p < 0.001). CONCLUSION Perioperative pneumoperitoneum after lobectomy-bilobectomy operations for lung cancer is an effective method to decrease air leak and chest tube drainage time.

Advances in surgical techniques have indicated that video-assisted thoracoscopic pneumonectomy is a safe alternative to open pneumonectomy. However, indications for video-assisted thoracoscopic pneumonectomy are controversial. We describe two patients who underwent left pneumonectomy because of destroyed lungs and speculated about the tight adhesions, enlarged lymph nodes, enlarged bronchial vessels, and access incisions. Two patients were operated by two different approaches mainly; anterior and posterior, because of the degree of contralateral lung herniation. Both of them experienced a safe perioperative period.

Objectives Published experiences with thoracoscopic apical or total pleurectomy for patients with a pneumothorax are limited. We aimed to evaluate the long-term results and effectiveness of pleurectomy in our patients, that vast majority of whom underwent thoracoscopic apical or total pleurectomy. Material and methods Between January 2001 and December 2010, in the Istanbul University Medical School Department of Thoracic Surgery, 67 patients, consisting of 52 patients with a primary spontaneous pneumothorax and 15 with a secondary spontaneous pneumothorax who underwent 72 processes of thoracoscopic resection of blebs or bullae and pleural symphysis, consisting of 43% total pleurectomy, 42% apical pleurectomy plus pleural abrasion, and 15% non-pleurectomy pleurodesis procedures due to prolonged air leak or recurrent spontaneous pneumothorax, were analyzed retrospectively. The applied pleural procedures were: 1. total pleurectomy 2. apical pleurectomy and pleural abrasion for the remaining parts and 3. non-pleurectomy pleurodesis procedures. The long-term outcomes of patients undergoing the three different pleural procedures were compared. Results Total pleurectomy process, apical pleurectomy and abrasion process for remaining parietal pleura, and non-pleurectomy pleurodesis procedures were performed 31, 30, and 11 times, respectively. No recurrence was observed in the total pleurectomy group, 1 recurrence was observed for the apical pleurectomy plus pleural abrasion group, and 2 recurrences were observed for the non-pleurectomy group. Conclusion Video-assisted thoracoscopic pleurectomy is a safe and effective method in spontaneous pneumothorax surgery. Especially, total pleurectomy has efficient results in the prevention of recurrences.

We describe a 37-year-old female patient who had a major vehicle accident 17 years ago. A chest tube had been inserted through the left side of the chest to treat pneumothorax. She was readmitted to the hospital with dyspnea 17 years later. Her examinations, including fiberoptic bronchoscopy, revealed total atelectasis of the left lung with a blind-ending left main bronchus. Anastomosis of the left distal main bronchus to left main bronchus was performed. She had no complications and was discharged on postoperative day 8. Follow-up demonstrated a perfectly functioning left lung with nuclear and tomographic investigations performed on the first postoperative year.

Hydatid disease is a parasitic infection caused by the larvae of tapeworm Echinococcus Granulosus. Hydatid cyst of the heart is an uncommon presentation of human echinococcosis which may lead to life-threatening conditions. We present a rare case of recurrent pericardial cyst in a 42-year-old man presenting with chest pain and ECG findings. We were able to avoid risks of resternotomy with a limited anterolateral thoracotomy. A direct enucleation of the cyst was possible without the need for cardiopulmonary bypass. He was free of complications at 6-month follow-up. Diagnosis should be suspected in every case of anginal symptoms or cyst-like mass in persons coming from areas where echinococcus granulosus is endemic.

To analyze the factors associated with survival and pulmonary recurrence after complete metastasectomy for patients with sarcomatous disease.Among the 51 patients who underwent complete pulmonary metastasectomy at our hospital between January 2002 and November 2010, 30 (58.8 %) suffered pulmonary recurrence in an ipsilateral hemithorax. We analyzed the factors affecting survival and recurrence after complete metastasectomy.The 51 patients who underwent pulmonary metastasectomy comprised 33 male and 18 female patients, with a median age of 22 years (range 11-61 years). The median survival was 24 months. Multivariate analysis revealed recurrence (p = 0.016) and the type of tumor (p = 0.024) as independent predictors of survival. Recurrence developed in 30 (58.8 %) patients. The risk of recurrence was higher in patients with a DFI12 months and1 metastasis resected during the initial metastasectomy.Based on the findings of our analysis, patients with a DFI12 months and1 metastases resected during initial surgery have a higher risk of recurrence. We recommend postoperative follow-up at frequent intervals and reconsideration of oncological treatment after complete resection.

The objectives of this study were to evaluate the feasibility of video-assisted thoracoscopic (VATS) thymoma resection and to analyze the factors contributing to a successful perioperative period.Fifty-one patients with thymoma underwent VATS with the aim of thymoma resection. Four patients underwent minithoracotomy [due to technical difficulties, including small chest cavity, high body mass index (BMI), and disintegration of the capsule] and three patients underwent sternotomy (due to invasion of major vascular structures). The seven open-converted patients and seven other patients who underwent complete VATS thymoma resection but experienced prolonged hospital stay (≥7 days) formed Group B (n = 14), namely, the unsuccessful group, while successful VATS thymoma resection patients formed Group A (n = 37). The groups were compared with each other in terms of the characteristics of patients, tumors, and perioperative period.Patients' characteristics, tumor size, WHO histologic type, and complications were similar in both Groups A and B (p0.05). Patients with Masaoka stage I and II thymomas were significantly more frequent in Group A (p0.01). Tumor size was a statistically insignificant variable for the determination of a successful VATS thymoma resection (p = 0.3). Masaoka stage and the size of the thymoma did not have any correlation with each other (p0.05).The size of the thymoma was not observed to be correlated with Masaoka stage and it was not noted to be an important factor in successful VATS thymoma resection. A higher Masaoka stage (III and IVa) was found to be the only variable that predicted unsuccessful situations. Thus, Masaoka stage, rather than the size of the thymoma, should be the main concern for the surgeon.