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Background Patients with chest wall invasion, which constitute 5-10% of operable non-small cell lung cancer cases, are heterogeneous in terms of factors that may affect the prognosis. We aim to share our experience including the surgical results of patients with non-small cell lung cancer (NSCLC) who underwent chest wall resection and identify the potential factors that may impact the survival. Methods The patients who underwent combined chest wall and lung resection due to primary lung cancer invading the chest wall in our center between 2007 and 2019 were reviewed. Variables such as age, tumor size, histological subtype, surgical technique, depth of invasion, the extent of resection, histological subtype, neoadjuvant, and adjuvant treatment status were examined. Results 254 patients who underwent combined chest wall and lung resection were included in the study. There were 245 men and 9 women. The mean age was 61.0 ± 8.4 years. The overall survival was 70.9 ± 4.6 months, and the 5-year survival rate was 41.5 ± 3.3%. In multivariate analyses, age, the extent of lung resection, the number of resected ribs, invasion depth, and completeness of chest wall resection were independent factors that have an effect on survival. Conclusions This study shows that age, the extent of lung and chest wall resection, invasion depth, and completeness of chest wall resection are independent prognostic factors of survival in patients who underwent combined lung and chest wall resection for NSCLC. Trial registration Institutional Review Board of the Dr Suat Seren Chest Diseases and Surgery Medical Practice and Research Center (No: E-49109414-604.02.02)

OBJECTIVES Nonsmall cell lung cancer (NSCLC) is a multifactorial disease, and differences in the characteristics of surgical patients may develop over the years. This study aimed to evaluate the patients who underwent curative surgical resection for NSCLC in the past 20 years at our center and analyze the changes in the treatment strategies based on demographics, surgical strategies, and histopathology. MATERIALS AND METHODS In this retrospective single-center cohort study, 1995 patients who had undergone lobectomy, bilobectomy, or pneumonectomy for primary NSCLC from January 1997 to January 2017 were analyzed. Patients were divided into two groups: Group I included patients operated in the first 10 years and Group II included patients operated in the last 10 years. RESULTS Overall, 77% of patients were operated in the last 10 years (458 vs. 1537 patients). Sleeve lobectomies performed in Group II reduced the rate of pneumonectomy from 37% to 20% (p

Background This study aims to investigate the operation-related complications, recurrence frequency, morbidity, mortality and survival rates as well as variables effective on survival of patients undergoing bronchial sleeve lobectomy due to primary non-small cell lung cancer. Methods A total of 85 patients ( 80 males, 5 females; mean age 59.9±8.4 years; range, 35 to 77 years) of bronchial sleeve lobectomy operated with the same surgical technique by the same team in our clinic between May 2007 and November 2015 were analyzed retrospectively. Survival and 30- and 90-day mortality rates were analyzed. Variables effective on survival rate were evaluated statistically. Complications related to bronchial anastomosis and the frequency of local recurrence in postoperative period were investigated. Results Twenty-five patients (29.4%) received neoadjuvant therapy and two of these patients (8%) developed complication in the anastomosis line. Local recurrence rate in the postoperative follow-up was 16.5%. Mean duration of follow-up was 35±29.9 months, median survival was 65.2 months, and five-year survival rate was 50.9%. Thirty- and 90-day mortality rates were 1.2% and 2.4%, respectively. In univariate analysis, patients with larger tumors, N2 disease, or those who underwent extended surgery had statistically significantly worse survival rates (p=0.001, p=0.002, and p=0.0001, respectively). In the Cox regression analysis, variables effective on survival were presence of extended surgery and node status (p=0.03 and p=0.012, respectively). Conclusion Sleeve lobectomy can be achieved with acceptable anastomotic complications, good survival and low mortality rates using continuous suture technique. When performed due to oncological reasons, its long-term results are not different from pneumonectomy.

Although meningioma is mainly a central nervous system tumor, primary pulmonary meningioma is a rare lung neoplasm located outside the central nervous system. There is no clear consensus on its origin. A 42-year-old female patient, without any pre-diagnosis or symptom, was admitted to our clinic due to an incidentally detected lesion on chest X-ray during routine controls. The lesion in the lower lobe of the left lung was successfully resected by surgical intervention. In this study; primary pulmonary meningioma was examined because of its rarity and presented with the literature data.

BackgroundCongenital lung malformation is an umbrella term and consist of various kind of parenchymal and mediastinal pathologies. Surgical intervention is often necessary for diagnosis and treatment for these pathologies. We aimed to review our experience in surgical treatment for congenital lung disease and present the role of minimally invasive surgery. Methods From January 2009 to May 2019, a total of 94 patients fitted the criteria for inclusion in this retrospective study. We investigated the clinical results obtained retrospectively.Results There were no significant differences between pathological subtypes in the postoperative length of hospital stay and drainage duration. There wasn't a significant difference between VATS and thoracotomy group in perioperative complicationsConclusions Congenital lung malformations consist of a heterogeneous group of diseases and video-assisted thoracoscopic surgery should be considered as the first choice in the surgical treatment of these patients.

Background Congenital lung malformation is an umbrella term and consist of various kind of parenchymal and mediastinal pathologies. Surgical resection is often required for diagnosis and curative treatment. We aimed to review our experience in surgical treatment for congenital lung disease and present the role of minimally invasive surgery. Methods Surgical resections performed for benign lesions of the lung and mediastinum between January 2009 and May 2019 were retrospectively analyzed. Patients who were found to have congenital lung malformation as a result of pathological examination were included in our study. Distribution characteristics of the patients according to congenital lung malformation subtypes, differences in surgical approach and postoperative results were investigated. Results A total of 94 patients who underwent surgical resection and were diagnosed with the bronchogenic cyst, sequestration, bronchial atresia, congenital cystic adenomatoid malformation (CCAM), or enteric cyst as a result of pathological examination were included the study. There were no significant differences between pathological subtypes in the postoperative length of hospital stay and drainage duration however, perioperative complication rate was higher in the sequestration group. In addition, in the first three days postoperatively, the mean pain score was found to be lower in the VATS group compared to thoracotomy. Conclusions Congenital lung malformations consist of a heterogeneous group of diseases and the surgical treatment in these patients can range from a simple cyst excision to pneumonectomy. Video-assisted thoracoscopic surgery should be considered as the first choice in the surgical treatment of these patients in experienced centers.

Primary mediastinal cysts are rare, congenital and benign lesions originating from various embryological tissue types. However, it can present with similar clinical and radiological findings at almost every age. We present this case to emphasize that two separate mediastinal cysts originating from different embryological origins in different compartments of the mediastinum are extremely rare and that these cysts can be simultaneously resected by videothoracoscopic surgery.

Background This retrospective single-center study aims to review the indications and outcomes of completion pneumonectomy after primary resection due to non-small cell lung cancer. Methods Of a total of 452 patients who underwent pneumonectomy between January 2004 and August 2017 for non-small cell lung cancer, 29 (24 males, 5 females; mean age 59.9±7.1 years; range, 45 to 72 years) were performed completion pneumonectomy. Patients" indications, factors affecting early and late-term outcomes, operative mortality and survival rates were analyzed. Results Operative mortality rate was 24.1%, including two intraoperative and five postoperative deaths. Complication rate was 44.8% and the most frequent complication was bronchopleural fistula with 24.1%. Study population was divided into two groups. While elective completion pneumonectomy group (n=19) consisted of recurrent malignant tumor patients, rescue completion pneumonectomy group (n=10) consisted of patients performed urgent pneumonectomy due to a bronchopulmonary complication developing after an anatomic lung resection. The morbidity and mortality rates for elective completion pneumonectomy and rescue completion pneumonectomy were 26.3% and 21.1%; and 70% and 30%, respectively. The morbidity for rescue completion pneumonectomy was significantly higher than elective completion pneumonectomy (p=0.016). Advanced age and presence of any preoperative risk (comorbidity and neoadjuvant treatment) were related to higher operative mortality (p=0.019 and p=0.049, respectively). The median survival after completion pneumonectomy was 19.5 months (95% confidence interval 17.2 to 21.9 months). Conclusion The morbidity and mortality rates of completion pneumonectomy are higher than standard pneumonectomy. Rescue completion pneumonectomy is related to higher postoperative risk, but has better survival. The most significant complication after completion pneumonectomy is bronchopleural fistula. Advanced age and presence of any preoperative risk are related to statistically significantly higher mortality in completion pneumonectomy. Nevertheless, completion pneumonectomy is still a significant treatment option in selected patients.

OBJECTIVES Pathological N2 (pN2) involvement has a negative impact on prognosis in patients operated on due to non-small-cell lung cancer (NSCLC). pN2 disease may cause skip (pN0N2) or non-skip (pN1N2) metastases with pathological N1 (pN1) involvement. The effect of pN2 subgroups on prognosis is still controversial. We analysed the effect of pN1 disease and single-station pN2 disease subgroups on survival outcomes. METHODS The medical records of patients who underwent anatomical lung resection due to NSCLC at a single centre between January 2007 and January 2017 were prospectively collected and retrospectively analysed. Operative mortality, sublobar resection, Stage IV disease, incomplete resection and carcinoid tumour were considered exclusion criteria. After histopathological examination, the prognosis of patients with pN1, pN0N2 and pN1N2 was compared statistically. Univariable and multivariable analyses were made to define independent risk factors for overall survival rates. RESULTS The mean follow-up time for 358 patients with 228 pN1 disease (63.7%), 59 pN0N2 disease (16.5%) and 71 pN1N2 disease (19.8%) was 40.4 ± 30.4 months. Median and 5-year overall survival rates for pN1, pN0N2 and pN1N2 diseases were 73.6 months [95% confidence interval (CI) 55.5-91.7] and 54.1%, 60.3 months (95% CI 26.8-93.8) and 51.2%, 20.8 months (95% CI 16.1-25.5) and 21.5%, respectively. The survival CIs of pN1 and pN0N2 diseases were similar, and the survival rates of these 2 groups were significantly better than those with pN1N2 (P

Background This study aims to examine the indications, timing and risk factors of rethoracotomy, analyze the postoperative results, and give suggestions to reduce the risks. Methods A total of 3,292 patients operated via thoracotomy between January 2006 and January 2017 were evaluated retrospectively. Demographic data, initial operative indications, surgical procedures, indications for rethoracotomy and preoperative risk factors, intraoperative findings and surgical methods, timing of rethoracotomy, morbidity and mortality results were analyzed of 66 patients (60 males, 6 females; mean age 59.4±12.4 years; range, 17 to 80 years) who were performed rethoracotomy before being discharged. Rethoracotomies performed within 72 hours after the first operation constituted the early and those performed after 72 hours constituted the late rethoracotomy group. Results Rethoracotomy was performed in average 4.7 days (range, 1 to 17 days). Early rethoracotomy was performed on 42 patients (1.3%) and 38 (90.4%) of these were due to hemorrhage. The most frequent indication for rethoracotomy was hemorrhage (n=41, 1.2%), followed by bronchopleural fistula (n=17, 0.5%). The other indications were chylothorax, lobe torsion, parenchymal air leak and collapse, and diaphragmatic laceration. Eight patients had rib fractures and all of these patients were over the age of 60. Eight patients who were performed rethoracotomy due to hemorrhage were using antiaggregant drugs. The postoperative morbidity and mortality rates were 33.3% (n=22) and 24.2% (n=16), respectively. Conclusion Rethoracotomy still has high morbidity and mortality rates. The main cause of rethoracotomy performed due to hemorrhage may be rib fractures or antiaggregant drugs. The most remarkable indications of rethoracotomy are hemorrhage and bronchopleural fistula.

Anterior mediastende kavernöz hemanjiomlar nadir görülür ve tüm mediastinal tümörlerin %0.5’inden daha azını oluşturmaktadır. En sık semptomları dispne, öksürük ve göğüs ağrısıdır. Erişkinde mediastende genellikle kavernöz tip hemanjiom görülür. Asemptomatik bir mediastinal kitle nedeniyle kliniğimizde opere olan ve patolojik inceleme sonucu kavernöz hemanjiom olarak bildirilen olgu literatür eşliğinde sunuldu.

PET-CT has been widely used for restaging after induction therapy in patients with non-small cell lung carcinoma. We aimed to as- sess the role of preoperative PET-CT in patients receiving induction therapy and compare with those without induction therapy. Pa- tients treated with surgery for non-small cell lung carcinoma were included. There were two subgroups according to the presence of preoperative induction therapy. The results of preoperative PET-CT in these two groups were compared. There were 217 pati- ents, 58 in neoadjuvant group and 159 in control (without preoperative induction therapy) group. In N2 lymph nodes, the positive predictive value (PPV) was significantly higher in the neoadjuvant group than in the control group (p=0.01), where the negative pre- dictive value (NPV) (p=0.0001) and accuracy (p=0.03) were significantly lower. In aorticopulmonary lymph nodes, the NPV was sig- nificantly higher in the control group (p=0.002). In lower N2 lymph nodes, the PPV was higher (p=0.007) and the NPV was lower (p=0.003) in the neoadjuvant group. In N1 lymph nodes, the specificity was found to be lower in the neoadjuvant group (p=0.01). The sensitivity, PPV and accuracy for mass was lower in the neoadjuvant group (p=0.002, p=0.0003, and p=0.001, respectively). The negative predictive value and accuracy of PET-CT were slightly decreased in patients with non-small cell lung carcinoma rece- ived induction therapy before surgical resection. PET-CT appears to be beneficial for the assessment of patients those are planned to be treated surgically for lung cancer whether they have received induction therapy or not.

Clear cell tumor of the lung is a rare benign tumor. The current study presents the case of a 60-yearold man who had an abnormal pulmonary nodule at chest x-ray. A computed tomography (CT) scan of the patient’s lung showed a 2x2x1.5 cm solitary nodule in the anterior segment of the left upper lobe. The patient underwent a lobectomy for the tumor. The pathologic examination revealed sheets of large round or polygonal cells with clear cytoplasm and immunoreactive positivity for HMB-45 and NSE. Investigation with PET/CT scan showed no evidence of renal disease. This case provides a very rare example of a solitary pulmonary nodule as clear cell carcinoma. The patient showed no evidence of recurrence or metastasis after three years postoperatively.

Purpose: Drug resistance has become a major problem in the treatment of tuberculosis, and pulmonary resection in combination with chemotherapy appears to be an effective measure for the treatment. The purpose of this study was to investigate the results of resection for multidrug-resistant pulmonary tuberculosis (MDR-TB). Patients and Methods: We retrospectively reviewed case files from January 2003 to December 2006 of 13 patients with MDR-TB underwent pulmonary resection. Results: Of 13 patients, 7 (53.9%) were sputum positive for mycobacterium tuberculosis preoperatively, though after surgery, they were sputum negative. Lobectomy was performed in 8 (61.5%) and pneumonectomy, in 5 (38.5%). In the lobectomy group, 2 patients had an additional superior segmentectomy and 1 had a middle lobectomy for other segmental or lobar lesions. Operative mortality was 7.6% (1/13). There were no late surgical deaths. In the early postoperative period, 3 patients had serious complications (postoperative bleeding, prolonged air leak, expansion deficit, bronchopleural fistula and empyema) that were resolved with surgery (morbidity 23.0%). The 12 patients who survived the operation received appropriate chemotherapy and were followed up for 24-37 months. None of the patients relapsed, and the overall cure rate was 92.3% (12/13).Conclusion: Even with high morbidity in the early post-operative period, surgery, in addition to medical therapy, offers higher cure rates than only medical therapy; however, meticulous preoperative evaluation of patients is needed.

OBJECTIVE: Patients who receive surgical treatment due to non-small cell lung cancer (NSCLC) and have surgical-pathologic N1 (pN1) disease represent a heterogeneous group. Differences in lymph node (LN) level (hilar or intrapulmonary LNs) may influence patient survival. The aim of this study was to evaluate the prognostic factors, including the level of N1 LN involvement. METHODS: Patients undergoing complete resection at a single center between January 2000 and January 2017 and diagnosed with surgical-pN1 NSCLC were analyzed retrospectively. Patients were examined in terms of demographic characteristics, preoperative and postoperative management, survival rates, as well as variables affecting survival. RESULTS: The mean follow-up duration was 50.9 ± 41.2 months (between 2.7 and 204 months); median and 5-year survival rates were 71.5 months and 53.7%, respectively. Five-year survival rates of patients aged 60 and below (n = 144) and patients over the age of 60 (n = 132) were 59.7% and 46.9%, respectively (P = 0.001). Five-year survival rates for patients receiving and not receiving adjuvant therapy were 58.4% and 45.3%, respectively (P = 0.02). When surgical-pN1 involvement was assessed with regard to localization, 5-year survival was 59.1% in hilar involvement, 52.4% in intrapulmonary involvement, and 49.4% in involvement of both zones at the same time (P = 0.58). In Cox regression analysis, variables affecting survival were age group and adjuvant therapy (P = 0.001 and P = 0.012, respectively). CONCLUSION: Surgical-pN1 localization or pleural involvement does not have a significant effect on survival, whereas advanced age and further T classification affect survival adversely. Adjuvant therapy, on the other hand, has a significantly positive effect on survival.

There is debate about which bronchial closure technique is the best to prevent bronchopleural fistulas (BPFs). We aim to assess the effect of bronchial closure procedures and patients' characteristics on BPF occurrence in pulmonary resections. Bronchial closures in 625 consecutive patients were assessed. Stumps were closed by manual suturing in 204 and by mechanical stapling in 421 cases. In the mechanical stapling group, stapling supported by manual suture was performed in 170 cases. BPFs occurred in 3.8%. Of these, stapling was used in 5.0%, whereas manual suturing was used in 1.5% (P=0.04). BPFs were more prevalent among patients who had undergone pneumonectomy (P

Background The prevalence of bronchiectasis has decreased significantly over recent decades in developed countries. However, resection for bronchiectasis still plays an important part in thoracic surgery practice in developing countries such as Turkey. This study was designed to evaluate the outcomes of surgical treatment for bronchiectasis, particularly in aspects related to the effects on functional well-being. Patients and method From January 1995 through December 2003, operations for bronchiectasis were performed in 81 patients. Demographic features, type of resection, and operative morbidity and mortality were evaluated. The outcomes related to overall “social” or nonpulmonary functional status were classified and compared according to a scale constructed to assess patients' well-being preoperatively and at the sixth postoperative month. Results The mean age was 24.4 years and 47 patients (58%) were male. Surgical treatment was lobectomy in 37 (45%), pneumonectomy in 10 (12%), segmentectomy in 13 (16%), and lobectomy plus segmentectomy in 22 (27%) of the operations. Complete resection of disease was achieved in 69 patients (85%). There was no operative mortality. The rate of morbidity was 18.3%. Improvement to a functional status of excellent was observed in 81.7% and improvement to a status of good was seen in 12.7% of patients; 5.6% experienced no change. The results of complete resection were significantly better than those of incomplete resection (P=.0015). Conclusion Functional results of surgical treatment for bronchiectasis in this series suggest that the outcomes are favorable and promising, particularly in selected patients with sufficient pulmonary reserves and localized disease who are suitable for complete resection.