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Bronchiectasis is a chronic pulmonary disease characterized by permanent enlargement of the bronchi and bronchioles. Anatomic resection of the affected lung part is still the most valid treatment option in localized disease. Despite the promising results of video-assisted thoracoscopic surgery (VATS) in patients with early-stage lung cancer, VATS is still controversial in bronchiectasis. In this study, we aim to present our surgical experience in patients with bronchiectasis by comparing the results of VATS and thoracotomy groups. We reviewed the medical records of patients who underwent anatomic lung resection via VATS and thoracotomy for the treatment of bronchiectasis between January 2009 and December 2019. Between January 2009 and December 2019, 50 patients with bronchiectasis were surgically treated in our department. Among them, 20 patients underwent attempted VATS lung resection, and 30 patients underwent thoracotomy. There was no difference in the intraoperative and postoperative complications, but postoperative pain scores were lower in the VATS group. Video-assisted thoracoscopic surgery is a safe and feasible technique in the surgical treatment of bronchiectasis.

The term aspergillosis describes the disease caused by Aspergillus species. The most common pathogen in this genus is Aspergillus fumigatus. Anatomic pulmonary resection is the preferred treatment modality in most of cases especially the presence of the localized disease, but sometimes patients complicate by prolonged air leakage, pleural space problems, and infection of this residual space. We reported a patient who undergone left upper lobectomy because of aspergilloma in the left upper lobe. After the operation, the patient’s condition became complicated because of expansion failure of the lung and space problems. After the period of conservative treatment, urgent re-operation was needed because of acute hemorrhage from the chest tube. Hemorrhage was controlled, but disseminated pleural aspergillosis and infection in the pulmonary arterial stump were seen in the thoracic cavity. Completion pneumonectomy and pleural decortication were applied, and the antifungal therapy was arranged. With this report, we aim to evaluate the relation between disseminated pleural aspergillosis and inflammatory erosion of pulmonary arterial stump. It is also important to consider possibility of dissemination of the Aspergillus infection especially in patients with expansion failure after lung resection.

Complete anatomic lung resection remains the best curative option in patients with early-stage lung cancer. In some cases, extended lung resections are required to achieve R0 resection. Although diaphragmatic invasion and resection is a well-known condition in lung cancer, direct invasion of the diaphragm and liver in lung cancer is rare. We report a 66-year-old man with left-sided lung cancer. Preoperative evaluation revealed the risk of diaphragm invasion, but the liver invasion was detected intraoperatively. In addition to left pneumonectomy, left-sided partial liver and diaphragm resection was performed. At 24 months from the operation, the patient is alive without any disease progression. We believe that combined resection including lung, diaphragm, and liver may have survival benefits in selected cases.

Introduction: The term bronchiectasis describes long-term condition where the airways of the lungs become abnormally and permanent widened, leading to a build-up of excess mucus. Video-assisted thoracoscopic surgery (VATS) for major lung resection has become a more frequent procedure in recent years with promising outcome. Aims and Objectives: Here we aim to analyzed total thoracoscopic lung resection for patients with localized bronchiectasis and compared it with patients who underwent thoracotomy in our hospital. Methods: We reviewed the medical records of consecutive patients who underwent lobectomy and pneumonectomy for bronchiectasis between January 2015 and March 2019 in our department. Patients were divided into two groups as VATS and thoracotomy. Median operative time, length of stay in hospital and complication rates were compared between two groups. Results: Between January 2015 and March 2019, 34 patients with bronchiectasis were operated in our department. Among them, 15 patients underwent thoracotomy and 19 patients underwent attempted VATS resection. VATS group had a shorter length of stay in the hospital (p: 0.95) and shorter length of drainage (p: 0.83) as compared with those in the thoracotomy group (as shown in Table 2). Postoperative minor complications were found in 7(%41,1) patients in VATS group, it was 5(%29,4) in thoracotomy group. Conclusion: In our study the duration of hospital stays, and drainage were shorter in VATS group. No significant difference was found between the two groups in terms of complication rates and operation time. Therefore, it is reasonable to recommend VATS instead of thoracotomy for selected patients with bronchiectasis.

Introduction: To prevent postpneumonectomy BPF it was suggested to coverage the bronchial stump in patients with risk factors. For this purpose, usage of omentum, pericardium, pericardial fat pad, thymus, diaphragm, intercostal muscle and pleura as an autologous tissue were described in the literature but there is no consensus on which technique is more successful in preventing BPF development. The aim of this retrospective study is to evaluate the efficacy of bronchial stump coverage with pedicled thymopericardial fat flap in patients who underwent pneumonectomy. Aims and Objectives: We investigated all 98 patients retrospectively and they were divided into two groups: those who underwent pneumonectomy plus bronchial stump coverage with thymopericardial fat flap (Group 1, n = 39) and those who underwent pneumonectomy without bronchial coverage (Group 2, n = 59). We aim to compare intraoperative and perioperative results of these two groups and demonstrate the efficacy and the usefulness of the thymopericardial fat pad flap in patients with pneumonectomy. Results: Bronchial fistula occurred in 1 patient (%2.6) in group 1 and 9 patients (%15.3) in group 2 and these differences was statistically significant (p=0.042). Neoadjuvant radiotherapy rates and mean preoperative albumin levels were also statistically different in these two group (p=0.001 and p=0.051) Conclusions: Bronchial stump reinforcement with a thymopericardial fat flap is a highly effective method for preventing postpneumonectomy bronchopleural fistula in patients with pneumonectomy.

Background VATS lobectomy is a recommended surgical approach for patients with early-stage lung cancer. However, it is still controversial in locally advance disease. This study was conducted to compare intraoperative and postoperative results of VATS and thoracotomy in patients with tumors greater than 5 cm. Methods From January 2014 to December 2018, 849 patients underwent lobectomy or pneumonectomy for the treatment of non-small-cell lung cancer at our center. The inclusion criterion of this study was patients who underwent anatomic lung resection for lung cancer with tumors larger than 5 cm((≥ T3). The patients were divided into two groups: those who underwent video-assisted thoracoscopic surgery (n = 24) and those who underwent thoracotomy (n = 36). Patient characteristics, intraoperative and postoperative results were evaluated by review of the hospital records. Results In the VATS group, mean drainage time and postoperative length of hospital stay were significantly shorter than the thoracotomy group. Kaplan–Meier survival curves showed that overall and recurrence-free survival was longer in the VATS group and this result was statistically significant. Conclusions According to the results of this study, we emphasize that VATS is a feasible surgical procedure for tumors larger than 5 cm.

Background Sleeve resection is a widely performed type of operation in the surgical treatment of non-small cell lung cancer. Video-assisted thoracoscopic surgery (VATS) is now used even in central tumor surgeries of the lung with the increasing technology and experience. Sleeve resection cases performed through VATS in our clinic in recent years were presented with demographic, surgical, pathologic, and survey characteristics. Materials and methods Twelve patients who underwent sleeve resection with VATS in our clinic between November 2015 and August 2019 were included in the study. Operative, pathologic, and postoperative characteristics of the patients were examined. Results A total of 12 patients, 3 female and 9 male individuals, were included in the study. The mean age of the patients was 61.7±12.9 years. According to the localization of the tumors, left upper lobectomy was performed in 4 patients and 8 patients underwent right upper lobectomy. During the sleeve anastomosis of the patients, 3/0 prolene sutures were used in 5 patients (36%) and 4/0 prolene sutures in 4 patients (36%), whereas 3/0 polydioxanone suture (PDS) was used in 3 patients (28%). The mean operation time was 288.2±77.1 (205 to 460) minutes and the mean anastomosis time was 70±18.5 (55 to 110) minutes. In the postoperative period, 1 patient who had acute myocardial infarction died on the fourth postoperative day. The mean postoperative drainage duration of the patients was 5.5±1.9 (3 to 10) days and the mean length of hospital stay was 6.4±1.9 (4 to 11) days. When the pathologic features were examined, the mean tumor diameter was found to be 2.5±1.2 (1 to 5.5) cm. The mean follow-up period was calculated as 26.1±15.6 months (2 to 47). Other than 1 patient who died, the follow-up of 11 patients still proceeds. Conclusions VATS approach of sleeve resections, which is performed cautiously even by thoracotomy, is becoming more common. These operations, which could be performed in experienced centers, offer a postoperative period of less morbidity to the patients with the advantage of reduced postoperative pain, drainage time, and hospital stay.

OBJECTIVES The effect of non-steroidal anti-inflammatory drugs (NSAID), mostly used for postoperative analgesic purposes for wound healing, is still a matter of debate. Our goal was to evaluate the effects of the most widely used NSAID and corticosteroids after surgical operations on tracheal wound healing in an experimental rat model. METHODS Thirty-nine male Wistar albino rats were included in this study. Tracheotomy was performed in 32 rats; then they were divided into 3 groups. After the first day, the animals in group 1 were treated with an NSAID (diclofenac 10 mg/kg/day) (NSAID, n = 12) for 7 days; the animals in group 2 were treated with a corticosteroid (dexamethasone, 2 × 0.1 mg/kg/day) (steroid, n = 10) for 7 days; the animals in group 3 (control, n = 10) were not given any medications. For a fourth group (histological control, n = 7), in order to evaluate normal morphological and histological characteristics, neither surgery nor medication was used. Five rats were eliminated from the study (2 rats in the NSAID group died and 3 rats in the steroid group developed local wound infections). The drop-out rate was 12.8%. Histological characteristics, inflammation, fibrosis, necrosis, neochondrogenesis, neovascularization and epithelization were evaluated in 34 rats. Non-parametric tests were used for statistical analysis. RESULTS Inflammation, vascularization and number of fibroblasts and chondrocytes were significantly higher in the control group than in the histological control group. There was some reduction in all parameters except vascularization in the NSAID group (P > 0.05). When the steroid group was compared to the NSAID group, inflammation (P 0.05) were more suppressed in the steroid group. The number of fibroblasts increased in the steroid group (P > 0.05). CONCLUSIONS Steroids and NSAID may have negative effects on tracheal wound healing, probably by suppressing inflammation and fibroblast proliferation. NSAID was mostly used postoperatively for analgesic purposes and should be avoided.

Background This study aims to analyze the prognostic factors affecting survival in pulmonary carcinoid tumors. Methods Gender, age, smoking habit, comorbidity, localization of the tumor, T status, N status, histological type, and pathological stage of patients who had undergone resection of pulmonary carcinoid tumor between January 1, 2005 and December 31, 2016 were retrospectively reviewed. Results A total of 47 patients (18 male, 29 female; mean age 50.5 years; range, 23 to 74 years) consisting of 40 typical and 7 atypical carcinoid tumor cases were included in our study. Anatomical resection and systematic mediastinal lymph node dissection was performed on all patients. Pathological studies revealed lymphatic involvement in six patients (12.8%; 4 pN1 and 2 pN2). In the typical group (n=40), three patients were classified N1 (7.5%) and one patient N2 (2.5%). In the atypical group (n=7), one patient were classified N1 (14.3%) and one patient N2 (14.3%). Throughout the study, four patients with typical histology (10%) and two patients with atypical histology (28.6%) had nodal involvement. All six patients with nodal involvement underwent adjuvant radiotherapy. Atypical histology (p=0.005) and nodal involvement (p=0.008) were determined as negative prognostic factors in statistical analysis. Conclusion Systematic hilar and mediastinal nodal dissection play a crucial role in the surgical treatment of pulmonary carcinoid tumors.

Introduction: VATS lobectomy is a safe and feasible procedure for early-stage non-small cell lung cancer. Despite surgical techniques have become refined and surgical instrumentation becomes more advanced, VATS for advanced-stage lung cancer still controversial. We aimed to evaluate the safety, feasibility, and efficacy of videothoracoscopic lobectomy for primary lung cancer with a diameter of >5 cm. Material and Method: We retrospectively reviewed patient characteristics, surgical procedures, perioperative course, pathological findings, and long-term prognoses of 26 patients who underwent videothoracoscopic anatomical pulmonary resection for primary lung cancer of >5-cm diameter. Results: 550 patients underwent a videothoracoscopic lobectomy for treatment of non-small-cell lung cancer at our center from May 2010 to December 2018. In 26 patients, the tumor was > 5 cm. There were 22 men and 4 women, median age 63,0 years (range: 39 – 78 years). Mean duration of lobectomy was 226,35 minutes, and median duration 212,50(range:135-385) minutes. No patient was converted to conventional open thoracotomy. Mean postoperative stay was 6,3 days and mean drainage duration was 5,8 days. The morbidity rate was 30,7%(%15,5 prolonged air leakage, %7,6 posoperative cardiac arrhythmia, %3,8 postoperative hemorrhage and %3,8 postoperative pneumonia). There were no perioperative and intraoperative deaths. Conclusion: Despite some disadvantages of videothoracoscopic surgery for large lung cancer, like less mobilization of the tumor and a reduced operating space, VATS lobectomy is a safe and technically feasible procedure even in for lung cancer of >5-cm diameter in experienced hands.

Introduction: Bronchogenic cysts are benign, congenital anomalies. Since it is asymptomatic in adults, the diagnosis is usually establised incidentally. The main treatment of bronchogenic cyst is surgery. Surgery should be performed to establish diagnosis, to eliminate symptoms and complications and to prevent malignancy. Material and Method: A retrospective study of 20 operated patients by the diagnosis of thoracic bronchogenic cysts was undertaken to detail their clinicopathologic features between the years of 2004 and 2018. Results: There are 11 female(%55) and 9 male(%45) patients with a mean age of 40,7±19,2(18-78). The location is mediastinal in 14 cases and intrapulmonary in 5 cases and on diaphragm in 1 patient. Surgery is performed via thoracotomy in 12 cases and thoracoscopy in 8 case. Total cyst excision is preferred for mediastinal cyts, whereas wedge resection or lobectomy for pulmonary cysts. Bronchial laceration repairment is performed in one case. The median hospitilization after operation is 5,95 ± 3,59 (2-19) days. The hospitilization is shorter for the patients who operated by thoracoscopy comparing with thoracotomy. No recurrence is obtained during the follow up period ranged between 3 months and 14 years . Conclusion: Surgery should be performed to establish diagnosis, to eliminate symptoms and complications and to prevent complications . It is also should be performed to prevent malignancy for asymptomatic patients. Total excision for mediastinal cysts and wedge resection or lobectomy for pulmonary cysts is appropriate treatmant approach. Operation is performed with minimal morbidty and no mortality by thoracoscopy or thoracotomy.

Background Predominant histologic subtypes have been reported as predictors of survival of patients with pulmonary adenocarcinoma. Aims To evaluate the predictive value of histologic classification in resected lung adenocarcinoma using the classification systems proposed by the International Association for the Study of Lung Cancer, American Thoracic Society, European Respiratory Society, and World Health Organization (2015). Study Design Cross-sectional study. Methods The histologic classification of a large cohort of 491 patients with resected lung adenocarcinoma (stages I-III) was retrospectively analyzed. The tumors were classified according to their predominant component (lepidic, acinar, papillary, solid, micropapillary, and mucinous), and their predictive values were assessed for clinicopathologic characteristics and overall survival. Results The patient cohort comprised 158 (32.2%) patients with solid predominant, 150 (30.5%) with acinar predominant, 80 (16.3%) with papillary predominant, 75 (15.3%) with lepidic predominant, 22 (4.5%) with mucinous, and 5 (1.0%) with micropapillary subtype, and 1 (0.2%) with adenocarcinoma in situ. Overall 5-year survival of 491 patients was found to be 51.8%. Patients with lepidic, acinar, and mucinous adenocarcinoma had 70.9%, 59.0%, and 66.6% 5-year survival, respectively, and there was no statistically significant difference between them. Whereas patients with solid, papillary, and micropapillary predominant adenocarcinoma had 41.0%, 40.5%, and 0.0% 5-year survival, respectively. Compared to other histologic subtypes, patients with solid and papillary predominant adenocarcinoma had significantly lower survival than those with lepidic (p

Objectives In this study, we aimed to investigate the effect of resection type on survival in patients with stage IA non-small-cell lung cancer (NSCLC) and other factors affecting the prognosis. Materials and methods Between January 2005 and December 2016, we retrospectively screened 269 patients who were resected and were having T1N0M0 non-small-cell pulmonary carcinoma. The survival time after surgery was obtained from the National Population Registration System (MERNIS) system. Patients were classified according to the extent of resection. Additionally, age, sex, smoking, concomitant disease, histological type, pathological stage (T1a-T1b-T1c), and the presence of postoperative complications were evaluated to determine whether they are prognostic factors or not. Results A lobectomy was performed in 257 cases (95.5%), and a sublobar resection was performed in 12 patients (4.5%). The 5-year survival was 62.5% for lobectomies and 73.3% for sublobar resections. Although 5-year survival was better in patients with a limited resection, it was not statistically significant (p=0.301). Histopathological evaluation revealed that 130 patients (48.3%) had adenocarcinoma, 113 (42.0%) had squamous cell carcinoma, and 26 (9.7%) had the other types. The 5-year survival rate was 69.9% in patients with adenocarcinoma and 53.2% in squamous cell carcinoma, and this was statistically significant (p=0.036). The overall 5- and 10-year survival rates in all patients were 65.0% and 47.2%, respectively. Conclusion Although lobectomy is the standard type of resection in the early stage of lung cancer cases in the Thoracic Surgery Department of Dr. Suat Seren Chest Diseases and Thoracic Surgery Training and Research Hospital patients who underwent sublobar resection were found to be having partially better survival, but it was not statistically significant. Owing to the small number of cases, we think that sublobar resections should be prospectively investigated with more extensive series in patients with T1 NSCLC.

Introduction Prolonged air leakage is the most common complication that can cause severe problems in cases of secondary spontaneous pneumothorax (SSP). The purpose of this study was to explore whether Goddard Classification Score (GCS) can be a marker of prolonged air leakage, particularly during the post-operative period, for patients with emphysema. Methods Fifty patients, who underwent tube thoracostomy for SSP, were retrospectively evaluated. For the evaluation of emphysematous on the preoperative computed tomography image, visual scoring system described by Goddard was used. The correlations between age, duration of hospitalization, duration of drainage, number of pneumothorax episodes, prolonged air leakage and GCS parameters, were evaluated. Results When 50 patients were scored, based on GCS, the distribution was as follows: G1: four cases, G2: 16 cases, G3: 17 cases, and G4: 13 cases. The mean number of pneumothorax episodes was 1.3 ± 0.5, the mean duration of drainage was 15.7 ± 11.3 days, and the mean duration of hospitalization was 9.2 ± 5.1 days. Prolonged air leakage was seen in 26 (52.2%) cases. The rate of prolonged air leakage was significantly higher in higher GCS cases (P = 0.035). There was a positive correlation between age and GCS (P = 0.011). The number of pneumothorax episodes rose significantly with increasing GCS (P = 0.011). The duration of hospitalization increased with the growing number of pneumothorax episodes (P = 0.027). Conclusion Prolonged air leakage and the recurrence rate of SSP rise with increasing GCS. Taking this condition into consideration in the treatment algorithm can be helpful for clinicians in patient follow-up.

Intrapericardial extracavitary lipomas are very rare. We would like to share our experience with a case of intrapericardial lipoma in a male aged 54 years. His mode of presentation and radiographic investigations are reported. He was successfully managed via a right anterior thoracotomy.

Background: This study aims to investigate whether papillary predominant histological subtype can predict poor survival in lung adenocarcinoma. Methods: Between January 2005 and December 2016, a total of 80 patients with papillary predominant subtype lung adenocarcinoma (70 males, 10 females; mean age 60.7 years; range, 42 to 79 years) operated in our clinic were included in the study. These patients were compared with those having lepidic, acinar, and mucinous subtypes. Overall and five-year survival rates were evaluated. Results: Five-year survival was 40.5% in papillary predominant histological subtype, while this rate was 70.9%, 59.0%, and 66.6% in lepidic, acinar, and mucinous subtypes, respectively. Papillary subtype showed significantly poor survival compared to lepidic (p=0.002), acinar (p=0.008), and mucinous subtypes (p=0.048). In Stage 1 disease, it was more evident (papillary, 47.5%, lepidic 86.9% [p=0.001], acinar 69.3% [p=0.040], and mucinous 90.0% [p=0.050]). Conclusion: Our study results suggest that papillary predominant subtype predicts poor survival in lung adenocarcinoma and these cases may be candidates for adjuvant treatment modalities even in the earlier stages of disease. © 2019 Turkish Society of Cardiovascular Surgery.

WOS: 000431767800002, OBJECTIVE: Preoperative evaluation in thoracic surgery is highly important to determine surgical suitability, estimate postoperative pulmonary complications, and for patient follow-up. However, there is neither a definite explanation about the possible complications nor a gold standard method. MATERIALS AND METHODS: In this study, 297 patients undergoing anatomic lung resection for primary lung carcinoma were retrospectively evaluated. To form a homogeneous group, all factors that increase the rate of pulmonary complication were excluded except emphysema. Patients who did not meet these criteria were removed from the study. The study continued with 104 other patients. This patient subgroup was divided into groups according to Goddard Classification-Score (GdCS). The correlation between GdCS and other variables was statistically investigated. RESULTS: According to the GdCS of 104 patients, the patient distribution was as follows: 10 patients (9.6%) were G0, 28 patients (26.9%) were G1, 42 patients (40.4%) were G2, 22 patients (21.2%) were G3, and 2 patients (1.9%) were G4. Thirty-five (33.6%) of 104 patients had a pulmonary complication during the postoperative follow-up. The average drainage time was longer for higher GdCS scores, and the rate of exposition to a pulmonary complication was higher in the patients with increased GdCS. CONCLUSION: In view of these findings, Goddard's scoring for chronic obstructive pulmonary disease-emphysema patients was considered likely to be an indicative parameter in the preoperative evaluation and postoperative follow-up of thoracic surgery patients.

Microabstract Study investigated if there was a survival difference between sinN2 and mulN2 disease in operated NSCLC patients. 73 patients had sinN2 and 38 patients had mulN2 disease. The median survival and the 5-year survival rate of sinN2 and mulN2 were 26 months and 20.5% against 20 months and 0%, respectively, and there was a statistically significant difference between two groups (0.032). Background The most important parameter determining the treatment and survival in non-small cell lung cancer is the stage of the disease and the associated lymph node involvement. The present study investigated if there was a survival difference between single-station N2 (sinN2-Group 1) and multi-station N2 (mulN2-Group 2) disease in operated non-small cell lung cancer (NSCLC) patients. Materials and methods The patients, who were diagnosed with NSCLC and underwent anatomic resection and mediastinal lymph node dissection and found to have ipsilateral lymph node metastasis between January 2005 and December 2011 in our clinic, were investigated retrospectively. Results 801 patients had anatomic resection. Among these patients, a total of 111 patients (13.8%) were found pathological N2 (+). 73 (66.6%) patients had sinN2 and 38 (33.4%) patients had mulN2 disease. Out of these patients, 94 (85.4%) were male and 17 (14.6%) were female, and the mean age was 58.9±10.2 (35–82) years. The median survival and the 5-year survival rate of sinN2 and mulN2 were 26 months and 20.5% against 20 months and 0%, respectively, and there was a statistically significant difference between two groups (0.032). Conclusions TNM system used in the current lung cancer staging assesses only the localizations of the metastatic lymph node stations. However, it seems that the localization of the lymph node stations alone is not completely enough for an estimated survival. The present study has found poorer survival in the multi-station N2 patients than the single-station N2 patients, which is also statistically significant.

Objective: Thymectomy via transsternal approach is the accepted standard surgical procedure within the treatment of myasthenia gravis (MG) cases for many years. In our study, minimally invasive thymectomy technique and its results are presented. Material and Method: Patients who were diagnosed myasthenia gravis by the neurology clinics and were performed extended thymectomy in our clinic between 2005 – 2016 are included to our study. Results: In our clinic 28 cases, diagnosed with non-thymomatous MG, underwent extended thymectomy; 11 patients were operated via sternotomy and 17 patients were operated via Video Assisted Thoracoscopic Surgery (VATS). The study group included 19 female and 9 male patients. While the sternotomy group included 5 male and 6 female patients; the VATS group had 4 male and 13 female patients (p=0,212). Whereas the median age for the sternotomy group was 40,82+16,1 years, the median age for the VATS group was 33,7+11,6 (48,05) years (p=0,082). Peroperative mortality was not seen in both groups, yet there was morbidity for 1 patient in each groups (p=0,833). The length of hospitalization in sternotomy group was 6,2+2,2 days and in VATS group it was 2,8+1,2 days. (p=0,019). Conclusion: Complete or extended thymectomy within the treatment of non-thymomatous is a safe and an effective method. In the experienced clinics minimally invasive techniques are appropriate choices for the patients upon with the lack of mortality and viable morbidity rates.

Objective: Diagnostic videothoracoscopic (VATS) methods for interstitial lung diseases (ILD), are generally administered under general anesthesia. To avoid mortality and morbidity of general anesthesia, experienced clinics would practice awake VATS for these group of patients. It has been intended to present the data from our clinical practice. Method: Eight patients underwent awake uniportal VATS resection with the pre-diagnosis of ILD were assessed retrospectively between 2015 and 2016. Results: All of the patients included in this study were prediagnosed ILD and refered from chest diseases clinic. Four male and four female patient is included and mean age is 52.3 ± 13.8 (21-61). Mean diagnosis duration is 24.75 ± 15.78 (2-36) months. All eight patients were under broncodilator therapy because of shortness of breath and cough. Left uniportal VATS is performed with the help of thoracic epidural anesthesia. In five patients, both upper and lover lobe wedge resection and in three patients only upper lobe wedge resection was made. Mean duration of the operation is 13.12 (5 - 20) minutes. There was no perioperative and postoperative mortality. Only in one patient, prolonged air leak was detected. Mean duration for hospital stay is 2.5 (1-4) days. After pathological study, six patients diagnosed as “usual interstitial pneumonia”, one patient as “bronchiolitis obliterans organizing pneumonia (BOOP)” and in one patient “micronodular pneumocyte hyperplasia” was ascertained. Conclusions: Awake uniportal VATS biopsy procedure lowers medical costs and also reduces the risks of general anesthesia and intubation. Postoperative recovery of patients with ILD after awake VATS is rapid and secure.

Amac: Bu calismada primer spontan pnomotoraks olgularindaki elektrokardiyografik (EKG) degisiklikler degerlendirildi. Ca­lis­ma­pla­ni:­Primer spontan pnomotoraksli toplam 48 hasta (42 erkek, 6 kadin; ort. yas: 29.7±12.5 yil; dagilim 15-58 yil) Kasim 2010 Kasim 2011 tarihleri arasinda prospektif olarak incelendi. Pnomotoraks alani Rhea metodu ile hesaplandi. Her hastaya en az iki kere standart 12 derivasyonlu EKG cekildi (pnomotoraks tanisindan sonra ve gogus tupu uygulamasindan once EKGpnomotoraks ve akcigerin yeniden ekspanse olmasi ve radyolojik olarak dogrulanmasindan sonra EKGre-ekspanse). P dalgasi olcumu, PR mesafesi, QRS mesafesi, QT intervali ve kalp hizi icin duzeltilmis QT araligi (QTc) hesaplandi. Ayrica kalp hizi (dakikada nabiz sayisi), aks deviasyonu olcumleri ve prekordial derivasyonlarda QRS amplitudleri (QRSV1-6) hesaplandi. Bul gu lar: Pnomotoraks hastalarin 29’unda (%60.4) sol, 19’unda (%39.6) sag hemitoraksta idi. Pnomotoraks alaninin ortalamasi %43.0±21.5 idi. En sik gorulen semptomlar, 34 hastada (%70.8) gogus agrisi, 14 hastada (%29.2) nefes darligi idi. Pnomotoraks suresi 30 hastada (%62.5) ≤24 saat iken, 18 hastada (%37.5) >24 saat idi. Tedavi oncesi ve tedavi sonrasi QT suresi, aks deviasyonu, kalp hizi, QRSV1, QRSV4, QRSV5 ve QRSV6 degerleri arasinda istatistiksel olarak anlamli bir fark saptandi (sirasi ile p=0.001, p=0.023, p=0.001, p=0.010, p=0.046, p=0.000, p=0.008). Uc hastada sag dal bloku, iki hastada ST yukselmesi ve bir hastada T dalgasi sivriligi olmak uzere toplam yedi hastada iliskili QRS anormallikleri saptandi. So­nuc:­Calisma bulgularimiz hem sag hem de sol pnomotoraksin kadinlarda daha belirgin olmak uzere, aks degisikligine neden olabilecegini ve QRSV 4, 5 ve 6 derivasyonlarinda voltajin drenaj sonu arttigini gostermektedir. Ayrica pnomotoraks sag dal bloku ve ST degisikligi gibi ozellikli EKG degisikliklerine de yol acabilir. Anah tar soz cuk ler: Elektrokardiyografi, pnomotoraks; sag dal bloku. Background:­This study aims to evaluate the electrocardiographic (ECG) changes in patients with primary spontaneous pneumothorax. Methods: A total of 48 patients (42 males, 6 females; mean age 29.7±12.5 years, range 15 to 58 years) with PSP were prospectively analyzed between November 2010 and November 2011. Pneumothorax size was calculated using the Rhea method. At least two standard 12-lead ECG were obtained for each patient (after the diagnosis of pneumothorax and prior to drain placement ECGpneumothorax, and after a complete re-expansion of the lung was achieved and confirmed radiologically ECGre-expanded). P wave measurement, PR distance, QRS distance, QT interval and QT interval corrected for heart rate (QTc) were calculated. Heart rate (bpm), axis deviation measurement and the QRS amplitudes (QRSV1-6) in precordial leads were calculated. Results:­There were 29 cases (60.4%) of left-sided and 19 cases (39.6%) of right-sided pneumothorax. The mean relative volume of pneumothorax was 43.0±21.5%. The most common symptoms included chest pain in 34 patients (70.8%) and dyspnea in 14 patients (29.2%). The pneumothorax duration was ≤24 hours in 30 patients (62.5%) and >24 hours in 18 patients (37.5%). There was a statistically significant difference between before and after the treatment for QT duration, axis deviation, heart rate, QRSV1, QRSV4, QRSV5 and QRSV6 (respectively; p=0.001, p=0.023, p=0.001, p=0.010, p=0.046, p=0.000, p=0.008). A total of seven patients had relevant QRS abnormalities including incomplete right bundle branch block in three patients, ST elevation in two patients and T-wave pointedness in one patient. Conclusion:­Our study results suggest that left and right lung pneumothorax may cause axis variation, which is more pronounced in women, and that voltage increases after drainage in QRSV 4, 5 and 6 leads. In addition, pneumothorax may lead to specific ECG variations such as right bundle branch block and ST variations.

Background: P63 is a gene located in chromosome 3q27-29, which has been implicated in regulation of stem cell commitment and promotion of squamous differentiation in various tissues. The aim of this study was to investigate whether there was a correlation between p63 expression, differential diagnosis of lung carcinoma, and prognosis. Material/Methods: Immunohistochemical expression of p63 in 62 lung carcinomas was investigated and mRNA analysis using RT-PCR method was done in 6 selected cases. Results: When cases were evaluated for p63 staining, 24 of 25 (96%) squamous cell carcinomas were strongly positive. Six of 20 adenocarcinomas (25%) and 1 (100%) large cell carcinoma (except neuroendocrine carcinoma) were mildly positive. p63 staining was statistically significant in favor of squamous cell carcinoma than other tumors (p

Central venous catheters (CVCs) are very useful tools in clinical medicine. It is important not only for the administration of medications or fluids but also the measurement of haemodynamic variables, especially in intensive care patients. CVC placement is a relatively safe procedure but may occasionally be associated with complications, such as pneumothorax, haemothorax, cardiac tamponade, sepsis and thrombosis. We aim to report an extraordinary case of bilateral hydrothorax due to CVC placement.

Leiomyomas are benign soft-tissue tumours which take origin from the smooth muscles. Pleura and chest wall are uncommon location for such tumours. Here, we report a case of a 26-year-old female patient presented with 3 months history of chest pain. Chest X-ray and CT showed a calcified mass of 6×12 cm in size in the left lateral of the chest wall. After resection of the mass, pathological examination diagnosed it as atypical deep somatic soft-tissue leiomyoma of extrathoracic chest wall. No pathological finding was detected during follow-up.

Malign melanoma (MM) develops as a result of malign transformation of the melanocytes and constitutes 2–4% of all skin cancers, while being the most common cause of mortality among all skin cancers. In addition to other organs, distant organ metastases also include lung metastasis. A metastasectomy is an acceptable treatment option in cases of malign melanoma with isolated lung metastasis. The current report presents a case with isolated lung metastasis that underwent a right upper VATS (video-assisted thoracoscopic surgery) lobectomy due to tumour localization.

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.

Aim of the study: To study the effect of thyroid transcription factor-1 (TTF-1) expression on ipsilateral mediastinal nodal (N2) metastases in primary ade nocarcinoma of the lung. Material and methods: The patients operated on with a diagnosis of prima ry adenocarcinoma of the lung were ret rospectively analyzed and divided into two groups according to their TTF-1 expression. The relationship between TTF-1 expression and N2 metastases was evaluated. Results:There were 73 patients (58 male, 15 female) with a mean age of 58.4 ±10.2 in the study group. Sixty-six lobec tomies or pneumonectomies and medi astinal lymph node dissection, and sev en mediastinoscopies were performed. Positivity of the TTF-1 protein expression detected by the immunohistochemical staining of the specimens was present in 33 patients (45.2%); these patients were classified as group A and the rest of the patients as group B. Eleven patients had N2 disease in group A versus five patients in group B and the difference between the two groups was statistically significant. Conclusions: Patients with primary ade nocarcinoma of the lung having TTF-1 expression are more likely to have N2 dis ease. They might be considered as can didates for adjuvant therapy.

Aim: This study aimed to evaluate the effect of adjuvant chemotherapy on survival in early stage lung adenocarcinoma. Method: In our clinic, 413 patients with adenocarcinoma and 586 patients with squamous cell lung cancer were operated between 2005-2014. After neoadjuvan therapy and N1-N2 patients were excluded, 180 stage I adenocarcinoma (TIa, TIb, T2a NOMO) and 239 stage I squamous cell carcinoma (TIa, TIb, T2a NOMO) were included in the study and analyzed retrospectively. Along adjuvant chemotherapy; patients who received chemotherapy for any other reasons (local relapse, metastases) are also included. This contributed 15% and 16% of all adenocarcinoma and squamous cell carcinoma respectively. Results: 153 stage I adenocarcinoma patients didn9t receive adjuvant or any chemotherapy and median survival were found 1.855,2±100,29 days. 27 stage I adenocarcinoma patients received chemotherapy and median survival were found 1.386,6±209,64 days. There was no statistical significance in survival between two groups (p=0.047). 200 stage I squamous cell carcinoma patients didn9t receive chemotherapy and median survival were found 2.303,6±116,39 days. 39 stage I squamous cell carcinoma patients received chemotherapy and median survival were found 1582,4± days. There was statistical significance in survival between two groups (p=0.047). Conclusion: Although early; when compared with squamous cell carcinoma we can say that in the early stage adenocarcinoma, chemotherapy prolongs survival. Because of the tendency of early relapse and metastases adjuvant chemotherapy should take place in the early stage adenocarcinoma treatment algorithm.

Objective: Elastofibroma dorsi (ED) is a benign solid and rare connective tissue tumor. It has a slow growth rate and most commonly it is placed under the scapula. Generally it is detected unilaterally but in 10% of cases bilateral placement is found. In this study, it is aimed to analyze the clinical specialties and management of treatments with the use of former studies in literature. Methods: Mean age in this study is 57.2 (37-71). 12 female and 6 male patients are included. Most frequent complaint was back pain. ED is found on the right side in 9 patients, on the left side in 7 patients and bilateral placement in two patients. It is detected as connective tissue lesion under the scapula with the help of computerized tomography or MRI. In 8 cases it is found simultaneously with malignancy (5 lung cancers, 3 metastatic lung cancers) and ED excision was made with proper lung resection. Pathological results were reported as elastofibroma dorsi for all lesions. Results: Because ED is a rare condition and difficult to identify during physical examination; it must be included in differential diagnosis. Also most common and advised method of treatment is total surgical resection.

Objective: Sleeve lung resections for patients with non-small cell lung cancer (NSCLC) after induction therapy may cause increase in mortality and morbidity. Cases which went thorough sleeve resection are divided into two groups and reviewed retrospectively. Group A is cases without induction therapy and Group B is cases operated after induction therapy. Methods: The patients with non-small cell lung cancer went thorough sleeve resection between 2005 and 2015 are evaluated retrospectively. In Group A 62 (75.6%) and in Group B 20 (24.4%) patients operated with sleeve lung resection are included in this study. Demographic data, type of operation, postoperative mortality, morbidity and survival rate is compared and analyzed. Results: Male population of Group A and Group B is 94% and 95% with the mean age of 59.8±9.5 and 56.3±9.0 respectively. Right upper sleeve lobectomy was most commonly performed in both groups (Group A 69%, Group B 75%). Technique of bronchial anastomosis was continuous saturation for all cases. In Group A 81% and in Group B 91% of the cases, the line of anastomosis supported with pleural tissue. Postoperative complications are detected as 20 (%32.2) in Group A and 6 (%30) in Group B. Intraoperative mortality was 2 in Group A (3.2%). The mean follow-up was 76 months for Group A and 70 months for Group B with a five year survival rate of 61.3% and 60.5% respectively. There was no significant difference statistically. Conclusions: The morbidity and mortality incidences of sleeve resection were similar in NSCLC patients with or without induction therapy. Sleeve resection after induction therapy could be counted as a safe operative technique.

Objective: Tracheal lesions represent only 2% of all tumors of respiratory system. Most frequent malignant tumors of trachea are squamous cell carcinoma and adenoid cystic carcinoma. Benign tumors of trachea are rarer than malignant lesions. With early diagnosis and proper treatment, long term survival is promising. Methods and Results: Between January 2004 and January 2014, 13 patients went thorough sleeve resection who has been diagnosed tracheal tumor, analyzed retrospectively. 5 female and 8 male were included in this study and the mean age is 51.4 (31-66) years. Squamous cell carcinoma is the most common pathological type (40%) followed by adenoid cystic carcinoma (20%). In three cases, other benign tracheal tumors were found (leiomyom, papilloma, glomus tumor). Upper 1/3 of the trachea is the most frequent placement for lesions (40%) and cervical incision and tracheal sleeve resection and anastomosis was used most of the cases as surgical approach. In three patients (23%) we encountered complications and the mortality occurred in one (7%). During postoperative follow-up, survival for benign tracheal tumors was 77.06 (35.4-103.1) months but survival rate for malignant tracheal tumors was 54.79 (1-108.3) months. Also during follow-up no restenosis or tumor recurrence was found. Conclusion: Complete excision is the most accepted technique for the treatment of the tracheal tumors and sleeve resection can be applied to properly chosen cases with low mortality and mobidity rates.

Objective: Chondrosarcoma of chest wall is the most common primer malignant chest wall tumour. We aimed to present the cases operated in our clinic. Methods: Between the years of 2003-2014, nine patients with chondrosarkoma included in this study. Age, gender, complaints, symptoms, radiological findings, operative techniques and postoperative follow-up is analyzed retrospectively. Results: In this study, there were 3 female and 6 male patients with a mean age of 49.67 ±16.53. Chest wall resection was performed to all patients with a 5 cm safe surgical margin. In 8 cases, reconstruction was needed and prosthetic materials and titanium bars were used. There was no operative mortality. Adjuvant chemotherapy was planned and carried out postoperatively by oncology department. In 2 cases reoperated because of recurrence. Survival rate was 52.44± 42.06 months. Mortality during follow-up was 2. Conclusion: Complete resection in chosen cases is important to achieve a long-term survival and successful treatment. Surgical intervention of chondrosarcoma could be performed with an agreeable risk of mortality and morbidity.

The term ‘pneumothorax’ was first coined by Itard and then Laennec in 1803 and 1819, respectively, and refers to air in the pleural cavity [1]. Primary spontaneous pneumothorax usually occurs in young healthy male population. Most common pathology is the rupture of an apical subpleural bleb [2]. Secondary spontaneous pneumothorax is associated with primary lung pathology, and the most common cause is chronic obstructive pulmonary disease [2]. Pneumothorax is rare during pregnancy [3]. The suitable birth method and the management are also challenging. In this study, we present the largest series reported to date of the management of pneumothorax in pregnancy, together with a review of the relevant literature. Five patients treated for spontaneous pneumothorax occurred during pregnancy or as a complication of vaginal delivery are presented. Case reports

Introduction: Several markers have been investigated to predict the prognosis of lung cancer. In the present study, the prognostic values of epithelial growth factor receptor (EGFR), vascular endothelial growth factor (VEGF), E-cadherin, and p120 catenin expression were investigated by immunohistochemistry in patients with a surgically resected non-small cell lung carcinoma (NSCLC). Patients and method: EGFR, VEGF, E-cadherin, and p120 catenin expression were prospectively determined in resected specimens from patients with NSCLC who had undergone surgery between 2003 and 2007. Patients’ and disease-related general characteristics and survival rate were recorded.

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.

This study aimed to evaluate the learning curve and efficacy of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) in the examination of mediastinal or hilar lymph nodes suspected of having cancer or of benign disease such as sarcoidosis. A success-adjusted cumulative sum model was used to evaluate the learning curve for diagnostic rates and operation time. A total of 99 patients (77 men and 22 women) who underwent EBUS-TBNA from April 2011 to March 2012 in a single centre were analysed retrospectively. The quantity of lymph node sampling was deemed to be appropriate for histopathological examination in 97 of 99 patients (97%). Twenty-three cases (23%) were clearly diagnosed with neoplastic disease, 60 (60%) with reactive hyperplasia, 11 (11%) with granulomatosis and 3 (3%) histopathologically suspicious for lymph node metastasis. The sensitivity, specificity, and positive and negative predictive values and diagnostic accuracy for EBUS-TBNA were 80, 100, 100, 87.1 and 91.5%, respectively. According to the learning curve analysis, the ability to perform EBUS required performing approximately 37 procedures for the trials. In conclusion, more successful results are obtained after a certain learning curve, as is the case for every other invasive procedure.

Echinococcosis/hydatidosis is a frequent parasitic and zoonotic disease in the population engaged with agriculture and stockbreeding. It is seen most frequently in the liver and lung in adults. Mediastinal location of the disease is very rare. In this study we aimed to present a 31-year-old man having hydatid disease in the anterior mediastinum fistulated to the skin in the right subclavicular region, together with the literature. The patient was operated on through a partial sternotomy incision, and excision of the cyst and the fistula was performed.

Although it is not a pathologically significant entity, cases of azygos lobe (AL) are interesting due to the difficulty of performing video-assisted thoracoscopic surgery (VATS) procedures in the affected patients and the presence of a congenital malformation. Currently, videothoracoscopic surgery has advanced to such a level that most thoracic procedures can be performed with video assistance. However, some technical difficulties may arise in cases with anatomical anomalies such as AL. This report presents the case of a patient with an azygos lobe who underwent videothoracoscopic lung resection due to the presence of non-small-cell lung carcinoma in the upper lobe of the right lung.