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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 nonpleurectomy 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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BACKGROUND: In patients being considered for lung-resection surgery, quantitative perfusion scintigraphy is used to predict postoperative lung function and guide the determination of lung-resection candidacy. Vibration-response imaging has been proposed as a noninvasive, radiation-free, and simpler method to predict postoperative lung function. We compared vibration-response imaging to quantitative perfusion scintigraphy for predicting postoperative FEV1 and diffusing capacity of the lung for carbon monoxide (DLCO). METHODS: We enrolled 35 candidates for lung resection. Twenty-five patients had preoperative FEV1 and DLCO measurements. RESULTS: The vibration-response-imaging measurements showed strong correlation with the quantitative-perfusion-scintigraphy measurements of predicted postoperative FEV1% (r = 0.87, P < .001), predicted postoperative FEV1 (r = 0.90, P < .001), and predicted postoperative DLCO% (r = 0.90, P < .001). There was a correlation between predicted postoperative FEV1 (% and L) measured via quantitative perfusion scintigraphy and the actual postoperative FEV1 (% and L) (r = 0.47, P = .048, r = 0.73, P < .001). There was no difference between the vibration-response-imaging measurements and the actual postoperative measurements of predicted postoperative FEV1 (% and L). There was a correlation between predicted postoperative FEV1 (% and L) measured via vibration-response imaging and actual postoperative FEV1 (% and L) (r = 0.52, P = .044, r = 0.79, P < .001). The mean differences between the predicted and actual postoperative FEV1 values were 49 mL with vibration-response imaging, versus 230 mL with quantitative perfusion scintigraphy. Neither the vibration-response imaging nor the quantitative perfusion scintigraphy predicted postoperative DLCO% values agreed with the actual postoperative DLCO% values. CONCLUSIONS: Vibration-response imaging may be a good alternative to quantitative perfusion scintigraphy in evaluating lung-resection candidacy. [ABSTRACT FROM AUTHOR]

In this case report we present a novel treatment for bronchial fistula after lobectomy. The patient had right upper lobectomy for T1 N0 M0 peripheral adenocarcinoma and he had been reexplored 4 days later for massive air leak in another chest surgery department. After the reoperation the bronchial fistula persisted and the patient was admitted to our department. Nineteen days after the reoperation, bronchoscopy confirmed that the bronchial stump was totally opened. A sleeve resection to the right main broncus including the fistulous stump of right upper lobe was performed. [Copyright &y& Elsevier]

A 54-year-old male patient was admitted to our department with fever, dyspnea and chest pain. Left pleural effusion and destroyed left lower lobe was noticed in his computerized chest tomography. After chest tube drainage, massive hemoptysis developed. An emergency thoracotomy was performed. A bronchopleural fistula, destroyed left lower lobe and the head of an oat were detected in the pleural space. Left lower lobectomy and perioperative pneumoperitoneum were performed. The patient had an uneventful postoperative (p.o.) course and was discharged on p.o. day 6. We present this case because of the rarity and to emphasize the clinical presentation. The physicians should be aware of life threatening complications of oat head aspiration. [Copyright &y& Elsevier]

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 (P<0.001), type of resection (P<0.01), histopathological subtype (P<0.001), completeness of the resection (P<0.05) and postoperative radiotherapy (P<0.001) 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. [Copyright &y& Elsevier]

Purpose: The benefit of adjuvant chemotherapy for tumors smaller than 4 cm is not clear. We aimed to evaluate the prognostic impact of adjuvant platin-based chemotherapy in high-risk stage I patients with non-small cell lung cancer (NSCLC)., Methods: This cooperative group study included 232 NSCLC patients who underwent curative surgery for stage I disease with tumor size 2-4 cm. Re ults: Median age at presentation was 63 years (range 18-90). The mean tumor size was 29.6 ± 7.3 mm. The frequency of patients with specified risk factors were: visceral pleural effusion (VPI): n: 82 (36.6%); lymphovascular invasion (LVI): n: 86 (39.1%); Grade 3: n: 48 (32.7%); Solid micropapillary pattern (SMP): n: 70 (48.3%). Adjuvant platin-based chemotherapy was administered to 51 patients. During a median follow-up period of 50.5 months 68 patients (29.3%) developed recurrence, 54 (23.3%) died from any cause and 38 (16.4%) of them died of lung cancer. Patients who received chemotherapy compared with the non-chemotherapy group had a longer 5-years relapse-free survival (RFS) (84.5 vs 61.1%). Also on multivariate analysis, adjuvant chemotherapy was a significant independent prognostic factor for RFS., Conclusion: Adjuvant platin-based chemotherapy should be considered for patients with small tumors with adverse risk factors. Key words: adjuvant chemotherapy, lung cancer, oncology, lymphovascular invasion, solid-micropapillary pattern, platinum-based therapy.

Purpose: 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., Methods: 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., Results: 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)., Conclusion: HIPEC may not be so safe with regard to kidney function. Every attempt should be taken to decrease kidney damage during this procedure.

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.