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Myastenia gravis (MG) asetilkolin reseptörlerine karşı oluşan otoimmün yıkım sonucu; göz, iskelet ve solunum kaslarında zayıflığa sebep olan ilerleyici bir hastalıktır (1). Medikal tedavinin yanında timusun cerrahi olarak çıkarılması, hastalık için alternatif bir tedavi yöntemidir (2). MG cerrahi tedavisinde birden çok cerrahi teknik [transservikal, videotorakoskopik (VATS), transsternal ve subksifoidal] tanımlanmış ve önerilmiştir (3). Kliniğimizde ilk kez uygulanan subksifoid VATS timektomi prosedürünü, MG tanılı bir hastada gerçekleştirdik. Bu olgu sunumu ile uyguladığımız cerrahi tekniği ve deneyimimizi paylaşmayı amaçladık.

The aim of this study was to investigate the correlation of preoperative 18F-fluorodeoxyglucose PET/computed tomography maximum standardized uptake value (SUVmax) in operated non-small cell lung cancer (NSCLC) cases with other prognostic parameters and survival.NSCLC patients treated by surgical resection were imaged with PET within 60 days before surgery.Overall, 525 cases consecutive patients were retrospectively reviewed. The median value of SUVmax in a total of 525 cases was 12.1, and the mean was 13.3 ± 7.13. Logistic regression analysis performed to identify the variables that have an impact on SUVmax revealed that histology [hazard ratio (HR: 1.893; 95% CI; P = 0.001) and T status (HR: 8.991; 95% CI; P = 0.000) are correlated with SUVmax. Kaplan-Meier analysis revealed a mean survival of 73.7 ± 1.95 months and a median survival of 85.6 ± 6.03 months. In the group with an SUVmax value of less than 10, the mean survival was 81.9 ± 3.02 months (76.0-87.8), and in the group with SUVmax greater than 10.1, the mean survival was 68.6 ± 2.4 months (63.9-73.3) (P = 0.000). In the multivariate analysis, SUVmax, age, tumor histology, lymph node metastasis, comorbid diseases and complete/incomplete status of the resection were identified as the factors predictive of prognosis.It is seen that preoperative SUVmax is a parameter with prognostic significance at least as much as histopathology, age, complete/incomplete status of resection and lymph node involvement.

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

Aim: This study aimed to evaluate surgical and 5-year survival outcomes in patients undergoing sleeve lobectomy and bilobectomy after induction theraphy in treatment of lung cancer. Methods: Our single-centered study included 265 lung cancer patients who were performed sleeve lobectomy and bilobectomy between 2005 and 2020. Patients were divided into two groups who received neoadjuvant therapy and those who did not. All variables affecting overall survival were investigated retrospectively. Results: Of all 265 patients (245 male and 20 female), the mean age was 58.9 years (range: 19-78). Lobectomy was performed to 91.7%, and in 3% of all cases, video-assisted thoracoscopy was preferred. 81.9% of the tumors confirmed to be squamous cell subtype. In the 55 of patients (20,8%) who reiceved neoadjuvant theraphy, R0 resection was provided in all, however according to pathology reports, %3,3 of the patients who did not recieved neoadjuvant theraphy had incomplete resection. The 5-year survival rate was found to be 58.3%, and the median survival time was 80.1 months in all patients, patients with induction theraphy was %56,6 and %58,8 in patient without respectively. There was no significant diffirence statistically. In the cox-regression analysis, patient age, tumor size, lymph node metastasis and histology were determined as variables that affect survival (p Conclusions: In this study, we evaluate surgical outcomes of sleeve lobectomies after neoadjuvant theraphy retrospectively with these large number of patients. And we found that neoadjuvant therapy is not a significant factor for survival in sleeve resections.

Background We conducted this study to investigate the need for dissection of station 9 lymph nodes during upper lobectomy for non-small-cell lung cancer (NSCLC) and to find out the operative results of inferior pulmonary ligament division. Methods A total of 840 patients who underwent upper lobectomy for NSCLC between January 2007 and June 2020 were evaluated retrospectively. The patients were separated into two groups - those having undergone lymph node dissection of station 9 and inferior pulmonary ligament dissection (Group I) and those who did not (Group II). In these groups, the prognostic value of station 9 lymph nodes and postoperative effects (drainage time, prolonged air leak, dead space and length of hospital stay) of ligament division or preservation were analyzed. Results The number of patients with station 9 lymph node metastasis was only one (0.1%) and that was multi-station pN2 disease. Station 9 lymph nodes were found in 675 (80.4%) patients, while 22 (2.6%) patients had no lymph nodes in the dissected material. In the other 143 (17%) patients, the inferior pulmonary ligament and station 9 were not dissected. While 5-year survival was 64.9% in 697 patients of Group I, it was 61.3% in 143 patients of Group II (p = 0.56). There was no statistically significant difference between the groups in postoperative effects of ligament division or preservation. Conclusions In upper lobectomies, status of station 9 does not have a significant impact on patients' survival and lymph node staging. Additionally, preservation or division of the inferior pulmonary ligament has no significant advantage or disadvantage.

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.

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.

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.

Introduction: Congenital malformation of the lung is an overarching term and consist of bronchogenic cyst, pulmonary sequestration, congenital cystic adenoid malformation, congenital lobar emphysema, bronchial atresia and enteric duplication cyst. To prevent future complications surgery is always almost needed even in asymptomatic patients. Aims and Objectives: This study aimed to review our experience in surgical intervention for congenital lung disease. We also aim to demonstrate the feasibility and efficacy of video-assisted thoracoscopic surgery in this patient group and to emphasize its increasing use over the years. Methods: We retrospectively reviewed medical records of 94 patients diagnosed with a congenital lung malformation and surgically treated in our clinic between January 2009 and May 2019. Results: From January 2009 to May 2019, a total of 94 patients fitted the criteria for inclusion in this retrospective study. The median age was 41, with a range of 16 to 78 years. The mean postoperative length of hospital stays, and drainage duration were longer in the VATS group, but this data wasn9t statistically significant (p>0.005). There wasn9t a significant difference between VATS and thoracotomy group in perioperative complications. Conclusions: In conclusion, in this study there is no significant differences between vats and thoracotomy groups in terms of intraoperative and perioperative data, but because of its possible and described benefits minimal invasive surgical techniques should be considered as the first choice in the surgical treatment of patients with congenital lung malformations.

Background Video-assisted mediastinoscopy (VAM) is a valuable method in the investigation of diseases with mediastinal lymphadenopathy or those localized in the mediastinum. The aim of this study was to determine the diagnostic value of VAM in the investigation of mediastinal involvement of nonlung cancer diseases and to describe our institutional surgical experience. Methods Clinical parameters such as age, sex, histological diagnosis, morbidity, and mortality of all patients who underwent VAM for the investigation of mediastinal involvement of diseases except lung cancer between January 2006 and July 2018 were retrospectively reviewed, and the diagnostic efficacy of VAM was determined statistically. Results During the study period, 388 patients underwent VAM, and 536 lymph nodes were sampled for histopathological evaluation of mediastinum due to mediastinal lymphadenopathy or paratracheal lesions. The most common diagnoses were sarcoidosis (n = 178 [45.9%]), tuberculous lymphadenitis (n = 108 [27.8%]), lymphadenitis with anthracosis (n = 72 [18.6%]), and lymphoma (n = 15 [3.9%]). Conclusion The results of the study show that VAM should be used because of its high diagnostic benefit in mediastinal lymphadenopathies, which are difficult to diagnose, or mediastinal lesions located in the paratracheal region. Despite the increase in the number of new diagnostic modalities, VAM is still the most effective method and a gold standard.

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 Ipsilateral pulmonary metastasis (PM) in the same lobe (T3Satell) or different lobe (T4Ipsi Nod) constitutes a small proportion of patients with non-small cell lung cancer (NSCLC). In our study, we aimed to determine prognostic factors and to evaluate long-term survival outcomes in the patients who underwent complete resection due to NSCLC. Methods Data of 1,502 surgically treated patients with NSCLC from January 2007 to December 2016 were retrospectively reviewed. Fifty (3.3%) patients diagnosed with PM were the basis of the study. Demographic and histopathological characteristics, surgical procedures, and prognostic factors for survival were analyzed, categorizing patients according to the presence of PM in the same lobe or different lobe. Results Among the 50 patients, 23 (46%) had PM in the same lobe as the primary tumor and 27 (54%) had PM in different ipsilateral lobes. The mean size of nodules was 11.5 mm. While T3Satell was detected mostly in squamous cell carcinoma (SCC) (65.2%), T4Ipsi Nod was more common in adenocarcinoma (AC) (70.4%), and the difference was statistically significant (p = 0.022). Survival was significantly better in the SCC-T3Satell group than the AC-T3Satell group (64 and 58.3%, respectively; p = 0.043). Although the overall 5-year survival was better in the T3Satell group, the difference between survival outcomes of both groups was not statistically significant (61.2 and 37.2%, respectively; p = 0.27). In the T3Satell group, nodule size was found to be a negative prognostic factor in survival (p = 0.042), whereas the number of nodules was found to be a negative prognostic factor in the T4Ipsi Nod group (p = 0.046). In multivariate analysis, advanced age was a poor prognostic factor for PM (p = 0.03). Conclusion There was no significant difference in survival between T3Satell and T4Ipsi Nod patients. Among surgically treated patients due to NSCLC, poor prognostic factors were advanced age for the patients with PM, nodule size and AC for T3Satell patients, and the number of nodules for T4Ipsi Nod patients.

Bronchopleural fistula (BPF) is a catastrophic complication after pneumonectomy, still associated with high mortality. We reviewed our recent experience of managing BPF, particularly after right pneumonectomy for non-small cell lung cancer (NSCLC), and analyzed our findings. A total of 436 patients underwent pneumonectomy for NSCLC in our department between January 2000 and June 2017. BPF developed during follow-up in 47 of these patients, who are the subjects of this retrospective analysis. The overall incidence of BPF was 10.8% (47/436), being 22.8% (33/145) after right pneumonectomy and 4.8% (14/291) after left pneumonectomy (P = 0.0001). The incidence of BPF in patients with a history of tuberculosis was 33.3% (6/18; P = 0.008). The fistula healed in 48.9% (23/47) of the patients and the rate of mortality caused by the fistula was 19.1% (9/47). The side of the pneumonectomy and previous tuberculosis were the two most important risk factors independent of the bronchial closure methods. The incidence of BPF was much higher after right pneumonectomy than after left pneumonectomy. The high mortality and morbidity rates show that the treatment of BPF is still not satisfactory.

Heimlich valve (HV) drainage system, described at 1965 from Henry Heimlich, is a oneway valve system used by thoracic surgeons in various conditions. So many studies have been described in the literature to demonstrate the effectiveness and usefulness of the method. Differently, our study was planned to evaluate HV system from the view of the patients. This prospective study included 50 patients who underwent tube thoracostomy with different indications since August 2016. All the patients were discharged from the hospital with HV system. Patients demographic data, primary disease, indication for drainage, operative history, date of connection of the drain to HV system and the duration of the system were recorded. After the discharge a “satisfaction questionnaire” was applied to determine possible questions and problems. The patients age ranged from 18 to 87. Most frequent indications were, postoperative expansion problems, prolonged air leakage due to surgery (n=13). The duration with HV at home was 2-102 days. Some of the patients had anxiety because of discharging with a chest drain (n=21), but only 5 of them had problems with the system and wound care. Eigthy percent of the patients thought that the aim of the system is “to make them more comfortable at their home and shorten the lenght of hospital stay”. Nearly half of the patients (48%) said; “even if the drain in my chest, going home was good”. Only 20% prefered to stay at the hospital instead of discharging with a drain. HV system has many advantages. Even though the 48% of patients satisfied seems to be small when other benefits are also taken into account we believe that it would be wise for the practice to be included in the daily practice of thoracic surgery.

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.

Tracheobronchial rupture is an uncommon but potentially serious complication of endotracheal intubation. In this study, the diagnosis and treatment strategies of a specific group of ruptures caused by double-lumen tube intubation are herein presented. The medical records of 18 patients diagnosed and treated for tracheobronchial rupture after undergoing double-lumen tube intubation between January 1999 and October 2010 are analyzed retrospectively. In all cases, the ruptures occurred in the membranous portion. The average length of laceration was 2.44 ± 1.78 cm. The most common site of rupture was in the lower third of the trachea (n = 7, 39 %) or the left mainstem bronchus (n = 7, 39 %). One patient was diagnosed before incision using fiberoptic bronchoscopy, and 17 patients were diagnosed using direct vision of the rupture intraoperatively. All patients were treated successfully with surgery. There were no morbidities or mortalities recorded in relation to tracheobronchial rupture. Thoracic surgeons must be alerted to the possibility for tracheobronchial rupture in patients intubated with double-lumen tubes, a procedure commonly used in thoracic surgery. Immediate repair must be performed for any laceration diagnosed intraoperatively.

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.

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.

Resumen Introduccion Los quistes mediastinicos forman un grupo de lesiones benignas heterogeneas y poco comunes de naturaleza neoplasica, congenita e inflamatoria. Continua la controversia sobre como tratarlos, ya sea mediante extraccion quirurgica u observacion. Examinamos nuestra experiencia en este campo, que incluye algunas situaciones infrecuentes, haciendo hincapie en el espectro clinico y el tratamiento quirurgico. Pacientes y metodos Se ha realizado un estudio retrospectivo de 34 pacientes atendidos entre 2000 y 2007 por lesiones quisticas primarias del mediastino. Se analizaron las caracteristicas clinicas, las tecnicas de imagen empleadas, el tipo de cirugia, la morbilidad, la mortalidad y el seguimiento. Resultados El grupo estuvo constituido por 18 mujeres (53%) y 16 varones (47%), con una media de edad (±desviacion estandar) de 45,3±14,1 anos (rango: 22–74). La mayoria de los quistes eran congenitos (94%), excepto en los pacientes con enfermedad hidatidica (6%). El 24% de los quistes (n=8) se detecto en el mediastino anterior y el resto (n=26) se localizo en el mediastino visceral. La mayoria de los pacientes (61%) presentaba sintomas. El dolor y las molestias toracicos fueron los sintomas mas frecuentes, seguidos de la disnea, la tos y la hemoptisis. En todos los casos se procedio a la escision del quiste, con la recuperacion sin incidentes de los pacientes y sin recurrencias en el seguimiento a largo plazo. Conclusiones Los quistes mediastinicos asintomaticos no son infrecuentes. La cirugia es un tratamiento seguro para los quistes mediastinicos, con una mortalidad y morbilidad aceptables.

Objetivo La prevalencia de las bronquiectasias ha disminuido significativamente durante los ultimos decenios en los paises desarrollados. Sin embargo, la reseccion quirurgica de las bronquiectasias desempena todavia un papel importante en la practica de la cirugia toracica en los paises en vias de desarrollo como Turquia. El presente estudio se ha disenado para evaluar los resultados obtenidos con el tratamiento quirurgico de las bronquiectasias, especialmente en lo que se refiere a sus efectos sobre el bienestar funcional de los pacientes. Pacientes y metodo Entre enero de 1995 y diciembre de 2003 recibieron tratamiento quirurgico debido a bronquiectasias 81 pacientes. Se evaluaron las caracteristicas demograficas, el tipo de reseccion quirurgica y la morbilidad y mortalidad operatorias. Los resultados relativos al nivel funcionalglobal “social” o extrapulmonar se clasificaron y compararon con una escala creada para determinar el grado de bienestar de los pacientes antes de la intervencion y a los 6 meses. Resultados La edad media de los pacientes era de 24,4 anos y 47 (58%) eran de sexo masculino. El tratamiento quirurgico consistio en lobectomia en 37 (45%), neumonectomia en 10 (12%), segmentectomia en 13 (16%) y la combinacion de lobectomia y segmentectomia en 22 (27%) de las intervenciones quirurgicas. La reseccion completa se llevo a cabo en 69 pacientes (85%). No se produjo ningun fallecimiento a consecuencia de la cirugia. La tasa de morbilidad fue del 18,3%. Se observo mejoria hasta un estado functional excelente en el 81,7% de los pacientes, asi como mejoria hasta un estado funcional bueno en el 12,7%; en el 5,6% no se observaron cambios. Los resultados obtenidos con la reseccion completa fueron significativamente mejores que los conseguidos con la reseccion incompleta (p = 0,0015). Conclusion Los resultados funcionales del tratamiento quirurgico de las bronquiectasias obtenidos en esta serie de pacientes son favorables y prometedores, especialmente en pacientes seleccionados con una reserva pulmonar suficiente y con un proceso patologico localizado en quienes es possible la reseccion completa.