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OBJECTIVE: We compared the survival outcomes of surgery within multimodality treatment regimens with the outcomes of definitive chemoradiation treatments in patients diagnosed with clinical (c) IIIB/N2 non-small cell lung cancer (NSCLC). We investigated whether surgery within multimodality treatment provides a survival advantage at this stage. MATERIAL AND METHODS: Data from 79 patients with cIIIB/N2 between 2009 and 2016 were analyzed retrospectively. While the surgery was performed after neoadjuvant therapy in 51 cases (IIIB/Surgery Group), definitive chemotherapy ± radiotherapy was applied in 28 cases (IIIB/Definitive Group). RESULTS: In cIIIB/N2 cases, the 5-year overall survival (OS) was 27.4%, with a median OS of 24.6 months. The 5-year OS of the IIIB/ Surgery Group was 27.3% (median survival 22.5 months), while it was 28.6% (median survival 29.1 months) in the IIIB/Definitive Group (P = .387, HR = 0.798, 95% CI, 0.485-1.313). Although there was a survival advantage in the group with a pathological complete response (PCR) after surgery (n = 14) compared to the group that did not (n = 37), the observed difference was not statistically significant. (5-year OS; 42.9% vs. 18.5%, P = .104). Additionally, there was no statistically significant difference between the survival of PCR patients and the IIIB/Definitive Group in terms of OS (P = .488). CONCLUSION: Surgery performed within multimodality treatment regimens in selected cIIIB/N2 cases did not provide a survival advantage over definitive chemoradiation treatments. [ABSTRACT FROM AUTHOR]

Aim: In this study is to evaluate the preoperative risk factors and compare the complications of patients who underwent diagnostic VATS for interstitial lung diseases in our clinic and patients who started thoracoscopic and converted to thoracotomy. Methods: Patients who underwent VATS due to interstitial lung disease between January 2010 and December 2019 in our clinic were included in the study. In the study, patients were evaluated under 2 groups. There are 159 patients who underwent VATS wedge (Group-V) and 29 patients who started with VATS and converted to thoracotomy (Group-T) due to unexpected intraoperative complications. Results: There was no significant difference between VATS and thoracotomy groups in terms of demographic characteristics, except for a history of tuberculosis. The most common postoperative pathology was unusual interstitial pneumonia (n=56, 28%). Complications were observed in 17 patients (9%). Prolonged air leak in 5 patients, pneumothorax after postoperative drain removal in 3 patients, wound infection requiring revision in 3 patients, respiratory failure requiring non-invasive mechanical ventilation in 6 patients developed. Mortality occurred in 5 patients (2.7%) in the first 30 days postoperatively. Conversion from VATS to thoracotomy occurred due to a previous history of tuberculosis and widespread pleural adhesions. Conclusion: Although revealing in videothoracoscopic surgery is considered to be a failure, postoperative complication and mortality rates were found to be similar to VATS. The main risk factor for conversion to thoracotomy is tuberculous sequelae observed in preoperative thoracic CT and perioperative pleural diffuse adhesions. Therefore, VATS is a reliable and applicable method in interstitial lung disease (ILD). We think that careful patient selection in the preoperative period will reduce the probability of the thoracotomy. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Thoracic epidural analgesia (TEA) reduces pulmonary complications after thoracotomy. Hypothetically, this advantage is partially because of the preserved pulmonary function, which is achieved by the reduction of postoperative pain and immobility. This study aimed to compare the principal methods of analgesia through early postoperative spirometric performance and gas exchange parameters after elective lung cancer surgery. TEA or intravenous analgesia (IVA) involving pethidine was used as the principal method in our sample population. MATERIAL AND METHODS: A total of 62 patients operated via the posterolateral thoracotomy approach were enrolled. Postoperative analgesia was secured using multimodal analgesia with either TEA with 0.1% bupivacaine or IVA. Pain perception was assessed with the visual analog scale (VAS) while at rest and on coughing. Arterial blood samples were collected at 1, 24, and 72 hours postoperatively. Preoperative and third postoperative day spirometric measurements were recorded. RESULTS: There were no significant differences among the groups in terms of demographic characteristics, properties of surgical technique, and disease-associated conditions. VAS scores of the TEA group were lower at the 72-hour follow-up, but a considerable fraction of these differences did not reach statistical significance. Reduction in the forced expiratory volume in the first second and forced vital capacities was more prominent in the IVA group on the third postoperative day, but these were not statistically significant either. Oxygenation parameters favored TEA but remained comparable. Finally, the pH values were significantly lower in the IVA group at 1 and 72 hours postoperatively (p=0.008 and p=0.02, respectively). CONCLUSION: We believe that TEA is advantageous over IVA with alteration of respiratory volumes during the early postoperative period. [ABSTRACT FROM AUTHOR]

Objective This study aims to evaluate the effects of prognostic factors depending on gender and the factors affecting survival in women patients who underwent resection for non-small cell lung cancer (NSCLC). Material and Methods Patients who underwent lung resection due to NSCLC in our hospital between January 2007 and December 2018 were included in the study. 1491 patients were included in the study. Results The mean age of the patients was 60.0±8.41 (range: 26-84) years. There were 1324 (88.8%) male patients and 167 (11.2%) female patients. Pneumonectomy was performed in 406 (27.2%) patients, lobectomy in 1077 (72.2%) patients, and segmentectomy in 8 patients (0.5%). The mean 5-year survival time was 57.5%. In the study, the 5-year survival rate of female patients was 66.8%, while it was 56.4% in males (p=0.005). When the pN2 status was evaluated, the 5-year survival rate was 34.3%, while the survival rate was 64.1% in patients with pN0 (p<0.001). The most important prognostic factors affecting survival in Cox regression analysis were gender, advanced age, wider resection, pN2, and advanced stage. When the factors affecting survival in female patients were evaluated in the subgroup analysis, the 5-year survival rate was 32.9% in patients aged 65 and over (p<0.001). When the histopathology was evaluated, the 5-year survival rate was 67.1% in adenocarcinomas, while 70.7% in squamous cell cancers. Conclusion As a result of our study, the main histopathological cell type seen in female patients is adenocarcinoma. Especially in women, advanced age, large cell cancers, advanced stage, and pN2 status are poor prognostic factors in survival. [ABSTRACT FROM AUTHOR]

Background: This study aims to investigate whether the invasive staging of aortopulmonary window lymph nodes could be omitted in the presence of a suspected isolated metastasis in the aortopulmonary window lymph node on positron emission tomography/computed tomography., Methods: Between January 2010 and January 2016, a total of 67 patients (54 males, 13 females; mean age: 59.9±8.7 years; range, 44 to 76 years) with metastatic left upper lobe tumors to aortopulmonary window lymph nodes were retrospectively analyzed. According to positron emission tomography/computed tomography findings in clinical staging, the patients were classified as positive (+) (n=33) and negative (-) (n=34) groups., Results: There was a statistically significant difference between the two groups in terms of sex distribution, lymph node diameter on computed tomography, maximum standardized uptake value of aortopulmonary window lymph nodes, and tumor diameter (p<0.001 for all). A trend toward significance was found to be in pT status, LN #6 metastases, and pathological stage between the two groups (p=0.067). The five-year overall survival rate for all patients was 42.4% and there was no significant difference between the groups (p=0.896). The maximum standardized uptake value of the aortopulmonary window lymph nodes was a poor prognostic factor for survival (area under the curve=0.533, 95% confidence interval: 0.407-0.675, p=0.648)., Conclusion: Invasive staging of aortopulmonary window lymph nodes can be omitted in patients with isolated suspected metastasis to aortopulmonary window lymph nodes in non-small cell lung cancer of the left upper lobe., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2023, Turkish Society of Cardiovascular Surgery.)

Background: In this study, we aimed to evaluate the effects of the transition from the 6 th edition of the Tumor, Node, Metastasis (TNM) staging system to the 7 th edition, and from the 7 th edition to the 8 th edition by comparing the stage migrations. We also aimed to externally validate the 8 th edition of the TNM staging system., Methods: Between September 2005 and June 2015, a total of 1,077 patients (986 males, 91 females; mean age: 59.6±8.3 years; range, 35 to 84 years) with non-small cell lung cancer who underwent lung resection were retrospectively analyzed. We re-staged patients according to 6 th , 7 th , and 8 th TNM staging and compared the stage migrations of cases among the three staging systems., Results: Stage migration in the transition to the 7 th edition of the TNM staging system was observed in 368 (34.1%) patients whereas it was observed in 541 (50.2%) patients in the transition to the 8 th edition (p<0.001). The rate of upstaging in transition to the 7 th edition staging system was 50.2% (n=185), whereas it was 98.1% (n=531) for the transition to the 8 th edition (p<0.001). The survival rates of Stages 1B, 2B and 3A increased with transition to the 7 th edition and the survival rates of Stages 1B, 2A, 2B, 3A, and 3B increased with the transition to the 8 th edition. The best stratification in the survival curves in the 6th edition was between 1B-1A and 3B-3A. In the 7 th edition, it occurred between 1B-1A, 3A-2B and 3B-3A and, in the 8 th edition, between 1B-1A and 3B-3A., Conclusion: Stratification according to the 7 th edition showed better prognostic validity compared to the 6 th edition; and that of the 8 th edition was better compared to the 7 th edition., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2022, Turkish Society of Cardiovascular Surgery.)

Background: The aim of this study was to investigate the long-term outcomes of patients who underwent anatomic lung resection for pulmonary aspergilloma and to evaluate the prognostic factors affecting early postoperative morbidity., Methods: Between January 2007 and January 2017, we retrospectively evaluated a total of 55 patients (40 males, 15 females; mean age: 44.6 years; range, 18 to 75 years) who underwent lobectomy and pneumonectomy for pulmonary aspergilloma. All patients were evaluated for simple or complex aspergilloma based on imaging and thoracotomy findings., Results: Thirty-two (58.2%) patients presented with hemoptysis. Seven (12.7%) patients underwent emergency surgery due to massive hemoptysis. Postoperative morbidity was observed in 15 (27.3%) patients. Prognostic factors that had an effect on morbidity were resection type, Charlson Comorbidity Index >3, and massive hemoptysis (p<0.05). There was no intra- or postoperative mortality. The five-year survival rate was 89.4%. None of the factors evaluated in the study were associated with survival., Conclusion: The main finding of this study is the absence of mortality after surgical treatment for pulmonary aspergilloma. The success of surgical treatment depends on the management of postoperative complications., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2022, Turkish Society of Cardiovascular Surgery.)

Background: This study aims to evaluate long-term results of induction treatment and to investigate prognostic factors affecting survival in non-small cell lung cancer patients with a pathological complete response., Methods: Between January 2010 and December 2017, a total of 39 patients (38 males, 1 female; mean age: 56.2±8.3 years; range, 38 to 77 years) having locally advanced (IIIA-IIIB) non-small cell lung cancer who were given induction treatment and underwent surgery after induction treatment and had a pathological complete response were retrospectively analyzed. Survival rates of the patients and prognostic factors of survival were analyzed., Results: Clinical staging before induction treatment revealed Stage IIB, IIIA, and IIIB disease in three (7.7%), 26 (66.7%), and 10 (25.6%) patients, respectively. The five-year overall survival rate was 61.2%, and the disease-free survival rate was 55.1%. In nine (23.1%) patients, local and distant recurrences were detected in the postoperative period., Conclusion: In patients with locally advanced non-small cell lung cancer undergoing surgery after induction treatment, the rates of pathological complete response are at considerable levels. In these patients, the five-year overall survival is quite satisfactory and the most important prognostic factor affecting overall survival is the presence of single-station N2., Competing Interests: Conflict of Interest: The authors declared no conflicts of interest with respect to the authorship and/or publication of this article., (Copyright © 2021, Turkish Society of Cardiovascular Surgery.)