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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]

Objective: This study was designed to investigate the causes of isolated mediastinal lymphadenopathy, the role of cervical mediastinoscopy (CM) in the diagnosis, and the accuracy of computed tomography (CT) to predict malign and benign pathology in patients with isolated mediastinal lymphadenopathy. Materials and Methods: The records of 348 patients who underwent CM for isolated mediastinal lymphadenopathy between 2006 and 2018 were analyzed. The group comprised 189 males and 159 females. The cases were evaluated in terms of age, distribution of lymph node stations in which lymphadenopathy was detected and sampled, mortality, morbidity, and histopathological diagnostic parameters. Results: The median age of the patients was 48 years (min--max: 18--79 years). The median lymph node diameter was 2 cm (min--max: 1--6 cm). Lymphadenopathy was found in a total of 724 lymph node stations. The median lymph node diameter was 3.7 cm in patients with malignant disease and 2 cm in cases of benign disease. The reliability of CT to predict malignancy was 76.8% specificity and 71.1% sensitivity when the lymph node diameter was >2.5 cm (area under the curve: 0.820; 95% confidence interval: 0.774--0.860; p<0.001). Complications occurred in 2 cases, however, no mortality was observed. The histopathological results were sarcoidosis (43.1%), tuberculosis (TB) (20.7%), reactive hyperplasia (14.7%), carcinoma metastasis (8.6%), lymphoma (6%), and other (6.8%). Conclusion: Although sarcoidosis is the most common cause of isolated mediastinal lymphadenopathy, TB is still prevalent in Türkiye. The sensitivity of CT imaging to identify malignancy increased with a larger lymph node diameter. CM is a safe and effective diagnostic procedure for patients with mediastinal lymphadenopathy. [ABSTRACT FROM AUTHOR]

Purpose: Bronchopleural fistula (BPF) is a complication that can occur after pulmonary resections onset may be early or late. This study aims to present our results using omentoplasty in the treatment of BPF. Materials and Methods: We retrospectively evaluated the data of patients who developed BPF after pulmonary resection between 2010 and 2020. The results of the patients who underwent omentoplasty during surgical revision for BPF were analyzed in terms of surgical methods used, timing of the procedure, and surgical success. Results: BPF formed in 52 (2.1%) of 2486 patients who underwent anatomical lung resection. Fourteen (26.9%) of the patients with BPF were treated with omentoplasty. All of the patients were men and the median age was 58 years (range, 27-75 years). Among the patients who underwent omentoplasty, the median time from pulmonary resection to BPF development was 22 days (range, 4-221 days). The median time from BPF development to omentoplasty was 9.5 days (range, 4-485 days). Seven (50%) of the patients developed BPF after pneumonectomy and the other 7 (50%) after lobectomy. Most post-pneumonectomy BPFs occurred after right pneumonectomy (n=6, 85.7%). BPF developing after right pneumonectomy constituted 43% of all BPFs (n=6). Surgical success was achieved in 13 (92.9%) of the 14 patients who underwent BPF closure with omentoplasty. Conclusion: Omentoplasty has low complication and high success rates and can be used safely for the treatment of BPF. [ABSTRACT FROM AUTHOR]

Objective Informed consent is the permission obtained verbally and in writing by the physician, so that the patient, who has the power of discrimination and has the ability to evaluate the legal consequences of his/her actions, can make a decision about the procedure and treatment to be applied.This study is a survey study aiming to determine the level of knowledge of Thoracic Diseases and Thoracic Surgery physicians about informed consent. Material and Method The "Informed Consent Knowledge Level Questionnaire" prepared by the researchers was applied to the Thoracic Diseases and Thoracic Surgery physicians working in the hospital between February and May 2020 by face-to-face interview technique. Significance was evaluated at the p<0.05 level. Results The questionnaire was applied to 84 physicians. 69% of the participants were women, 71.4% were thoracic diseases physicians, 28.6% were thoracic surgeons, and the mean age was 36.93±11.58 years. It was determined that 71.4% of the participants received training on informed consent during or after university education, and 97.6% had an informed consent form in their department. 92.9% of the physicians think that having the patient sign an informed consent form will protect them from malpractice lawsuits. While it was determined that the mean level of informed consent knowledge was 70.46±9.09 (min:50-max:85), it was established that there was no statistically significant relationship between status, branch, length of service in medicine and branch, and having been educated about informed consent and the level of informed consent knowledge (p>0.05). Conclusion It has been determined that physicians think that informed consent will protect them from malpractice lawsuits, that the practice of obtaining consent has become widespread, but physicians continue to feel the need to receive education on consent. Although no significant relationship was found between the level of informed consent knowledge and the parameters obtained in the study, the ongoing education needs of physicians on this subject should also be taken into consideration. In order to better understand the factors affecting the level of informed consent knowledge, it is recommended to conduct a large-scale survey classified according to different hospitals, different geographical regions, different age groups and statuses. [ABSTRACT FROM AUTHOR]

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.

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: This study aims to investigate the changes in the clinical and radiological presentations of pulmonary aspergilloma in patients undergoing surgery and to evaluate changes in the surgical outcomes over time., Methods: Between January 2000 and January 2020, a total of 88 patients (69 males, 19 females; mean age: 45.4±11.2 years; range, 17 to 70 years) who underwent surgery for pulmonary aspergilloma were retrospectively analyzed. Surgeries performed were divided into two groups based on their chronological order: first period (from 2000 to 2010, n=44) and second period (from 2010 to 2020, n=44)., Results: The most frequent underlying disorder was tuberculosis (72.7%), whereas 10 patients did not have any predisposing conditions for pulmonary aspergilloma. Regarding the aspects of radiological imaging and operative findings, 22 patients had simple aspergilloma and 66 patients had complex aspergilloma. Complications and mortality rates were 33.0% and 5.7%, respectively. A statistical downward was observed in the second period compared to that in the first period regarding the rate of patients with tuberculosis history (61.4% vs. 84.1%, p=0.01). There were more patients who did not have any predisposing conditions for pulmonary aspergilloma in the second period and in the simple aspergilloma group (p=0.04 and p<0.001, respectively). Simple aspergilloma was often observed in the second period than that in the first period (31.8% vs. 18.2%). There was no significant difference between the periods regarding the type of surgical resection (p=0.506), whereas in the simple aspergilloma group, more patients underwent wedge resection (p<0.001). There were no significant differences between the periods and radiological groups in terms of complications and mortality. Patients who underwent pneumonectomy had significantly higher rates of complications and mortality (p=0.01 and p=0.03, respectively)., Conclusion: Although pulmonary aspergilloma patients who underwent surgery in the last 10 years had a lower history of tuberculosis than those who were operated in the previous 10 years, there was no change in postoperative complications and mortality rates. An increase in simple aspergilloma prevalence may reduce the rate of surgical morbidity., 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.)