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Pulmonary hydatid cyst (PHC) can imitate many diseases. Sometimes, positron emission tomography/computed tomography (PET/CT) is performed in terms of malignancy exclusion for complicated cysts. Although some specific findings (doughnut sign) have been identified in hydatid cyst of the liver, there is no specific sign described for PHC. The aim of this study is to investigate the presence of a common finding in PHC patients scanned with PET/CT inadvertently.From January 2015 to 2020, patients proven to have PHC were analyzed retrospectively. From all the patients, only 17, having a previous PET/CT, were included the study. Lesions were evaluated in three groups according to FDG uptake: A, negative; B, focal; C, doughnut sign.The total number of patients was 17. Nine of the patients were male and the median age was 41.94 + 14.68 (16-65) years. SUV max of the lesions ranged from 0.5 to 15.8 (mean ± SE: 4.68). According to the FDG uptake of the lesions, five were in Group A, two in Group B, and the remaining ten (58.8%) in Group C with doughnut sign. To correlate the CT findings with PET/CT findings, doughnut sign, which is a typical finding of hydatid cysts of liver, is seen in only four patients in Group 1-classified cysts which are non-complicated. But in Group 2 (n = 3) and 3(n = 4), the finding of doughnut sign is three in both groups.PET/CT is not a recommended imaging technique for PHC, but in cases where a definitive diagnosis is difficult, interpreting PET/CT findings is significant. This study demonstrates that previously described doughnut sign for liver hydatid cysts is also common for perforated pulmonary cysts. According to our knowledge, this is the first largest series of determining PET/CT findings of PHC. Further larger series will contribute to the literature.

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)

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.

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.

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.

The translocation of the intraabdominal organs into the intrathoracic cavity via the injured area in the diapragm after blunt or penetrated trauma is called traumatic rupture of the diapragm.The translocation of intrabdominal organs into the intrathoracic cavity is a rare, well known, but easily overlooked complication. In cases of severe traumatic events the diagnosis may be skipped due to hemodynamic instability of the patient which may delay treatment. We reported a patient with diaphragmatic rupture diagnosed 1.5 months after a blunt thoracic trauma.

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.

OBJECTIVES Severe acute respiratory syndrome coronavirus 2, a novel coronavirus, affects mainly the pulmonary parenchyma and produces significant morbidity and mortality. During the pandemic, several complications have been shown to be associated with coronavirus disease 2019 (COVID-19). Our goal was to present a series of patients with COVID-19 who underwent chest tube placements due to the development of pleural complications and to make suggestions for the insertion and follow-up management of the chest tube. METHODS We retrospectively collected and analysed data on patients with laboratory-confirmed COVID-19 in our hospital between 11 March and 15 May 2020. Patients from this patient group who developed pleural complications requiring chest tube insertion were included in the study. RESULTS A total of 542 patients who were suspected of having COVID-19 were hospitalized. The presence of severe acute respiratory syndrome coronavirus 2 was confirmed with laboratory tests in 342 patients between 11 March and 15 May 2020 in our centre. A chest tube was used in 13 (3.8%) of these patients. A high-efficiency particulate air filter mounted double-bottle technique was used to prevent viral transmission. CONCLUSIONS In patients with COVID-19, the chest tube can be applied in cases with disease or treatment-related pleural complications. Our case series comprised a small group of patients, which is one of its limitations. Still, our main goal was to present our experience with patients with pleural complications and describe a new drainage technique to prevent viral transmission during chest tube application and follow-up., The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) primarily affects the lower respiratory system.

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: 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.

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.

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.

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.

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

The aim of this study was to evaluate of the results of the treatment of patients who underwent surgery due to large cell lung carcinoma and to analyze the variables affecting the survival outcomes. Pulmonary resections were performed on 1221 patients with pathological stages I, II, III non-small cell lung cancer between January 2003 and January 2013. A total of 85 patients (7%) who were histologically diagnosed with large cell lung carcinoma and 10 patients were excluded from the study because of operative mortality, incomplete resection, and follow-up. The records of 75 patients undergoing complete resection were evaluated in terms of demographics, survival rates, and variables affecting the survival. Seventy-one (94.7%) male and four (5.3%) female patients with a mean age of 58.1±9.8 years (range: 38 to 76 years) were included in the study. Neoadjuvant treatment was administered to four (5.3%) patients. Lobectomy was performed on 53 (70.7%) patients and 28 (37.3%) had neuroendocrine differentiation (NED) in their tumors. Median and five-year survival rates were 80.8 months and 51.1%, respectively in a mean follow-up period of 34.9±27.7 months (range: 2.4 to 91.6 months). Five-year survival rates in the groups with and without neuroendocrine differentiation were 37.8% and 57.9%, respectively, with no statistically significant difference between the groups (p=0.53). The absence of lymph node metastasis and adjuvant treatment had positive effects on survival in patients with large cell lung carcinoma who underwent resection. Although not statistically significant, neuroendocrine differentiation led to a lower survival rates.

OBJECTIVES Among the nodule types, the most controversial group are indeterminate solid nodules from 1 to 2 cm in size with the first choice being transthoracic needle biopsy (TTNB) or positron emission tomography (PET-CT) or both methods together. However, no single diagnostic algorithm could be applied to all cases. This research discusses the diagnostic success of PET-CT and TTNB. MATERIALS AND METHODS 407 Patients who referred to our hospital for any reason, with solid nodules with the size from 1 to 2 cmincidentally identified on the thoracic CT tests were investigated. Among the patients who underwent biopsy, 312 cases had PET-CT, and maximum SUV (SUVmax) values of the nodules were examined. Values of ≥2.5 were accepted as hypermetabolic. RESULTS The mean age of the patients was 61 ± 10.8 years. 84 patients were female (20.6%) and 323 were male (79.4%). For TTNB; sensitivity, specificity and accuracy rates of all cases, who were correctly diagnosed, were 76.9%, 83.3% and 78.9%, respectively (P

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.

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.

The aim of this study was to investigate the effects of preope­ rative albendazole treatment on the tensile strength of the cuticular membranes of pulmonary hydatid cysts. Material and methods: A study including 44 patients operated on for pulmonary hydatid cysts was carried out between January 2009 and November 2010. The patients were divided into two groups according to their preoperative albendazole administration. Seventeen patients (with 20 cysts) in group A were operated on after three cycles of peroral 10 mg/kg/day albendazole treatment, whereas 27 patients (with 29 cysts) in group B underwent the operation without any preoperative administration of albendazole. Fresh tissue tensile stress tests were carried out on the cuticular membranes excised from both groups. Results: The results of this study demonstrated that the tensile strength values of the cuticular membrane of the cysts excised from group A were lower than those obtained from group B, with a statistically significant difference. Conclusions: Albendazole treatment decreases the tensile strength of the cuticular membranes of pulmonary hydatid cysts, which may lead to their perforation. The patients should be operated on as soon as possible and without any preoperative medical treatment in order to prevent complications before the definitive surgical operation.