Is primary thoracic ewing sarcoma aggressive than others? seventeenyears’ experience

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-08-05 6 2 44 50 10.26663/cts.2021.0009 136 article Is primary thoracic ewing sarcoma aggressive than others? seventeenyears’ experience Seray Hazer 1 Göktürk Fındık 1 Koray Aydoğdu 1 Yetkin Ağaçkıran 2 Selim Şakir Erkmen Gülhan 1 Mustafa Şevki Demiröz 1 Pınar Bıçakçıoğlu 1 Sadi Kaya 1 Department of Thoracic Surgery, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TurkeyDepartment of Pathology, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TurkeyBackground: Ewing sarcoma (ES) is an uncommon aggressive malignant tumor of the bone and/or soft tissue and belongs to peripheral primitive neuroectodermal tumor (PNET) family of tumors. Bone PNETs primarily arise from the diaphysis of long bones, where as soft tissue PNETs are most commonly found in the chest wall. Multidisciplinary treatments, including chemotherapy, surgery, radiotherapy, or all three combined, improve the survival of patients with localized ES. However, the best approach to achieve local control remains controversial. Materials and Methods: We retrospectively analysed the medical records and pathology data of 14 patients (8 male, 6 female; mean age, 23.2 [range, 4-54] years) with primary thoracic ES who underwent surgery in our clinic between January 2002 and December 2019. In addition, the treatment modalities and tumor-related factors of chest wall ES and lung parenchyma were evaluated. Results: The most frequent complaint was chest pain (n = 7). In 10 patients, the tumor originated from the ribs, whereas the remaining 4 patients had lung parenchymal tumors. Ten patients underwent complete tumor excision with chest wall resection, one patient underwent lower lobectomy with chest wall resection, and three patients underwent complete tumor excision via wedge resection. All patients were treated with chemotherapy, except two who underwent bone marrow transplantation. The median follow-up was 31.6 (range, 2-84) months. Relapses were seen in 5 cases in the median 19.8th (range, 4-60) month. Conclusions: Complete tumor resection is the most effective treatment for thoracic ES and multimodal therapy (surgical resection, chemotherapy, and local radiation therapy), which is recommended when indicated, constitutes the optimal treatment for ES. Although relapses occur within the early postoperative period, late relapses are not uncommon. The follow-up periods must be short and should be maintained long term for late relapses. https://cts.tgcd.org.tr/pdf.php?id=136 Ewing’s sarcomachest wallchemotherapysurgeryrecurrence eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-08-05 6 2 51 57 10.26663/cts.2021.0010 137 article Comparing the outcomes of video-assisted thoracoscopic surgery and rethoracotomy in the management of postoperative hemorrhage Volkan Erdoğu 1 Meral Selin Onay 1 Ayşegül Çiftçi 1 Ece Yasemin Emetli 1 Semih Erduhan 1 Atilla Pekçolaklar 2 Mustafa Vedat Doğru 1 Yunus Aksoy 1 Ali Cevat Kutluk 1 Muzaffer Metin 1 Department of Thoracic Surgery, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Bursa City Hospital, Bursa, TurkeyBackground: Although postoperative hemorrhage after thoracic surgery is uncommon, it is the most common indication for revision surgery after these procedures. Most postoperative hemorrhages are due to surgical technique, although some comorbidities can predispose the patient to bleeding. We investigated whether video-assisted thoracoscopic surgery (VATS) and re-thoracotomy had the same outcomes in the management of postoperative hemorrhage in patients who underwent open thoracotomy or VATS. Materials and Methods: We retrospectively analyzed patients with postoperative hemorrhage after thoracotomy (n = 659) or VATS (n = 883) between 2018 and 2020. Revision surgery was performed after thoracotomy in 22 patients (3.3%) and after VATS in 4 patients (0.4%). Of these, 11 patients (42.3%) were re-operated by re-thoracotomy (Re-thoracotomy Group) and 15 patients (57.7%) by revision VATS (VATS Group). Results: Revision due to postoperative hemorrhage was required significantly more frequently after thoracotomy than VATS (3.3% vs. 0.4%, p < 0.001). In patients with hemorrhage after pneumonectomy (n = 14), revision by VATS was preferred to re-thoracotomy (n = 10, 71.4% vs. n = 4, 28.6%). The mean time to discharge after revision surgery was 5.1 ± 2.2 days (range, 2-12 days) overall and was significantly shorter in the revision VATS Group than in the Re-thoracotomy Group (4.4 ± 1.5 days vs. 6.2 ± 2.5 days, p = 0.004). Conclusions: VATS has similar results to re-thoracotomy and is advantageous in terms of earlier recovery and shorter hospital stay. Therefore, VATS should be the preferred method for postoperative hemorrhage management. https://cts.tgcd.org.tr/pdf.php?id=137 VATSre-operationthoracic surgerythoracotomypostoperative hemorrhage eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-08-05 6 2 58 63 10.26663/cts.2021.00011 138 article Comparison of thoracotomy and videothoracoscopy for intrathoracic bronchogenic cysts Kenan Can Ceylan 1 Hüseyin Mestan 1 Şeyda Örs Kaya 1 Ali Galip Yener 2 Department of Thoracic Surgery, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, İzmir, TurkeyDepartment of Pathology, Dr. Suat Seren Chest Disease and Thoracic Surgery Training and Research Hospital, İzmir, TurkeyBackground: Bronchogenic cyst is a generally benign and rare congenital anomaly. The mediastinum and lung parenchyma are the most common sites the cysts occur. This study aimed to compare the effectiveness of thoracoscopy and thoracotomy for the treatment of bronchogenic cysts. Materials and Methods: Twenty-one patients were operated on in Dr. Suat Seren Thoracic Surgery Clinic between 2004 and 2019 with the diagnosis of bronchogenic cyst. Patients were divided into two groups according to the surgery method as video-assisted thoracoscopic surgery (VATS) or thoracotomy. Demographic and operative features, radiological findings, and complications were retrospectively analyzed. Results: Patients underwent either VATS (10 patients) or thoracotomy (11 patients). Sixteen patients underwent simple cyst excision, whereas parenchymal resection was performed for five patients. The mean Visual Analogue Scale (VAS) value was 3.5 ± 1.1 for the VATS group and 6.5 ± 1 for the thoracotomy group. Duration of hospital stay and chest drainage was 4.2 ± 1.7 and 3.2 ± 1.7 days, respectively, in the VATS group, while in the thoracotomy group, it was 7.1 ± 4.5 and 6.1 ± 4.5 days. The time of hospitalization stay, duration of chest drainage, operative time, and VAS values were found statistically significantly lower in the VATS group. Conclusions: Both VATS and thoracotomy are preferred surgical methods in bronchogenic cyst surgery. VATS is superior to thoracotomy in terms of shorter hospital stay, chest drainage duration, operative time, and lower postoperative pain level. Minimally invasive methods can be chosen safely for the treatment of bronchogenic cyst in appropriate cases. https://cts.tgcd.org.tr/pdf.php?id=138 bronchogenic cystvideothoracoscopythoracotomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-08-05 6 2 64 68 10.26663/cts.2021.0012 139 article Efficiency of vocal cord medialization for recurrent laryngeal nerve dysfunction following pulmonary resections Melis E Demirağ 1 Çağatay Tezel 2 Volkan Baysungur 2 Serdar Evman 2 Department of Otorhinolaryngology, University of Health Sciences, Kartal Dr.Lutfi Kirdar Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, University of Health Sciences, Sureyyapasa Training and Research Hospital, Istanbul, TurkeyBackground: Evaluating the incidence of postoperative vocal cord dysfunction after pulmonary resections and the impact of timing for vocal cord medialization on preventing postoperative pulmonary complications for these patients. Materials and Methods: Patients developing vocal cord dysfunction (VCD)/unilateral vocal cord paralysis (UVCP) after pulmonary resection were examined retrospectively, in terms of postoperative pulmonary complication (PPC) rates and hospital length of stay. Total of 2740 patients underwent anatomical pulmonary resection for malignancy. Eleven patients were referred to otolaryngology team with pre-diagnosis of VCD following the operation. UVCP diagnosis was confirmed with indirect laryngoscopic examination. Results: UVCP diagnosis was confirmed in 8 (0.3%) with indirect laryngoscopic examination. Performed resections were left upper lobectomy in 3 and left pneumonectomy in 5 patients. Atelectasis necessitating bronchoscopy and pneumonia were the PPC, seen in 3 (37.5%) patients. Calcium hydroxyapatite injection for 6 patients and polytetrafluoroethylene graft implantation for 2 patients was performed. Mean duration between pulmonary resection and medialization was 5.3 days in patients developing PPC and 3.6 days in patients with no PPC (p = 0.011). All patients were discharged within an average of 8.1 (6-13) days, uneventfully. One patient required re-injection of calcium hydroxyapatite on 5th month. Throughout a mean follow-up duration of 14.8 months, all patients had stable vocal cord position. Conclusions: Vocal cord medialization can be performed safely for postthoracotomy UVCP. In order to minimize phonetic and respiratory complications, this procedure must be applied on early postoperative period. https://cts.tgcd.org.tr/pdf.php?id=139 acquired vocal cord palsycomplicationsmedialization laryngoplastythoracotomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-08-05 6 2 69 74 10.26663/cts.2021.0013 140 article Minimally invasive pectus excavatum surgery: nuss procedure Tuba Apaydın 1 Murat Akkuş 1 Thoracic Surgery Unit, SBU Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, TurkeyBackground: We reviewed pre-, intra-, and post-operative clinical data, including morbidity and mortality rates, for patients who underwent Nuss surgery to repair pectus excavatum. Materials and Methods: Nuss procedure was performed in 140 patients at our clinic between 2012 and 2019 (males: 108; females: 32 females; mean age: 15.7 ± 7.8 years; range: 3-40 years). The Haller index was mild (2.5-3.2) in 72, moderate (3.2-3.5) in 40, and severe (3.6-6.0) in 28 patients. Results: None of the patients died. Morbidity or bad blood loss was not observed. The mean duration of surgery was 59.5 ± 21 min (range: 30-120 min). The mean duration of postoperative hospitalization was 4.6 ± 2.9 days (range: 3-19 days). The procedure was performed using one (n = 107; 76.4%), two (n = 31; 22.2%), or three (n = 2; 1.4%) bars. There were five cases of early pneumothorax, four pleural effusions, five bar displacements, two wound infections, one hematoma, seven bar exposures due to allergies, and three costal fractures. Conclusions: The Nuss operation is an effective, minimally-invasive treatment for pectus excavatum. It has the advantages of a short duration of surgery and low morbidity and mortality rates. Therefore, the Nuss operation may be considered the treatment of choice in cases of pectus excavatum. https://cts.tgcd.org.tr/pdf.php?id=140 pectus excavatumsurgeryminimally invasive eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-08-05 6 2 75 77 10.26663/cts.2021.0014 141 article Late term broncho-eosophageal fistula and endoscopic treatment: a case report Muammer Cumhur Sivrikoz 1 Erhan Durceylan 1 Department of Thoracic Surgery, Eskisehir Osmangazi University, School of Medicine, Eskişehir, TurkeyFistulas between the respiratory and digestive tract (trachea-esophageal, broncho-esophageal) can be congenital or acquired. Acquired fistulas due to malignancy can occur by direct invasion of the malignant tissue; or it may be a result of surgical treatment, chemotherapy or radiotherapy. Although such fistulas occur during or shortly after treatment, it is unlikely that they will emerge long years after treatment. We report a case of late term broncho-esophageal fistula and an endoscopic treatment method in a patient who underwent left pneumonectomy for bronchial carcinoma. Treatment of the patient was accomplished with bronchoscopic placement of polyglycolic acid patch with surgical tissue glue into the fistula tract. Fistulas between trachea-bronchus and digestive tract should be kept in mind, after surgical interventions of neighborhood structures. Bronchoscopic interventions may be a treatment alternative in appropriate patients. https://cts.tgcd.org.tr/pdf.php?id=141 broncho-esophageal fistulabronchoscopybronchial carcinomapolyglycolic acid patchsurgical tissue glue eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-08-05 6 2 78 81 10.26663/cts.2021.0015 142 article Pulmonary large cell neuroendocrine carcinoma: a diagnostic challenge Demet Yaldız 1 Mehmet Sadık Yaldız 1 Ayça Tan 2 Department of Thoracic Surgery, Manisa Celal Bayar University, Faculty of Medicine, Manisa, TurkeyDepartment of Pathology, Manisa Celal Bayar University, Faculty of Medicine, Manisa, TurkeyPulmonary large cell neuroendocrine carcinoma (LCNEC) is known by its highly aggressive behaviour. General presentation is early spread to both regional lymph nodes and distant sites. Here we present a totally asymptomatic patient with a huge fluid-filled cystic lesion detected incidentally in a chest radiograph. https://cts.tgcd.org.tr/pdf.php?id=142 large cell neuroendocrine carcinomapulmonaryhydatid cyst eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2021-08-05 6 2 82 85 10.26663/cts.2021.0016 143 article A case of mediastinitis causing massive hemothorax Sercan Aydın 1 Şükriye Miray Kılınçer Bozgül 2 Tevfik İlker Akçam 3 Devrim Bozkurt 2 Department of Thoracic Surgery, Kastamonu Education and Research Hospital, Kastamonu, TurkeyDepartment of Internal Medicine, Ege University, School of Medicine, Izmir, TurkeyDepartment of Thoracic Surgery, Ege University, School of Medicine, Izmir, TurkeyAcute mediastinitis is an infection of the mediastinal tissue, which is a rare condition with high mortality and morbidity usually requiring intensive care follow-up. The most common reported causes of this condition are postoperative mediastinitis and descending necrotizing mediastinitis. The patients of the condition usually present with nonspecific symptoms such as fever, dysphagia, and chest pain. Laboratory findings observed are nonspecific, and also leukocytosis and high C reactive protein (CRP) values are encountered. Heterogeneity in the mediastinal tissues, air densities in the mediastinum and loculated fluid collections are radiologically observed. The treatment of the condition is antibiotherapy and surgery. Hemothorax is not reported as an expected complication in the follow-up of mediastinitis. In this case report, we present a patient with hemothorax hospitalized with the diagnosis of mediastinitis and empyema after an extraction of a tooth. https://cts.tgcd.org.tr/pdf.php?id=143 abscessempyemahemothoraxmediastinitis