Reason based analysis of totally implantable venous access port explanted oncology patients: a single-center study

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-12-08 7 3 109 118 10.26663/cts.2022.019 174 article Reason based analysis of totally implantable venous access port explanted oncology patients: a single-center study Hüseyin Ulaş Çınar 1 Department of Thoracic Surgery, Biruni University Medical Faculty, Istanbul, TurkeyBackground: Explantation of totally implantable venous access port (TIVAP) is of great importance as it may interrupt treatment in oncology patients. The aim of this study is to determine the reasons of TIVAP explantation, the relationship between TIVAP in situ time and early explantation for these reasons, and also to analyze the effect of increasing experience over time on these results. Materials and Methods: Patients who underwent TIVAP explantation between 2014 and 2020 were retrospectively reviewed. Demographic characteristics of the patients, indications for TIVAP implantation and explantation, the TIVAPs’ in situ time, early explantation rate and post-explant complications were investigated. The results obtained were compared in two time periods (January 2014-June 2017 and July 2017-December 2020). Results: A total of 90 patients were analyzed. The mean age was 58.7 ± 10.2. While TIVAP implantation was most frequently performed for digestive tract cancers (73%), the most common cause of TIVAP explantation was an infection (53.3%). In patients with TIVAP explant due to infection, mean TIVAP in situ time (73 days) was significantly shorter compared to other reasons (p < 0.001). In contrast, the early explantation rate due to infection was only 16.6%. Hematoma was the most common post-explant complications, with a total complication rate of 13%. In the time, it was determined that explantations secondary to complications, early explantations and post-explant complications decreased, while TIVAP in situ time increased. Conclusions: Infection is the reason of more than half of TIVAP explantations. Although infection significantly decreases the TIVAP survival, it rarely causes early explantation. It is important that TIVAP-related processes are performed in multidisciplinary centers and with experienced staff. https://cts.tgcd.org.tr/pdf.php?id=174 venous portexplantationinfectionchemotherapycancer eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-12-08 7 3 119 124 10.26663/cts.2022.020 175 article Preoperative assessment and outcomes of general thoracic surgery approaches during covid-19 pandemics Seray Hazer 1 Necati Solak 1 Leyla Nesrin Üstün Acar 1 Funda İncekara 1 Koray Aydoğdu 1 Pınar Bıçakçıoğlu 1 Göktürk Fındık 1 Selim Şakir Erkmen Gülhan 1 Department of Thoracic Surgery, Health Sciences University, Atatürk Chest Disease and Thoracic Surgery Research and Training Hospital, Ankara, TurkeyBackground: COVID-19, a novel coronavirus affecting the respiratory system, was diagnosed in China in December 2019. With the pandemic, many new changes had to be made in thoracic surgery clinics. Materials and Methods: The patients who underwent surgery at Thoracic Surgery Department between March 11, 2020, and October 11, 2020, during the COVID-19 pandemic were evaluated retrospectively. The precautions and new preoperative procedures in our thoracic surgery clinics were analyzed retrospectively. Results: A total of 1177 patients were treated in thoracic surgery clinics, 299 underwent surgery under general anesthesia during the pandemic, and 948 patients were excluded. Common complications were prolonged air leakage and pleural effusion, and complications occurred in 16.4% of the patients. The mortality rate was 1%. One of the patients with bullae excision due to prolonged air leakage (with COPD) was diagnosed on the fifth postoperative day, another with right pneumonectomy had radiological findings compatible with COVID-19 on the fourth postoperative day, despite negative PCR results four times, and the third patient with thymoma who underwent extended thymectomy without any COVID-19 findings were deceased. Conclusions: Considering that COVID-19 increases mortality due to increased inflammation and pulmonary involvement, COVID-19 infection co-occurring surgical interventions of the lung will adversely affect the patient’s prognosis and cause an increase in transmission. While caution should always be exercised in all surgical procedures in the pandemic, more severe precautions should be taken in thoracic surgery operations. Implementing comprehensive protective measures such as preoperative PCR test, thorax CT before surgery, quarantine, and disinfection are essential to control nosocomial infection. https://cts.tgcd.org.tr/pdf.php?id=175 COVID-19thoracic surgerypandemics eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-12-08 7 3 125 131 10.26663/cts.2022.021 176 article Specific indication for tracheobronchial stenting in patients with postpneumonectomy bronchopleural fistula: massive air leakage and respiratory distress Güntuğ Batıhan 1 Kenan Can Ceylan 2 Şeyda Örs Kaya 2 Department of Thoracic Surgery, Kars Harakani State Hospital, TurkeyDepartment of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, TurkeyBackground: Postpneumonectomy bronchopleural fistula is still one of the complications that are difficult and time-consuming to treat despite advances in surgical technique and technology. Although many surgical and non-surgical methods have been described in its treatment, there is no consensus on the optimal approaches. In this study, we aimed to share our experience in tracheobronchial stenting and to evaluate the efficacy and safety of the modified silicone stents and J-shaped endobronchial selfexpandable nitinol stent in patients with postpneumonectomy bronchopleural fistula presenting with severe dyspnea and massive air leak. Materials and Methods: We retrospectively analyzed data of the patients who underwent tracheobronchial stenting for postpneumonectomy bronchopleural fistula between January 2010 and December 2020 in our center. Two different endobronchial stent types were used. Modified silicone and covered self-expandable nitinol stent. The clinical features of the patients and the results of the intervention were evaluated. Results: A total of 10 patients with bronchopleural fistulas were treated with tracheobronchial stenting. Modified silicone stent was used in 4, full covered J-shape nitinol stent was used in 6 patients. No complications were observed during the procedure. After the placement of the tracheobronchial stent, air leakage ceased in all patients and their dyspnea regressed significantly. Conclusions: Tracheobronchial stents are an appropriate treatment option in patients with postpneumonectomy bronchopleural fistula presenting with severe dyspnea and massive air leak. https://cts.tgcd.org.tr/pdf.php?id=176 bronchopleural fistulapneumonectomytracheobronchial stent eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-12-08 7 3 132 140 10.26663/cts.2022.022 180 article Investigation of the effect of surgical technique on survival and recurrence in thymoma Merve Sengul Inan 1 Kubilay Inan 2 Selim Sakir Erkmen Gulhan 3 Koray Aydogdu 3 Pınar Bıcakcıoglu 3 Göktürk Fındık 3 Department of Thoracic Surgery, Gulhane Education and Training Hospital, Ankara, TurkeyDepartment of Thoracic Surgery, Ankara City Hospital, Ankara, TurkeyDepartment of Thoracic Surgery Ataturk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TurkeyBackground: Although rare, thymomas are common primary tumors of the anterior mediastinum. Herein we aimed to investigate the outcomes of thymoma surgeries, with a focus on survival rates and in reference to the demographic and histological characteristics of patients. The secondary aim is to identify the factors that affect recurrence. Materials and Methods: Fifty-five patients were operated on for thymoma have been retrospectively evaluated according to their demographics, clinical characteristics, pathologies, complications, recurrences and survival. Results: The mean SUVmax value was found to be 5.5 ± 2.05 and showed no correlation with mass diameter or stage (p = 0.284 and p = 0.176, respectively). The mean survival was 55.9 ± 35.31 months in the R0 resection group. Overall survival was not correlated with age and mass diameter at a statistically significant level (p = 0.056, p = 0.108 respectively). There was no difference in the frequency of recurrence between the WHO stages (p = 0.775). Conversely, when classified as per the Masaoka–Koga classification, recurrence was detected in all stage-4 patients (p < 0.001). Conclusions: To date, there is no practical structure that classifies and integrates prognostic factors and creates a usable system out of them but, in thymomas, the best results are achieved by complete surgical resection. https://cts.tgcd.org.tr/pdf.php?id=180 thymomathymectomytumor stagingVATS thymectomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-12-08 7 3 141 146 10.26663/cts.2022.023 181 article No-touch isolation technique in early-stage non-small-cell lung cancer surgery: a retrospective study Mehmet Çetin 1 İlteriş Türk 2 Ebru Sayılır Güven 2 Göktürk Fındık 2 Koray Aydoğdu 2 Selim Şakir Erkmen Gülhan 2 Pınar Bıçakçıoğlu 2 Department of Thoracic Surgery, Omer Halisdemir University Training and Research Hospital, Niğde, TurkeyDepartment of Thoracic Surgery, Ataturk Chest Disease and Thoracic Surgery Training and Research Hospital, Ankara, TurkeyBackground: In parallel with the change in circulating tumor cells, the no-touch isolation technique is offered as an option to reduce recurrences of non-small-cell lung cancer. We aimed to examine the relationship of this technique with recurrence and survival in our clinic. Materials and Methods: Among 675 patients who were operated on with the diagnosis of lung cancer between 2009 and 2015, 98 patients with tumor size of less than 3 cm in the postoperative pathology report, no visceral pleural invasion or lymph node involvement, and a negative surgical margin were included in the study. The patients were divided into two groups as patients treated with and without the no-touch isolation technique (i.e., a wedge resection group prior to lobectomy and a direct lobectomy group), and the results of recurrence and survival were evaluated statistically. Results: While adenocarcinoma was observed more frequently in the wedge resection group, squamous cell carcinoma was observed statistically more frequently among patients treated with direct lobectomy (p < 0.001). There was no statistically significant difference in recurrence or survival rates between patients treated with and without the no-touch isolation technique (p = 0.746 and p = 0.689, respectively). Conclusions: Although wedge resection before surgery is theoretically well grounded, we found that it was not clinically significant as a result of our study. The technique may prove beneficial in reevaluating chemotherapy indications based on circulating tumor cells, especially in early-stage cases where patients have not received chemotherapy, and prospective studies are needed in this regard. https://cts.tgcd.org.tr/pdf.php?id=181 lung cancerwedge resectioncirculated tumor cellthoracic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-12-08 7 3 147 154 10.26663/cts.2022.024 182 article Short- and long- term results of surgery in non-cystic fibrosis bronchiectasis: analysis of 7 years of follow-up Oya Baydar Toprak 1 Alper Avci 2 Efraim Guzel 1 Burak Mete 3 Department of Chest Diseases, Cukurova University Faculty of Medicine, Adana, TurkeyDepartment of Thoracic Surgery, Cukurova University Faculty of Medicine, Adana, TurkeyDepartment of Public Health, Cukurova University Faculty of Medicine, Adana, TurkeyBackground: There are limited data in the literature regarding the early and long-term results of surgery in non-cystic fibrosis bronchiectasis. The aim of this study is to contribute to literature with clear analysis of early postoperative complications and to determine the rate of postoperative complications in non-cystic fibrosis bronchiectasis. Materials and Methods: One hundred two patients with non-cystic fibrosis bronchiectasis who underwent surgical resection participated in the study between April 2012 and November 2019 at Çukurova University. Patients were contacted by phone and scheduled for a face-to-face interview. For five patients who died during the postoperative period, mandatory information was collected through family members or from retrospective assessment of their medical records. Results: Of the 102 patients, 47 (46.1%) were male and 55 (53.9%) were female, with an average age of 38.8 ± 14.0 years. The indication for surgery was hemoptysis in 16 (15.7%), recurrent pulmonary infections in 74 (72.5%), and suspicion of malignant transformation in 12 (11.8%) patients. The mean follow-up period was 71.4 ± 28 months. The early postoperative complication rate was 21.5% with no intraoperative fatality and a 4.9% mortality rate with long-term follow-up. The most common postoperative complications were surgical site infection and hemorrhage. The type of bronchiectasis (varicose bronchiectasis), lower forced vital capacity (FVC) and the diffusing capacity of the lung for carbon monoxide (DLCO) in the perioperative period were identified as risk factors for the development of postoperative complications. Long-term mortality was also higher in individuals who had early postoperative complications. Conclusion: With low mortality and morbidity rates, surgical interventions in non-cystic fibrosis bronchiectasis remains a feasible choice in selected cases. https://cts.tgcd.org.tr/pdf.php?id=182 non-cystic fibrosis bronchiectasisbronchiectasissurgerypostoperative complicationsrisk factors eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-12-08 7 3 155 158 10.26663/cts.2022.025. CTSID: 779 183 article Is surgical treatment necessary in trans-sternal nail gun injury? Omer Faruk Demir 1 Omer Onal 1 Oguzhan Turan 1 Department of Thoracic Surgery, Faculty of Medicine, University of Erciyes, Kayseri, TurkeyNail gun injuries have been reported in the medical literature since the introduction of these tools in 1959. The number of injury cases is increasing over time due to the increasing use of nail guns in the construction industry. While the most common site of nail gun injuries is non-dominant hand and fingers, rarely head, thoracic, abdominal, and cardiac injuries have been reported. Depending on the injured organ, the primary method of treatment for such injuries, which have catastrophic consequences, is appropriate surgical interventions. https://cts.tgcd.org.tr/pdf.php?id=183 conservative treatmentnail guntrauma eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-12-08 7 3 159 162 10.26663/cts.2022.026 184 article A case report of lung cancer: is it spread through air spaces or endoluminal metastasis? Huseyin Yildiran 1 Guven Sadi Sunam 2 Fikret Kanat 3 Atilla Can 1 Halil Sen 1 Department of Thoracic Surgery, Selcuk University Medical Faculty, Konya, TurkeyThoracic Surgeon, Istanbul, TurkeyDepartment of Pulmonology, Selcuk University Medical Faculty, Konya, TurkeyLung cancer is the most common cause of death due to malignancy and early diagnosis is important for surgical treatment. Endotracheal and endobronchial metastasis after left upper lobectomy is a very rare condition in the patient who was followed up for one year postoperatively. By the presented case, it was aimed to determine the approach and etiology of this clinical condition. https://cts.tgcd.org.tr/pdf.php?id=184 Lung cancermetastasisspread through air spa eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2022-12-08 7 3 163 166 10.26663/cts.2022.027 185 article Videothoracoscopic tracheal resection and reconstruction in postintubation tracheal stenosis: case report Semih Erduhan 1 Celal Bugra Sezen 1 Gamze Tanrıkulu 1 Yasar Sönmezoglu 1 Volkan Erdogu 1 Muzaffer Metin 1 Department of Thoracic Surgery, Health Sciences University, Yedikule Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyBronchoscopy of a 58-year-old female patient who complained of dyspnea after prolonged intubation revealed stenosis of approximately 2 cm in length at a distance of 2 cm from the carina. Upon that, the patient underwent tracheal resection and reconstruction with VATS using 3 ports. Operations can be performed safely through minimally invasive surgical approaches for tracheal stenoses at the thoracic level. https://cts.tgcd.org.tr/pdf.php?id=185 video-assisted thoracoscopic surgerypost-intubation tracheal stenosistracheal resectionminimally invasive surgerytracheal surgery