Does lung cancer histology affect the efficacy of talc pleurodesis throughpleural catheter?

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-12-11 8 3 117 121 10.26663/cts.2023.0021 206 article Does lung cancer histology affect the efficacy of talc pleurodesis throughpleural catheter? Melike Badoglu 1 Hüsnü Baykal 1 Department of Chest Diseases, Ankara Atatürk Sanatoryum Training and Research Hospital, University of Health Sciences, Ankara, TurkeyBackground: Up to 50% of lung cancer patients develop pleural effusion during the course of the disease. Dyspnea is the primary indication for intervention. After drainage, chemical pleurodesis may be applied. Talc is the most effective sclerosing agent, and sometimes the procedure may not be successful. Adults, histologically confirmed lung cancer patients with pleural effusion who had talc pleurodesis through pleural catheter between 2014 and 2019 were included. The aim was to clarify whether lung cancer histological type and talc pleurodesis efficacy were correlated or not. Materials and Methods: A total 222 patients were enrolled retrospectively. Through the study; age, sex, cancer histological type, pleural/pleural effusion FDG uptake in PET/CT, pleural effusion’s location, amount, biochemical property, and pleurodesis efficacy were recorded. Results: Mean age was 65.52 years, 22.9% of them were women, and 73.3% were men. Lung cancer histological types were; small cell lung cancer (13.1%), adenocarcinoma (72.1%), squamous cell carcinoma (9.5%), and not specified non-small cell lung cancer (5.4%). In 22.1% of the patients, pleurodesis was efficient, in 50% partially efficient, and in 27.9% inefficient. The only independent factor affecting pleurodesis efficacy was found as cancer histological type (p < 0.05). Pleurodesis efficacy was found higher in the squamous cell carcinoma group (p < 0.05). Conclusions: As far as we know, this is the first study on correlation between efficacy of talc pleurodesis through the pleural catheter and the lung cancer histological types. Pleurodesis was significantly more efficient in patients with squamous cell carcinoma, possibly due to its immunohistochemical behavior. https://cts.tgcd.org.tr/pdf.php?id=206 lung cancermalignant pleural effusionpleurodesis efficacytalc pleurodesis eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-12-11 8 3 122 127 10.26663/cts.2023.0022 207 article Did covid-19 anxiety cause a delay in the patients’ decision to be operated on for lung malignancy? Seda Kahraman Aydın 1 Tiffany Melissa Ergin Onar 1 Tevfik Ilker Akcam 1 Ufuk Cagirici 1 Ali Ozdil 1 Department of Thoracic Surgery, Ege University School of Medicine, Izmir, TurkeyBackground: With the COVID-19 pandemic, "corona anxiety and phobia" negatively affect people in various fields which can lead patients to delay even their lung cancer operations. It was investigated whether the reason was COVID-19 phobia in patients who wanted to postpone lung surgery, and it was aimed to evaluate the COVID-19 anxiety scores in these patients. Materials and Methods: Between April 2020 and January 2022, the data of patients who were recommended to be operated on due to lung malignancy, but who reported that they wanted to postpone the surgery were analyzed retrospectively. The patients were contacted by phone and questioned whether the reasons for the postponement were the COVID-19 pandemic. The patients were evaluated in the context of the “Coronavirus Anxiety Scale (CAS)” and their anxiety scores and reasons for delay were analyzed with CAS scores. Results: Of the 122 patients who were recommended to be operated on due to lung malignancy, 90 were operated on, while 32 patients (26.2%) postponed the operation. The mean surgery delay time was 11.59 ± 7.13 months, it was detected that the mean anxiety score was 2.47 ± 2.46 (0-9) points. The average anxiety score of those who answered “no” to the questionnaire was 0.79 points, those who answered “partially” had 2.69 points, and those who answered “yes” were 6.60 points. The CAS score was significantly higher in patients who reported that they postponed their surgeries mainly due to COVID-19 (p < 0.001). Conclusions: Higher levels of coronavirus anxiety were detected in patients who reported that they postponed lung surgery due to COVID-19. https://cts.tgcd.org.tr/pdf.php?id=207 coronaphobiacoronavirus anxietydelaylung cancersurgical treatment eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-12-11 8 3 128 135 10.26663/cts.2023.0023 208 article Chest wall reconstructions with synthetic prosthetic materials Seray Hazer 1 Necati Solak 2 Leyla Nesrin Üstün 1 Pınar Bıçakçıoğlu 1 Göktürk Fındık 1 Selim Şakir Erkmen Gülhan 1 Department of Thoracic Surgery, Ankara Atatürk Sanatoryum Training and Research Hospital, Ankara, TurkeyDepartment of Thoracic Surgery, Sincan Training and Research Hospital, Ankara, TurkeyBackground: Chest wall tumors can be malignant and benign and present as primary or metastatic lesions. For the definitive treatment of malignant thoracic wall tumors, the surgical margin should be established at a distance of at least 4 cm from the tumor. A 1-2 cm distance from the tumor is often sufficient in benign or low-grade malignancies. Repairing the deformity with prosthetic materials in 3 or more rib resections (>30 cm) is recommended. In resections containing four or more ribs, the mesh should be supported with metallic rib bars screwed to the periphery of the defect. Materials and Methods: Thoracic wall resection was performed on 285 patients between 2008 and 2019 in the Department of Thoracic Surgery of Ankara Atatürk Sanatoryum Training and Research Hospital. Repair with prosthetic graft was performed in 70 cases, and thoracic wall resection was performed in 215 patients without using mesh. The results of 50 patients who underwent thoracic wall reconstruction with a prosthetic graft were evaluated retrospectively. Results: The female/male ratio in those using mesh is 0.47; the mean age is 52.5 (14-76 years); the tumor size (mean long diameter) is 11 cm (4-18 cm); the number of removed ribs is 2.5 (1-5 pieces) is Sternal resection was performed in 2 patients, sternum resection in 1 patient, left clavicle partial resection, right clavicle partial resection, and first and second ribs of the left side resection. Partial excision of the clavicle and first rib was performed in 1 patient. Polypropylene mesh in 28, PTFE mesh in 20, and polyglactin mesh in 2 patients were used. The mean postoperative hospital stay was 10.6 days (2-58 days), and the mean follow-up period was 16.6 months (0-96 months, median 7 months). Complications developed in 10 patients (20.0%). Three patients underwent revision surgery; one was operated on for empyema at four months, and the patch was removed. The others were performed at the 16th and 30th months due to recurrence. Mortality developed in 4 patients in long-term follow-ups. Conclusions: Polypropylene mesh can cause wrinkles and folds as it shows less stretch when suturing than Polytetrafluoroethylene (PTFE). In addition to the difficulties of providing a smooth surface, it also causes the passage of fluid and air in the pleural space from the pores to the subcutaneous space. PTFE patches are frequently used, non-permeable, flexible, high tissue compatibility, durable and robust, but poor body wall integration has been reported. Polypropylene and PTFE mesh comparison results are similar to the literature. Suppose a significant defect (>30 cm2) exists in patients who have undergone thoracic wall resection; reconstruction should be performed to stabilize the thoracic wall, prevent lung hernia, paradoxical breathing, mediastinal structures, and intrathoracic dislocation of the scapula, and provide aesthetically appropriate rib cage contours. https://cts.tgcd.org.tr/pdf.php?id=208 chest wallreconstructionpolyprolen meshPTFEthoracic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-12-11 8 3 136 142 10.26663/cts.2023.0024 209 article Postpneumonectomy bronchopleural fistula: cohort of patients in a pevurian national hospital Karin Gonzales-Peña 1 W Samir Cubas 2 Pamela Villanueva-Zúñiga 3 Service of Thorax and Cardiovascular Surgery, Hipolito Unánue National Hospital, Lima, PeruDepartment of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital, Lima, PeruPostgraduate Area, School of Medicine, Universidad San Martín de Porres, Lima, PeruBackground: Bronchopleural fistula (BPF) is a complication with a great impact on morbidity, mortality and survival in postoperative pneumonectomy patients. Our study aimed to determine the associated clinical-surgical characteristics of the BPF in a Peruvian cohort of patients with BPF following pneumonectomy. Materials and Methods: Cross-sectional, and retrospective study during January 2015-June 2020 in a Peruvian National Hospital. Medical records and operative reports were reviewed, and all patients over age (>18 years) and with all-cause pneumonectomy were considered. The variables were grouped into pneumonectomies with and without BPF, and the characteristics were grouped as a baseline, clinicalsurgical and postoperative. Results: Among fifty-seven patients who underwent pneumonectomy, 28% presented BPF. The mean age was 38.3 ± 15 years, and 62.5% were male. The main pathologies associated with BPF were posttuberculosis fibrocavitary sequelae (62.5%), pulmonary hydatidosis (18.8%), and post-surgical cavitary sequelae (12.5%). 81.3% were left BPF (p = 0.342) and 100% were related to postoperative empyema (p < 0.05). The mortality associated with BPF was 6.25%, and in the non-BPF group it was 4.87% (p = 0.098). Characteristics that were statistically associated with the presence of bronchopleural fistula were low predicted forced expiratory volume (FEV1) (56.3% vs. 31.7%; p = 0.046), preoperative empyema (37.5% vs. 2.4%; p = 0.001), postoperative empyema (100% vs. 9.8%; p = 0.000) and operative time (450.69 min vs. 367.73 min; p = 0.032). Conclusions: There are a series of factors associated with the presence of patients with BPF following pneumonectomy, many of them mainly related to operative and postoperative events, which is an important predictor of associated complications in our Peruvian population. https://cts.tgcd.org.tr/pdf.php?id=209 bronchopleural fistula; pneumonectomy; empyema; tuberculosis; complication eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-12-11 8 3 143 147 10.26663/cts.2023.0025 210 article Pathological diagnoses and adenosine deaminase levels in patients undergoing pericardial window operation for large pericardial effusions Ayfer Utkusavas 1 Murat Akkus 2 Ilker Kolbas 3 Hande Ikitimur 4 Department of Pulmonology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Istanbul Aydin University Medical Faculty, Istanbul, TurkeyDepartment of Pulmonology, Istanbul Aydin University Medical Faculty, Istanbul, TurkeyBackground: It might be challenging to determine the etiology of pericardial effusions as studies have usually focused on pericardial effusions in patients suspected to have specific underlying clinical conditions. We aimed to evaluate adenosine deaminase (ADA) levels in pericardial fluid samples of patients with large pericardial effusions in whom pericardial window surgeries with biopsy and pathological examinations were carried out. Materials and Methods: Pericardial fluid ADA levels of 149 consecutive patients having large pericardial effusions were evaluated. Pericardial effusion was detected by transthoracic echocardiography, ADA levels were measured from the fluid taken during pericardial windowing procedure, and pathological examination of the tissue samples were performed. Results: The median age of selected patients participating in the study was 58.43 ± 14.47 years. All the pericardial fluid samples were found to be exudative and 116 (77.9 %) of the cases had also concomitant pleural effusions. The median ADA level of the cases was calculated to be 19.57 U/L (9.47-38.70), well below the cut-off value (40 U/L). The mean ADA levels value was 9.21 U/L (7.70-9.91) in the nonspecific inflammations group and 38.35 U/L (23.92-48.67) in the lung malignancy group (p < 0.001). In the subgroup analysis of lung cancers, ADA levels in pericardial effusions of patients with adenocarcinoma were found to be statistically significantly higher than patients with squamous cell cancer. (p = 0.007). Conclusion: ADA levels in pericardial effusion were found to be significantly higher in lung cancer, especially in cases of lung adenocarcinoma. High levels of ADA may be used as a significative biochemical marker in the diagnosis of lung cancer. https://cts.tgcd.org.tr/pdf.php?id=210 pericardial effusionadenosine deaminasecancer eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-12-11 8 3 148 150 10.26663/cts.2023.0026 211 article Video-assisted thoracoscopic surgery lobectomy with guillotine stapler technique for the second primary adenocarcinoma of the lung after immunotherapy Dilara Gürsoy 1 Özgür Samancılar 2 Kutsal Turhan 1 Department of Thoracic Surgery, Faculty of Medicine, Ege University, Izmir, TurkeyDepartment of Thoracic Surgery, Medicana Hospital, Izmir, TurkeyImmunotherapy is gaining increasing attention as a neoadjuvant therapy for resectable non-small cell lung cancer (NSCLC). We report a case with second primary lung adenocarcinoma that was applied via video-assisted thoracoscopic surgery (VATS) lobectomy with guillotine stapler technique after treatment with immunotherapy in combination with chemotherapy. Although surgery is challenging after immunotherapy, this particular case showed that the VATS approach may be safe and feasible in experienced hands. https://cts.tgcd.org.tr/pdf.php?id=211 non-small cell lung cancerneoadjuvant therapyimmunotherapyvideo-assisted thoracoscopic surgery (VATS)nivolumablung resection eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-12-11 8 3 151 154 10.26663/cts.2023.0027 212 article Pulmonary carcinoid tumor of endobronchial presentation: a case report Mayra Valderrama-Saldaña 1 W Samir Cubas 2 Helen Reina 3 José Somocursio 3 Max Small 1 Service of Pneumology, Edgardo Rebagliati Martins National Hospital, Lima, PeruDepartment of Thoracic and Cardiovascular Surgery, Edgardo Rebagliati Martins National Hospital, Lima, PeruService of Pathological Anatomy, Edgardo Rebagliati Martins National Hospital, Lima, PeruLung carcinoid tumors account for 1-2% of malignant lung neoplasms. Early diagnosis is crucial, and surgery at an early stage may improve the clinical picture and may even be a curative option. We present a 78-year-old woman with a history of poorly controlled arterial hypertension, anxious syndrome, irritable bowel syndrome, and paroxysmal palpitations for the last two years. Radiologic imaging showed a left hilar nodular lesion causing endobronchial obstruction in the left lower lobe. Anatomopathology revealed a low-grade pulmonary neuroendocrine tumor, and pulmonary resection with nodal staging was promptly considered. The diagnosis of pulmonary carcinoid tumor is challenging; therefore, it is necessary to maintain suspicion in patients with non-specific and/or persistent respiratory symptoms, and complete resection and prolonged close follow-up should be considered despite a satisfactory postoperative course. https://cts.tgcd.org.tr/pdf.php?id=212 carcinoid tumorneuroendocrine tumorlung tumorcarcinoid syndrome eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-12-11 8 3 155 159 10.26663/cts.2023.0028 213 article First awake uniportal video assisted thoracoscopic lobectomy in turkey Volkan Karaçam Gönül Sagıroglu 2 Emrah Karcı 1 Fatma Mutlu 1 Ilkay Kaya 1 Department of Thoracic Surgery, Dokuz Eylul University Faculty of Medicine, Izmir, TurkeyDepartment of Anestesia and Reanimation, Dokuz Eylul University Faculty of Medicine, Izmir, TurkeyAs in all surgical branches, the importance of minimally invasive surgery in thoracic surgery has been increasing in recent years. Especially in the last decade, the preference of thoracic surgeons is mostly in favor of VATS. As a result of today's developing technology and experience, minimally invasive surgery is not limited to surgical technique only, and less invasive non-intubated methods have been started to be used in anesthesia applications. While non-intubated (awake) VATS is usually applied for reasons such as pleural effusion, empyema, hemothorax, pneumothorax, it is now preferred for anatomical resection of the lung. We also prefer the awake VATS method in suitable patients in our clinic. In this study, we aimed to talk about our case in which we performed left lower lobectomy and mediastinal lymph node dissection with awake uVATS (uniportal VATS) method in our clinic. https://cts.tgcd.org.tr/pdf.php?id=213 awake anesthesiauniportal VATSlobectomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2023-12-11 8 3 160 162 10.26663/cts.2023.0029 214 article Tuberous sclerosis and chylothorax Burcu Oksuz Gungor 1 Sami Karapolat 1 Omer Topaloglu 1 Atila Turkyilmaz 1 Department of Thoracic Surgery, Karadeniz Technical University Faculty of Medicine, Trabzon, TurkeyA 48-year-old female with tuberous sclerosis admitted with shortness of breath. The chest radiography revealed a left sided hydropneumothorax. A tube thoracostomy was and 2000 cc of chylous fluid was drained. As the daily drainage was not reduced, ligation of the thoracic duct was performed. The patient was discharged uneventfully. In cases of tuberous sclerosis presenting with chylothorax, a successful treatment can be applied with early thoracic duct mass ligation. https://cts.tgcd.org.tr/pdf.php?id=214 tuberous sclerosischylothoraxsurgery