eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 2 32 41 10.26663/cts.2025.009 255 article İlker Kolbaş 1 Serdar Evman 2 Hakan Kıral 2 Elçin Ersöz 2 Çağatay Tezel 3 Volkan Baysungur 2 Department of Thoracic Surgery, Istanbul Aydın University, VM Medical Park Florya Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Health Sciences University, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery Memorial Hospital, Istanbul, Turkey<b>Background:</b> Although stage IV non-small cell lung cancer (NSCLC) is often considered incurable, a growing body of evidence suggests that patients with oligometastatic disease-characterized by a limited number of metastases-may benefit from aggressive local treatment. This study evaluates the outcomes of patients with synchronous extrathoracic oligometastases and explores factors influencing survival.<p> <b>Materials and Methods:</b> We retrospectively analyzed 35 consecutive patients (4 females, 31 males) diagnosed with NSCLC who presented with synchronous extrathoracic metastases. All patients underwent standardized staging, including cervical mediastinoscopy, and, where feasible, both the primary tumor and metastatic lesions were managed with curative intent (surgery or ablative therapies).<p> <b>Results:</b> Overall mean survival was 38 ± 6 months; when hospital mortality (n = 4) was excluded, mean survival rose to 43 ± 7 months with a median of 27 months. The 1-, 2-, and 5-year survival rates were 58.9%, 47.7%, and 38.1%, respectively. Brain metastases were the most frequent site (74% of patients), and patients with brain metastases insignificantly exhibited higher mortality compared to other metastasis sites. Neither age, smoking history, nor tumor laterality significantly affected survival, and histological subtype did not confer a clear survival advantage.<p> <b>Conclusions: </b>In selected patients with synchronous oligometastatic NSCLC, aggressive treatment targeting both the primary tumor and metastases can extend survival beyond historical expectations for stage IV disease. Further large-scale prospective studies are needed to identify the subgroups most likely to benefit from bifocal (primary and metastatic) surgical management. https://cts.tgcd.org.tr/pdf.php?id=255 non-small cell lung cancersynchronous metastasisoligometastatic diseaselobectomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 2 42 48 10.26663/cts.2025.010 256 article Halil Kolcu 1 Caner İşevi 2 Yasemin Bilgin Büyükkarabacak 2 Ahmet Başoğlu 3 Department of Thoracic Surgery, Bayburt State Hospital, Bayburt, TurkeyDepartment of Thoracic Surgery, Ondokuz Mayis University, Medical Faculty, Samsun, TurkeyDepartment of Thoracic Surgery, Istanbul Atlas University, Medical Faculty, İstanbul, Turkey<b>Background: </b>Obesity, defined as a body mass index (BMI) of 30 kg/m² or greater, constitutes a substantial global health concern and is associated with an extensive spectrum of comorbid conditions, including numerous malignancies. Among these, lung cancer presents distinctive challenges, particularly with regard to surgical management. The present study examines the impact of obesity on clinical outcomes - namely, prognosis, postoperative complications, and overall survival - among patients undergoing lobectomy for primary lung cancer.<p> <b>Materials and Methods:</b> This retrospective analysis was conducted on a cohort of 1,000 patients who underwent lobectomy for lung cancer between 2010 and 2017. Following the application of predefined inclusion criteria-namely, pathological staging limited to 2A through 3A and the exclusion of cases with concurrent malignancies-a total of 71 patients were deemed eligible for the final analysis. Key clinical and perioperative variables were assessed, including body mass index (BMI), incidence of postoperative complications, duration of hospitalization, operative time, smoking history, and overall survival. Statistical analysis was performed using SPSS version 21.0. Group comparisons were conducted using independent samples t-tests for continuous variables with two categories, while one-way analysis of variance (ANOVA) was applied for comparisons involving more than two groups. Categorical data were evaluated using chisquare tests. A two-tailed p-value of less than 0.05 was considered indicative of statistical significance.<p> <b>Results: </b>Patients classified as obese exhibited a significantly longer postoperative survival duration when compared to individuals with normal or overweight BMI (p < 0.05). The incidence of postoperative complications was also notably lower in the obese group (p < 0.05). However, no statistically significant differences were observed among the BMI categories in terms of hospital stay length or operative time (p > 0.05). Interestingly, the prevalence of smoking was markedly lower among obese patients (p < 0.001). In contrast, among patients who survived less than five years following surgery, BMI was not found to be significantly associated with either extended hospitalization or postoperative complication rates.<p> <b>Conclusions: </b>The findings of this study highlight a compelling example of the so-called “obesity paradox” within the context of thoracic surgery. Despite the anticipated risks associated with higher BMI and accompanying comorbidities, obese patients demonstrated more favorable postoperative outcomes and improved survival compared to their non-obese counterparts. These results prompt further investigation into the biological and clinical factors contributing to this paradoxical trend, with the aim of better informing perioperative risk stratification and individualized treatment strategies in lung cancer surgery. https://cts.tgcd.org.tr/pdf.php?id=256 obesitybody mass indexlung cancerlobectomypostoperative complications eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 2 49 56 10.26663/cts.2025.011 257 article Ilker Kolbas 1 Feyza Sonmez Topcu 2 Berivan Karatekin 3 Berker Ozkan 4 Department of Thoracic Surgery, Istanbul Aydın University, Medical Faculty, Istanbul, TurkeyDepartment of Radiology, Istanbul Aydın University, Medical Faculty, Istanbul, TurkeyDepartment of Pulmonology, Istanbul Aydın University, Medical Faculty, Istanbul, TurkeyDepartment of Thoracic Surgery, Istanbul University, Medical Faculty, Istanbul, Turkey<b>Background:</b> Diaphragmatic elevation is among the earliest compensatory changes following lung resection; however, its extent and duration remain inadequately defined.<p> <b>Materials and Methods: </b>A retrospective analysis was conducted on 198 patients who underwent surgical treatment for non-small cell lung cancer between January 2022 and June 2023. Of these, 102 patients who underwent upper or lower lobectomy were included in the study. Diaphragmatic position was assessed using chest radiographs obtained preoperatively and on postoperative days 1, 10, and 30. Measurements were performed by independent radiologists and compared according to surgical approach (VATS vs. thoracotomy), lobectomy location (upper vs. lower), and operative side (right vs. left).<p> <b>Results:</b> Significant diaphragmatic elevation was observed on the first postoperative day and persisted through day 10. The mean difference between preoperative and postoperative day 1 measurements was 29.16 ± 12.93 mm (p < 0.0001). Partial recovery was noted by day 10 (p < 0.001). Both hemidiaphragms showed similar patterns, although the right hemidiaphragm demonstrated greater recovery. No significant associations were identified between diaphragmatic elevation and surgical approach, lobectomy location, or laterality (p > 0.05 for all comparisons).<p> <b>Conclusions: </b>Diaphragmatic elevation represents a normal anatomical adaptation in the early postoperative period following lung resection. Defining its expected extent and duration may facilitate the early recognition of postoperative complications. Larger-scale studies are warranted to establish definitive reference criteria for postoperative diaphragmatic elevation. https://cts.tgcd.org.tr/pdf.php?id=257 diaphragm elevationlobectomynon-small cell lung cancerpostoperative radiographic changesvideo-assisted thoracoscopic surgerythoracic surgery outcomes eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 2 57 63 10.26663/cts.2025.012 258 article Gamze Tanrıkulu 1 Tolga Evrim Sevinc 2 Hüseyin Melek 2 Eylem Yenturk 3 Erhan Ozer 4 Nilufer Aylin Acet Ozturk 5 Ahmet Ursavas 5 Cengiz Gebitekin 2 Ahmet Sami Bayram 2 Department of Thoracic Surgery, Gülhane Training and Research Hospital, Ankara, TurkiyeDepartment of Thoracic Surgery, Uludag University Faculty of Medicine, Bursa, TurkiyeThoracic Surgery Clinic, Luleburgaz State Hospital, Tekirdag, TurkiyeThoracic Surgery Clinic, Cekirge State Hospital, Bursa, TurkiyeDepartment of Pulmonary Diseases, Uludag University Faculty of Medicine, Bursa, Turkiye<b>Background: </b>This study was conducted to examine the change and results of our experience in bronchiectasis surgery.<p> <b>Materials and Methods:</b> The records of the patients who were operated for bronchiectasis between January 2000 and January 2022 were analyzed retrospectively. Patients were grouped according to the time of surgery (Group I: Jan 2000- Jan 2012 vs. Group II: Jan 2021- Jan 2022) and surgical approach (thoracoscopy vs. thoracotomy). Demographic and clinical characteristics of the patients, localization of bronchiectasis, surgical interventions and postoperative follow-up results were recorded and analyzed using SPSS 25.<p> <b>Results:</b> A total of 220 operations were performed. Eighty-six patients (39.1%) were male, mean age was 34.89 ±12.68 years. Bronchiectasis was mostly located in the lower lobes (55.9%). The most frequently performed resection was left lower lobectomy (44.5%). The mean tube extraction time was 4.78 ± 4.13 days, and the mean length of hospital stay was 5.88 ± 3.18 days. Patients who underwent thoracoscopy had significantly shorter hospital stays and lower complication rates compared to those who underwent thoracotomy (p = 0.001 and p = 0.004, respectively). Patients operated on in the last 10 years (Group II) had significantly fewer complications compared to those operated in the earlier 12-year period (Group I) (p = 0.028). Multiple logistic regression analysis revealed that VATS reduced the complication rates by 82.5%. No surgical mortality was observed, and the overall morbidity rate was 26.8%.<p> <b>Conclusions:</b> Bronchiectasis surgery is very beneficial in patients who do not respond to medical treatment. Due to the effects of developing technology and experience gained, successful results have been achieved with minimally invasive approaches in recent years. https://cts.tgcd.org.tr/pdf.php?id=258 videothoracoscopynon-cystic fibrosis bronchiectasisthoracotomylogistic regression eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 2 64 80 10.26663/cts.2025.018 259 article Ali Bilal Ulas 1 Yener Aydin 1 Atilla Eroglu 1 Department of Thoracic Surgery, Ataturk University, Medical Faculty, Erzurum, TurkeySurgical resection of pulmonary metastases is now widely considered for patients who meet the following criteria: controlled primary disease, absence of extensive extrapulmonary disease, fully resectable lung metastases, sufficient cardiopulmonary reserves, and lack of superior systemic treatment alternatives. Since the development of these selection criteria, additional prognostic factors have been proposed to better predict survival and optimize the selection of surgical candidates. Factors such as the disease-free interval (DFI), completeness of resection, surgical approach, number and laterality of lung metastases, and lymph node involvement play a dynamic role in determining patient outcomes.<p> Pulmonary metastasectomy is a common practice among thoracic surgeons, accounting for approximately 15% of all lung resections. While it is widely believed that pulmonary metastasectomy from a primary tumor elsewhere improves survival in selected patients, evidence for the additional benefit provided by surgery remains weak.<p> For patients with untreated metastatic disease, the five-year survival rate is less than 5–10%. Pulmonary metastasectomy often represents the best hope for treatment in cases of isolated metastatic disease to the lungs. It is a safe and effective treatment that offers potential recovery for selected patients. Regardless of the primary tumor, achieving complete resection is the key to improving survival. Low morbidity and mortality rates justify the aggressive surgical approach in the absence of effective systemic oncologic treatments. Thoracoscopic resection is a valid option for selected patients with a small number of peripherally located metastases. In cases of recurrent pulmonary disease, surgery should be repeated if the patient continues to meet the initial criteria for pulmonary metastasectomy. Postoperative aggressive follow-up is mandatory. Patients should be treated in close collaboration between medical oncologists, diagnostic radiologists, and thoracic surgeons. https://cts.tgcd.org.tr/pdf.php?id=259 pulmonary metastasectomysurgical resectiondisease-free intervalthoracoscopic surgerysurvival outcomesthoracic oncology eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 2 81 84 10.26663/cts.2025.013 260 article Argün Kış 1 Eren Zenci 1 Gökhan Öztürk 1 Department of Thoracic Surgery, Pamukkale University, School of Medicine, Denizli, Turkey<b>Background: </b>Spontaneous pneumothorax during pregnancy is a rare condition that can pose significant risks to both the mother and the fetus. This report presents the case of a 35-year-old woman with twin pregnancy resulting from in vitro fertilization who developed recurrent pneumothorax on the right side. The patient was initially treated with tube thoracostomy; however, due to prolonged air leakage, video-assisted thoracoscopic surgery with wedge resection was performed. This case underscores the necessity of a multidisciplinary approach for managing pneumothorax during pregnancy and evaluates optimal treatment strategies in light of current literature. https://cts.tgcd.org.tr/pdf.php?id=260 spontaneous pneumothoraxpregnancyin vitro fertilizationsurgeryvideo-assisted thoracoscopic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 2 85 88 10.26663/cts.2025.014 261 article Mehmet Akif Ekici 1 Oğuzhan Turan 1 Bayram Metin 1 İbrahim Ethem Özsoy 1 Mehmet Akif Tezcan 1 Department of Thoracic Surgery, Kayseri Education and Research Hospital, Kayseri, TurkeySchwannomas, also referred to as neurilemmomas, are benign neoplasms arising from Schwann cells within the peripheral nervous system. These tumors may develop at various anatomical sites, including the respiratory system, most commonly involving the chest wall and posterior mediastinum. Primary tracheobronchial schwannomas are exceedingly rare. In this report, we present the case of a 22-year-old male patient with an endotracheal schwannoma originating from the carina and extending into the trachea. https://cts.tgcd.org.tr/pdf.php?id=261 schwannomaendobronchial lesionbronchoscopy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 2 89 93 10.26663/cts.2025.015 262 article Ikram Arramach 1 Hicham Harmouchi 1;2 Khaoula El Amraoui 1 Maha Tachaouine 1 Marouane Lakranbi 1;2 Yassine Ouadnouni 1;2 Mohamed Smahi 1;2 Mustapha Maaroufi 2;3 Department of Thoracic Surgery, Hassan II University Hospital, Fès, MoroccoFaculty of Medicine, Pharmacy, and Dental Medicine, Sidi Mohamed Ben Abdellah University, Fès, MoroccoDepartment of Radiology, Hassan II University Hospital, Fès, MoroccoNodular ganglioneuroblastoma is an exceptionally rare neuroblastic neoplasm in the adult population. This report details a highly unusual case of posterior mediastinal ganglioneuroblastoma in a 55-year-old male who presented solely with posterior chest pain. Radiological investigations, including computed tomography and magnetic resonance imaging, demonstrated an encapsulated, highly cellular tumor in the left costovertebral groove at the D7 level, with no evidence of distant metastasis on positron emission tomography. The patient underwent successful surgical resection following preoperative embolization and experienced an uneventful postoperative recovery. Histopathological analysis confirmed the diagnosis of nodular ganglioneuroblastoma. In summary, ganglioneuroblastoma should be considered in the differential diagnosis of posterior mediastinal tumors, even in adult patients. https://cts.tgcd.org.tr/pdf.php?id=262 ganglioneuroblastomaneuroblastic tumorcase reportmediastinal tumorsurgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 2 94 97 10.26663/cts.2025.016 263 article Mehmet Akif Ekici 1 Oğuzhan Turan 1 Enes Fatih Çelik 1 Muhammet Halil Aydoğdu 1 Department of Thoracic Surgery, Kayseri Education and Research Hospital, Kayseri, TurkeySchwannomas are slow-growing, encapsulated, benign neoplasms originating from Schwann cells. Although these tumors are frequently asymptomatic, the most commonly reported symptoms include chest pain, back pain, dyspnea, and cough. In this report, we present a case of schwannoma treated surgically at our institution, with particular emphasis on the tumor’s size and the uncommon occurrence of cystic presentation. https://cts.tgcd.org.tr/pdf.php?id=263 schwannomacystic schwannomathoracic mass eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 10 2 98 101 10.26663/cts.2025.017 264 article Volkan Karaçam 1 Emrah Karcı 1 Fatma Mutlu 2 Department of Thoracic Surgery, Dokuz Eylul University Faculty of Medicine, İzmir, TurkeyDepartment of Thoracic Surgery, Eskisehir City Hospital, Eskişehir, TurkeyStraight back syndrome is an uncommon clinical entity characterized by tracheal compression resulting from loss of the normal dorsal curvature of the thoracic vertebrae and a reduced distance between the manubrium and the thoracic vertebrae. Herein, we present a case in which respiratory distress developed secondary to tracheal compression attributable to straight back syndrome, and partial manubrium sterni resection was performed utilizing a minimally invasive technique. https://cts.tgcd.org.tr/pdf.php?id=264 straight back syndrometracheal stenosisdyspneasternumtracheal compression