Thoracic injury profile in the geriatric population: an analysis of age-specific patterns and independent risk factors

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 116 124 10.26663/cts.2026.018 299 article Thoracic injury profile in the geriatric population: an analysis of age-specific patterns and independent risk factors Yusuf Cankaya 1 Fatih Catal 2 Burak Yesiltas 1 Emin Uysal 3 Burak Demirci 4 Abuzer Coskun 4 Department of Emergency Medicine, Siirt Training and Research Hospital, Siirt, TürkiyeDepartment of Emergency Medicine, Medical Faculty, Siirt University, Siirt, TürkiyeDepartment of Emergency Medicine, University of Health Sciences, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, TürkiyeDepartment of Emergency Medicine, University of Health Sciences, Istanbul Bağcılar Training and Research Hospital, Istanbul, TürkiyeBackground: The aim of this study was to evaluate the association between geriatric age and the presence of specific thoracic injuries in patients who presented to the emergency department with Materials and Methods: This retrospective observational study included 486 adult patients with thoracic trauma, categorized into young adults (18-64 years, n = 366) and geriatric patients (≥65 years, n = 120). Data on demographics, trauma etiology, thoracic pathologies, and concomitant injuries were analyzed using univariate and multivariate binary logistic regression models to identify independent Results: Significant differences were observed in trauma mechanisms; ground-level falls were the predominant mechanism in the geriatric group (p < 0.001), while high-energy mechanisms such as penetrating trauma, assault, and falls from height were significantly more frequent in young adults (p < 0.001). Regarding specific injuries, rib fractures were significantly more common in the geriatric group (p < 0.001). Conversely, pneumothorax and pneumomediastinum were significantly more prevalent in the young adult group (p < 0.001 and p = 0.01, respectively). Multivariate logistic regression analyses revealed that geriatric age was an independent risk factor for the development of rib fractures (OR: 3.99; p = 0.01) and was independently associated with a decreased risk of pneumothorax (OR: 0.36; p = 0.01). Conclusions: This study revealed that thoracic injury patterns vary with age. Geriatric age is independently associated with rib fractures, whereas pneumothorax and pneumomediastinum are more frequent in young adults. These findings highlight the importance of considering age-specific injury https://cts.tgcd.org.tr/pdf.php?id=299 emergency servicehospitalgeriatricpneumothoraxrib fracturesrisk factorsthoracic injuries eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 125 130 10.26663/cts.2026.019 300 article Short-term effects of respiratory physiotherapy training on pulmonary function test parameters Mehmet Unal 1 Bayram Cagri Sakariya 1 Ozlem Bolel 2 Mustafa Kuzucuoglu 1 Servet Seckin Tunc 3 Keramettin Ibrahim Taylan 3 Serdar Sirzai 3 Department of Thoracic Surgery, Faculty of Medicine, Izmir Katip Çelebi University, Izmir, TürkiyeDepartment of Physiotherapy and Rehabilitation, İzmir Atatürk Education and Research Hospital, Izmir, TürkiyeDepartment of Thoracic Surgery, Izmir Atatürk Education and Research Hospital, Izmir, TürkiyeBackground: In this study, we aimed to determine the effect of preoperative respiratory exercise training and practice on spirometric parameters, which are among the most critical factors evaluated Materials and Methods: Fifth-year medical students consisting of healthy individuals were included in the study. The participants were divided into a study group and a control group. The study group received respiratory physiotherapy training and was instructed to perform the exercises for four days. Pulmonary function tests were administered to both groups on the first and fifth days. Results: A total of 118 healthy individuals with a mean age of 24.27 ± 1.18 years were included in the study. Of these, 66 participants constituted the study group and 52 the control group. In the study group, the second measurement of forced vital capacity (FVC) was significantly lower than the first measurement (p < 0.001). In the control group, no statistically significant difference was observed between pre- and post-measurements. The FVC% predicted was also significantly lower in the second measurement compared to the first in the study group (p < 0.001). Furthermore, the second FVC measurement in the study group was significantly lower than that of the control group (p = 0.045). The change in forced expiratory volume in one second (FEV1) differed significantly between the study and control groups (p = 0.018). While a decrease in FEV1 was observed in the study group, an increase was Conclusions: We suggest that individualized physiotherapy protocols and targeted interventions are required to accurately determine the true impact of respiratory physiotherapy in preoperative settings. https://cts.tgcd.org.tr/pdf.php?id=300 enhanced recovery after surgery (ERAS)thoracic surgerypulmonary rehabilitationspirometry 125 eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 131 137 10.26663/cts.2026.020 301 article Dual-axis learning curve of a newly established robotic mediastinal surgery program: an approach-adjusted cusum analysis Mehlika Iscan 1 Omer Yavuz 1 Ali Yeginsu 1 Department of Thoracic Surgery, Başakşehir Çam and Sakura City Hospital, İstanbul, TürkiyeBackground: To objectively evaluate the dual-axis learning curve and safety profile of a newly established robotic mediastinal surgery program using an approach-adjusted methodology to account for anatomical and Material and Methods: A retrospective analysis of 41 consecutive patients who underwent robotic-assisted thoracic surgery (RATS) for mediastinal lesions between December 2023 and December 2025 was conducted. Procedures included lateral decubitus and subxiphoid approaches. To mitigate variations in case complexity, an Observed-Expected (O-E) approach-adjusted Cumulative Sum (CUSUM) model was employed for both access/docking time (operating room team adaptation) and console time (procedural adaptation). Phase 1 Results: The mean age was 44.8 ±13.4 years. The approach-adjusted console time CUSUM demonstrated an inflection point at case 16, whereas the access/docking time CUSUM reached inflection at case 24. Comparing Phase 1 (n = 16) and Phase 2 (n = 25), the median O-E console time deviation showed a trend toward improvement from +10.0 to -13.9 minutes (p = 0.219), despite an increased proportion of technically demanding subxiphoid cases in Phase 2. Estimated blood loss significantly decreased in Phase 2 (0.0 mL vs. 10.0 mL, p = 0.025). The safety profile remained high, with no conversions in the learning phase, low postoperative complications (n = 2 vs. n = 2), and zero mortality. Conclusions: The implementation of a newly established robotic mediastinal surgery program demonstrates feasibility with acceptable short-term outcomes when preceded by structured training. A dual-axis approachadjusted CUSUM analysis suggests that procedural proficiency and team adaptation occur at different phases, https://cts.tgcd.org.tr/pdf.php?id=301 Robotic-assisted thoracic surgerythymectomymediastinal diseaseslearning curve eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 138 146 10.26663/cts.2026.021 302 article Outcomes and prognostic factors following surgical treatment of pulmonary large cell neuroendocrine carcinoma Berk Cimenoglu 1;2 Fatma Tugba Ozlu 1 Talha Dogruyol 1 Attila Ozdemir 1 Mesut Buz 1 Recep Demirhan 1;2 Department of Thoracic Surgery, Kartal Dr. Lutfi Kirdar City Hospital, İstanbul, TürkiyeDepartment of Thoracic Surgery, University of Health Sciences, International Medical Faculty, İstanbul, TürkiyeBackground: Pulmonary large cell neuroendocrine carcinoma (LCNEC) is a rare subtype of lung cancer with a poor prognosis, making its management challenging. This study aimed to evaluate the surgical outcomes of patients who underwent resection for LCNEC at our clinic during the past 10 years Materials and Methods: Patients who underwent surgery for lung cancer were retrospectively reviewed. Those with a postoperative histopathological diagnosis of LCNEC were included. Demographic and clinicopathological characteristics were analyzed, and factors affecting survival were investigated. Results: Between January 2016 and December 2025, pulmonary resection was performed in 1066 patients with primary lung cancer, of whom 36 (3.4%) had LCNEC. The mean overall survival (OS) was 56.4 ± 8.0 months, with a 5-year OS rate of 42.8%. The mean disease-free survival (DFS) was 37.7 ± 7.4 months, with a 5-year DFS rate of 26.1%. Patients who received adjuvant therapy had significantly better OS (p < 0.001) and a trend toward improved DFS (p = 0.215) compared to those who did not, particularly in stage II and higher disease (p < 0.001 and p = 0.177, respectively). The presence of spread through air spaces (STAS) and higher N stage were associated with worse survival outcomes, although these differences did not reach statistical significance. Conclusions: Adjuvant therapy is associated with improved survival in patients undergoing surgery for https://cts.tgcd.org.tr/pdf.php?id=302 pulmonary large cell neuroendocrine carcinomasurgical resectionprognosis eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 147 155 10.26663/cts.2026.022 303 article Clinical access restrictions in totally implantable venous access port (tivap) implantation: revision and malposition outcomes in a 1,224-patient cohort Omer Yavuz 1 Mehlika Iscan 1 Muhammet Kertmen 1 Reyhan Ertan 1 Ali Yeginsu 1 Department of Thoracic Surgery, Basaksehir Çam and Sakura City Hospital, İstanbul, TürkiyeBackground: Current guidelines recommend the right internal jugular vein as the primary access route for totally implantable venous access port (TIVAP) implantation. However, oncologic patients frequently present with anatomical or clinical constraints that necessitate alternative venous access routes. This study aimed to evaluate whether clinical conditions restricting guideline-preferred access planning are associated with increased revision or catheter malposition rates in TIVAP implantation. Material and Methods: This retrospective single-center, single-operator study included 1,224 consecutive adult patients who underwent TIVAP implantation between June 2022 and January 2026. Patients with clinical conditions limiting cervical or pectoral access were classified as the restrictedaccess group (n = 115), while the remaining patients comprised the standard-access group (n = 1,109). Primary outcomes were revision and catheter malposition. Logistic regression analyses were performed Results: Left-sided access (12.2% vs 1.4%, p < 0.001) and subclavian vein use (47.0% vs 20.2%, p < 0.001) were significantly more frequent in the restricted-access group. Revision rates (4.3% vs 3.7%, p = 0.612) and catheter malposition rates (1.7% vs 0.7%, p = 0.240) did not differ significantly between groups. Restricted-access status was not independently associated with revision (OR 1.08, 95% CI 0.38-3.01, p = 0.887) or malposition (OR 0.86, 95% CI 0.15-4.70, p = 0.861). Subclavian vein use was associated with catheter malposition (OR 34.84, 95% CI 4.31-281.2, p = 0.001). Conclusions: No statistically significant increase in revision or catheter malposition risk was observed in patients with clinical conditions restricting guideline-preferred access planning. When applied within a standardized procedural framework, alternative venous access strategies may be feasible according to https://cts.tgcd.org.tr/pdf.php?id=303 vascular access devicerevision surgerysubclavian veinhead and neck neoplasm eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 156 161 10.26663/cts.2026.023 304 article Lower body mass index is associated with prolonged air leak after pulmonary resection Cagatay Cetinkaya 1 Hasan Fevzi Batirel 2 Department of Thoracic Surgery, Uskudar University, İstanbul, TürkiyeDepartment of Thoracic Surgery, Biruni University, İstanbul, TürkiyeBackground: Prolonged air leaks are one of the most common complications following pulmonary resection and are associated with increased morbidity, prolonged hospital stays, and higher healthcare costs. This study evaluated factors associated with prolonged air leak, with emphasis on body mass Material and Methods: This retrospective single-center study included 152 patients who underwent pulmonary resection between October 2022 and October 2025. Prospectively collected data were analyzed retrospectively. Patients were divided into two groups: Group 1 (air leak >5 days) and Group 2 (no air leak or ≤5 days). Demographic, clinical, and perioperative variables were compared. Results: Prolonged air leaks occurred in 20 patients (13.2%). Patients in Group 1 had lower body mass index compared to Group 2 (23.6 ± 3.8 vs. 27.1 ± 4.7 kg/m², p = 0.0009). Anatomical resection was more frequent in Group 1 (85.0% vs. 50.0%, p = 0.007). Diffusing capacity of the lung for carbon monoxide (%) was lower in Group 1 (64.0 ± 19.1 vs. 74.0 ± 22.6, p = 0.042). The length of hospital stay was longer in Group 1 (6.0 ± 2.7 vs. 4.0 ± 2.2 days, p = 0.004). No significant differences were Conclusions: Prolonged air leak remains a common complication following pulmonary resection and is associated with prolonged hospital stay. Lower body mass index and anatomical resection were significant factors associated with its development. These findings suggest that body mass index, evaluated as a continuous variable, may help identify patients at higher risk and guide perioperative https://cts.tgcd.org.tr/pdf.php?id=304 prolonged air leakpulmonary resectionbody mass indexrisk factorslength of stay eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 162 174 10.26663/cts.2026.024 305 article Predicting talc pleurodesis outcomes: insights from early systemic inflammatory biomarkers and machine learning analysis Ismail Tombul 1 Elgun Valiyev 1 Aysegul Kurtoglu Turan 2 Ismail Cuneyt Kurul 2 Muhammet Sayan 2 Ali Celik 2 Department of Thoracic Surgery, Ankara Training and Research Hospital, University of Health Sciences, Ankara, TürkiyeDepartment of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, TürkiyeBackground: This study aimed to investigate the predictive value of early post-procedural systemic inflammatory biomarkers and baseline pleural fluid parameters in determining the clinical success of talc pleurodesis using a machine learning-based framework. Materials and Methods: Data from 51 evaluable patients who underwent talc pleurodesis between June 2019 and April 2026 were retrospectively analyzed. Clinical success was defined as the absence of recurrence at the 1-month follow-up. Baseline pleural fluid parameters and post-procedural 2-hour systemic inflammatory markers were recorded. Features were analyzed using a regularized LASSO (L1) logistic regression model under stratified 5-fold cross-validation and visualized via global TreeSHAP analysis. Unsupervised k-means clustering was additionally implemented to identify distinct patient stratification trajectories based on inflammatory kinetics. Results: The overall success rate was 68.6% (n = 35). Although acute post-procedural shifts occurred across traditional systemic markers, univariate analyses demonstrated no linear differentiation between outcomes. However, in the LASSO multivariate framework, baseline intrapleural total protein emerged as the strongest independent predictor of success, validated by robust AUC and TreeSHAP configurations. Unsupervised k-means clustering successfully stratified patients into distinct phenotypes, revealing that a regulated, stable inflammatory kinetic profile yields significantly superior clinical efficacy compared Conclusions: While early systemic inflammatory markers lack standalone linear predictive capacity, machine learning uncovers critical non-linear prognostic phenotypes based on acute biomarker kinetics. Baseline intrapleural total protein remains a robust local predictor, highlighting that a pre-existing exudative microenvironment, coupled with a regulated systemic inflammatory response, dictates talc https://cts.tgcd.org.tr/pdf.php?id=305 pleurodesisinflammationtalcstressphysiological eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 175 183 10.26663/cts.2026.033 306 article Environmental microplastic exposure and lung cancer: emerging evidence and a thoracic surgery perspective Rasih Yazkan 1 Süleyman Emre Akın 1 Hasan Ekrem Camas 1 Department of Thoracic Surgery, Süleyman Demirel University, School of Medicine, Isparta, TürkiyeIn modern times, microplastics are common environmental contaminants that are of increasing importance for human health. Ingestion has been traditionally regarded as the dominant route of exposure. However, inhalation of airborne microplastics represents a direct and biologically relevant exposure route to the respiratory system. Increasing evidence, both experimental and review-based, suggests that inhaled microplastics may become trapped in lung tissue, remain there for long periods of time, generate oxidative stress and chronic inflammation, and disrupt normal cellular function in the lungs. These pathophysiological mechanisms may be directly involved in the development of lung cancer. From the perspective of thoracic surgery, exposure to microplastics can influence the epidemiology of lung cancer, tumor biology, perioperative risk, and future surgical decision making. Identification of these novel relationships could place thoracic surgeons at the intersection of surgical oncology and environmental health. This article aims to increase public awareness of environmental microplastic exposure and the possible link between microplastic exposure and lung cancer based on published peer-reviewed research. The purpose is to evaluate the potential impact of microplastics on thoracic surgery procedures and to alert thoracic surgeons about the possibility of an increase in lung https://cts.tgcd.org.tr/pdf.php?id=306 microplasticenvironmentallung cancerthoracic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 184 189 10.26663/cts.2026.025 307 article Late-onset right main bronchus erosion and penetration developing on the basis of chronic fungal infection (aspergillus) originating from a central venous port: a rare case report Nurefsan Okyay 1 Damla Hasgul 2 Tibet Ugur Kurak 3 Erhan Ayan 1 Department of Thoracic Surgery, Faculty of Medicine, Mersin University, Mersin, TürkiyeDepartment of Thoracic Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, TürkiyeDepartment of Thoracic Surgery, Karaman Education and Research Hospital, Karaman, TürkiyeCurrently, the increase in the population of patients with malignancies has led to a rise in the use of chemotherapeutic treatments. Due to the thrombophlebitic effects of chemotherapeutic agents, temporarily established vascular access routes gradually lose their functionality. Therefore, clinicians increasingly prefer central venous port placement in this patient group. Central venous port placement offers advantages such as multi-drug administration, rapid fluid resuscitation, administration of chemotherapeutic agents, and parenteral nutrition. However, since it is an invasive procedure, various complications can occur in both the early and late stages. Early complications include carotid artery injury, catheter malposition, hydrothorax, pneumothorax, air embolism, tracheobronchial injury, and nerve damage. Late complications include infections, thrombophlebitis, and, in rare cases, catheter malpositioning. In this report, we aimed to present the management of a complicated catheter-related complication in a patient who underwent central venous port placement for radical chemotherapy due to pancreatic malignancy and was subsequently diagnosed with mediastinal aspergilloma during followup. After antifungal therapy, follow-up evaluation revealed erosion of the right main bronchus by the port catheter, resulting in penetration of the catheter into the bronchial lumen. https://cts.tgcd.org.tr/pdf.php?id=307 late catheter-related complicationmediastinal aspergillomatracheobronchial penetration eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 190 193 10.26663/cts.2026.026 308 article Management of intraoperative breast implant injury during sternal metastasectomy and chest wall reconstruction: a surgical challenge Kubra Nur Kilic 1 Serkan Ozden 1 Sami Karapolat 1 Department of Thoracic Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, TürkiyeBreast cancer is the most common malignancy in women, and the concept of oligometastasis supports local treatment in selected cases. Bone is the most frequent metastatic site, while isolated sternal involvement is uncommon. However, prior implant-based breast reconstruction introduces additional technical challenges, including the risk of intraoperative implant injury. A 40-year-old woman with a history of bilateral mastectomy and implant-based reconstruction presented with an isolated lytic metastasis of the sternal corpus 14 months after initial treatment. She underwent subtotal sternal resection with en bloc removal of adjacent costochondral segments, followed by chest wall reconstruction using titanium bars and costal clips. Intraoperatively, implant injury was detected and managed through the same incision with immediate replacement in collaboration with plastic surgery. The postoperative course was uneventful, and the patient was discharged on postoperative day three without complications. Isolated sternal metastasis from breast cancer is rare and may be amenable to surgical resection in selected patients. Although prior implant-based reconstruction increases technical complexity, sternal metastasectomy and chest wall reconstruction can be safely performed with careful planning and multidisciplinary management, even in the setting of intraoperative implant injury. https://cts.tgcd.org.tr/pdf.php?id=308 breast cancersternummetastasisbreast implantsthoracic wallreconstructive surgical procedures eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 194 198 10.26663/cts.2026.027 309 article Single-port left lower lobe common basal segmentectomy: the first experience in robotic surgery in türkiye Tugba Cosgun 1 Cagatay Saim Tezel 1 Department of Thoracic Surgery, Haliç University Medical Faculty, Memorial Şişli Hospital, İstanbul, TürkiyeRobotic thoracic surgery has evolved as an advanced minimally invasive approach that provides enhanced dexterity, three-dimensional visualization, and improved ergonomics compared with video-assisted thoracoscopic surgery. The dedicated da Vinci SP platform represents a further development in robotic surgery, enabling true single-port access and potentially reducing surgical trauma while maintaining the benefits of minimally invasive surgery. We present the first thoracic surgical case in Türkiye performed using the Intuitive Surgical da Vinci SP system: a single-port robot-assisted left lower lobe common basal segmentectomy with mediastinal lymph node dissection. A 51-year-old female non-smoker was found to have a 13-mm centrally located pulmonary nodule that remained stable during follow-up but demonstrated moderate metabolic activity on positron emission tomography. Owing to its proximity to the segmental bronchus, wedge resection was not feasible, and anatomical segmentectomy was planned. The procedure was successfully completed using the da Vinci SP platform with systematic lymph node dissection and indocyanine green-guided identification of the intersegmental plane. The postoperative course was uneventful, with chest tube removal on postoperative day 1 and discharge on postoperative day 3. Final pathology revealed sclerosing pneumocytoma. This case demonstrates the feasibility of anatomical segmentectomy using the dedicated da Vinci SP system and highlights its potential technical advantages in the management of centrally located indeterminate pulmonary nodules. https://cts.tgcd.org.tr/pdf.php?id=309 robotic-assisted thoracic surgerysingle-port robotic surgerypulmonary segmentectomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 199 202 10.26663/cts.2026.028 310 article Presternal elastofibroma: an unusual anterior chest wall presentation following median sternotomy Sukran Sena Ozdemir 1 Fevzi Oguzhan Temirkaynak 1 Gunel Ahmadova 1 Ali Celik 1 Muhammet Sayan 1 Department of Thoracic Surgery, Faculty of Medicine, Gazi University, Ankara, TürkiyeElastofibroma is an uncommon benign soft-tissue lesion that most frequently arises in the subscapular region of elderly patients. It predominantly affects females, and occurrences outside the periscapular region are exceedingly rare and may pose a diagnostic challenge. A 59-year-old man presented with a progressively enlarging, palpable, and painful mass in the presternal region. Physical examination revealed a firm, fixed lesion beneath a previous sternotomy scar. Ultrasonography demonstrated a vascularized soft-tissue mass, while thoracic computed tomography showed a solid lesion adjacent to the sternum. Because malignancy could not be ruled out, complete surgical excision was performed. Histopathological evaluation established the diagnosis of elastofibroma. The postoperative course was uneventful, and no recurrence was detected during follow-up. Presternal elastofibroma is an exceptionally rare entity. In the present case, chronic mechanical irritation related to a malpositioned sternal wire may have contributed to lesion development, highlighting the importance of considering elastofibroma in the differential diagnosis of unusual anterior chest wall masses. https://cts.tgcd.org.tr/pdf.php?id=310 elastofibroma dorsichest wallpresternal masssternotomysoft tissue neoplasms eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 203 207 10.26663/cts.2026.029 311 article Staged reconstruction of thoracic ectopia cordis with complete sternal aplasia: a case report Ahmet Umut Yuvaci 1 Eyüphan Gencel 1 Onur Benli 2 Private Practice in Plastic, Reconstructive and Aesthetic Surgery, İstanbul, TürkiyeDepartment of Cardiovascular Surgery, Faculty of Medicine, Çukurova University, Adana, TürkiyeEctopia cordis is a rare and frequently fatal congenital anomaly characterized by partial or complete displacement of the heart outside the thoracic cavity due to defective midline fusion during embryogenesis. Surgical management remains challenging because of the associated cardiac and chest wall defects. A 37-week gestational age neonate presented with thoracic ectopia cordis, atrial septal defect, pericardial defect, and complete sternal aplasia. On day 29 of life, after hemodynamic stabilization and multidisciplinary operative planning, the patient underwent combined cardiovascular and reconstructive surgery. Following cardiac repositioning into the thoracic cavity and pericardial reconstruction using a bovine pericardial patch, chest wall reconstruction was performed with bipedicled fasciocutaneous flaps harvested from the pectoral region. Initial postoperative recovery was complicated by suture line necrosis, which required surgical debridement and Z-plasty reconstruction. Subsequent patch exposure was successfully managed with patch excision, flap release, medial advancement, repeat Z-plasty reconstruction, and wound dressings. Wound cultures demonstrated no significant bacterial growth. Complete secondary healing was achieved without additional complications. Thoracic ectopia cordis requires individualized multidisciplinary management and careful staged reconstruction. Bipedicled fasciocutaneous flaps provided reliable soft tissue coverage and allowed successful reconstruction following postoperative wound complications. Flexible reconstructive strategies and close postoperative monitoring may improve outcomes in these complex patients. https://cts.tgcd.org.tr/pdf.php?id=311 ectopia cordischest wall reconstructionsurgical flapssternal aplasia eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 208 213 10.26663/cts.2026.030 312 article Simultaneous robotic right middle lobectomy and thymectomy via a single-docking, supine approach: a strategic 5-port solution Huseyin Yildiran 1 Atilla Can 1 Tuba Sahinoglu 1 Muhammet Ali Tiske 1 Serhat Kizilkaya 1 Esra Sahiner 1 Department of Thoracic Surgery, Faculty of Medicine, Selçuk University, Konya, TürkiyeThe management of synchronous mediastinal and pulmonary pathologies presents a significant technical challenge, often requiring staged operations, intraoperative patient repositioning, or system re-docking. We report a case of a 67-year-old man with active myasthenia gravis and a synchronous right middle lobe pulmonary nodule who successfully underwent simultaneous robotic total thymectomy and right middle lobectomy during a single session. This single-docking robotic strategy maximizes the robotic system’s ergonomic advantages, eliminates the risks of repeated anesthesia in neurologically vulnerable patients, and offers an efficient alternative for multi-compartment thoracic resections. https://cts.tgcd.org.tr/pdf.php?id=312 lobectomymyasthenia gravisrobotic surgical proceduresthymectomysynchronous neoplasms eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 214 219 10.26663/cts.2026.031 313 article Primary mediastinal small round cell tumor suggestive of ewing’s sarcoma associated with pneumothorax: a case report Peter O. Adeoye 1;2 Hassan I. Abubakar 2 Akolo A. Dominic 3 Robert Udo 2 Department of Surgery, Division of Thoracic and Cardiovascular Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Kwara, NigeriaDepartment of Surgery, Division of Cardiothoracic Surgery, Federal Medical Centre Keffi, Nasarawa, NigeriaDepartment of Anatomic Pathology and Forensic Medicine, Federal Medical Centre Keffi, Nasarawa, NigeriaEwing’s sarcoma (ES) is a rare form of malignancy that commonly affects the bone. Extraskeletal ES (EES) accounts for 20% of ES cases. The mediastinum is an exceedingly rare primary site of EES and presents with non-specific symptoms that may mimic several other thoracic pathologies. We describe a suspected case of primary mediastinal ES presenting with pneumothorax in a 17-year-old female who presented with chronic cough, dyspnea, and chest pain. The patient had been commenced on empirical treatment for tuberculosis (a common diagnosis in our sub-region) for six weeks before presentation to our facility, due to a lack of improvement in symptoms. Chest computed tomography scan revealed a huge anterior mediastinal mass extending into the left hemithorax with pneumothorax on the right. She underwent a transthoracic percutaneous biopsy, and histological analysis revealed a monomorphic small-round-cell morphology, suggestive of primary mediastinal Ewing’s sarcoma. https://cts.tgcd.org.tr/pdf.php?id=313 mediastinal neoplasmsEwing’s sarcomapneumothoraxneuroectodermal tumorsextraskeletal eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 0000-00-00 11 2 220 229 10.26663/cts.2026.032 314 article Surgical management of complex esophageal perforations: a case series with early and delayed presentations Mohamed El Adel 1 Mohamed Alaa Nady 1 Department of Cardiothoracic Surgery, Assiut University, Faculty of Medicine, Asyut, EgyptEsophageal perforation from sharp trauma, including ingested foreign bodies, carries significant morbidity and mortality. This retrospective case series describes our experience with early surgical management across seven heterogeneous cases. We reviewed the records of seven patients with esophageal perforation admitted to our center between July 2015 and January 2022. Etiologies included impacted disc batteries (n = 3), a penetrating syringe needle, an ingested nail, a firearm injury, and false intubation. Data on presentation, surgical intervention, and outcomes were collected. The series included five children (10 months to 4 years) and two adults (aged 23 and 43 years). Surgical approaches varied by injury location and included cervicotomy, thoracotomy, and laparotomy for feeding tube placement. Six patients survived with eventual resumption of oral intake, though recovery was prolonged in delayed presentations. One mortality occurred from an unrecognized aorto-esophageal fistula following disc battery extraction. In this small, heterogeneous case series, early surgical intervention facilitated foreign body removal, mediastinal drainage, primary repair, and enteral access, contributing to favorable outcomes in most patients. Delayed diagnosis, particularly of aorto-esophageal fistula, remains a critical https://cts.tgcd.org.tr/pdf.php?id=314 foreign body impactionesophageal perforationfalse intubationaorto-esophageal fistuladisc battery ingestion