Pneumonectomy; a risky type of resection in non-small cell lung cancer: survival and mortality analysis

eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 102 109 10.26663/cts.2019.00020 55 article Pneumonectomy; a risky type of resection in non-small cell lung cancer: survival and mortality analysis Serkan Yazgan 1 Soner Gursoy 1 Ahmet Ucvet 1 Ozgur Samancilar 1 Ahmet Emin Erbaycu 2 Mehmet Unal 1 Tarik Yagci 1 Department of Thoracic Surgery, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, İzmir, TurkeyDepartment of Chest Diseases, University of Health Sciences, Dr. Suat Seren Chest Diseases and Surgery Medical Practice and Research Center, İzmir, TurkeyBackground: This study aims to evaluate the mortality and survival rates of patients undergoing pneumonectomy due to primary non-small cell lung cancer (NSCLC) and to identify the factors which affect these variables. Materials and Methods: This retrospective single center cohort study included a total of 250 patients who underwent pneumonectomy due to NSCLC between January 2007 and July 2015. 30- and 90-day mortality rates and survival rates of the patients were analyzed. The factors which affected survival and mortality were evaluated. Results: The mean age was 59 (range: 35 to 77) years. The median survival was 48.1 months (95% C. I. 30.6 – 65.6 months) and five-year survival rate was 45.6%. The 30- and 90-day mortality rates were 6.4% and 7.6%, respectively. Age, nodal disease, and complete resection were factors to affect the survival (p = 0.002, p = 0.0001 and p = 0.017, respectively). Age was also effective on 30- and 90-day mortality (p = 0.004, RR: 3.3 and p = 0.006, RR: 2.5, respectively). The early rethoracotomy rate was 5.6% (n = 14) and the postoperative mortality rate in these patients was 28.6% (n = 4). Conclusions: Although implementation of pneumonectomy due to lung cancer seems fearful, the present study found lower survival rates only depending on advanced age and N2 disease. The high levels of 30- and 90-day mortality and the increased mortality after early rethoracotomy was associated with advanced age and comorbidity. In terms of postoperative mortality, the selection of eligible patients is important in elderly patients who are candidates of pneumonectomy due to lung cancer. https://cts.tgcd.org.tr/pdf.php?id=55 non-small cell lung cancerpneumonectomysurvival rateearly mortality eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 110 115 10.26663/cts.2019.00021 56 article Is surgical treatment effective option for survival of small cell lung cancer? Celal Buğra Sezen 1 Umut Kilimci 1 Oğuz Girgin 1 Yunus Aksoy 1 Ozkan Saydam 1 Seyyit İbrahim Dincer 1 Muzaffer Metin 1 Department of Thoracic Surgery, Health Sciences University, Chest Diseases and Thoracic Surgery Health Application and Research Center, Istanbul, TurkeyBackground: Small cell lung cancer (SCLC) accounts for 10% of all lung cancers. Due to the fact that it is an aggressive tumor, there is still no consensus on treatment. Our aim in this study was to evaluate prognostic factors affecting survival in early-stage small cell lung cancer. Materials and Methods: Between 2008 and 2017, 21 patients who underwent resection due to earlystage SCLC were evaluated retrospectively in the study. 16 (76.2%) stage I and 5 (23.8%) stage II patients were included in the study. All patients received adjuvant therapy after surgery. Results: Sixteen (76.2%) male and 5 (23.8) female patients were included in the study. The mean age was 60.19 ± 7.13 years. Patients were followed for a mean of 33 months. There was 16 (76.2%) small cell, and 5 (23.6%) combined small cell carcinoma. The 5-year survival rate was 48.6% (59.6 ± 10.6 months). In 7 patients (33.3%) postoperative morbidity was observed. No statistically significant difference was found between N status and survival. Statistically significant differences were found between tumors smaller than 1 cm and tumors greater than 1 cm in terms of T stage (p = 0.043). Conclusions: In conclusion, multimodal treatment is very important for survival in early-stage small cell lung cancer. Although our results in our study are aggressive tumors of the SCLC, survival outcomes in the early stages are quite satisfactory. Early stage survival outcomes, especially after stage I tumors, are as successful as non-small cell lung cancers. https://cts.tgcd.org.tr/pdf.php?id=56 small cell lung cancerlobectomyprognostic factors eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 116 122 10.26663/cts.2019.00022 57 article Can neutrophil to lymphocyte ratio and platelet to lymphocyte ratio predict the severity of sternum fractures? Muharrem Özkaya 1 Cihan Bedel 2 Department of Thoracic Surgery, Health Sciences University, Antalya Training and Research Hospital, Antalya, TurkeyDepartment of Emergency Medicine, Health Sciences University, Antalya Training and Research Hospital, Antalya, TurkeyBackground: Although the NLR and PLR are cheap and widely available biomarkers, literature regarding their usage in trauma patients is scarce. It seemed to us interesting to evaluate the prognostic value of the NLR and PLR for trauma patients. In this manner, we selected a small group of trauma patients with sternal fractures and aimed to investigate their correlation with the serum NLR and PLR. To the best of our knowledge, this is the first study investigating the clinical value of these cheap and widely available biomarkers in trauma patients. Materials and Methods: We designed a retrospective study examining the utility of NLR and PLR in estimating trauma severity in sternum fracture patients who admitted to our hospital between January 2013 and April 2018. Patients were divided into two groups: isolated sternum fracture group (36 patients with sternal fracture and without any complications in thorax or other system and/or only 1 or 2 rib fractures) and complicated sternum fracture group (19 patients with sternal fracture and with associated complications in thorax or other systems). Injuries were not graded but referred as severe according to the associated complications in thorax or other systems. The key clinical parameters, including NLR and PLR were compared among the groups. Results: Based on the ROC curve, the best NLR cut-off value to predict complicated sternum fracture group patients was 2.1, with 88.9% sensitivity and 28% specificity, whereas the best PLR cut-off value was 123.8, with 72% sensitivity and 68% specificity. Conclusions: The results may indicate a clinically useful marker that can be easily and reliably measured from a blood sample to predict outcome of trauma patients with sternal fractures. https://cts.tgcd.org.tr/pdf.php?id=57 sternum fractureneutrophillymphocyteplateletratio eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 123 127 10.26663/cts.2019.00023 58 article Comparison of the outcomes of the implanted subcutaneous ports in cancer patients: six-years single center experience Ali Cevat Kutluk 1 Hasan Akın 1 Department of Thoracic Surgery, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyBackground: The preferred site of venous access ranges from deep veins (internal jugular or subclavian veins) to superficial veins (external jugular, anterior jugular, and upper limb veins). The aim of the study is to evaluate experience of single surgeon and compare the outcomes of the subclavian (SCV), internal jugular (IJV), and external jugular (EJV) veins in terms of procedure time and complications retrospectively. Materials and Methods: The study included 327 patients who had port placement between 2012 and 2018. The mean age of all cases was 55.67 years, and the patients were divided into 3 groups according to venous sites; subclavian (SCV), internal jugular (IJV), and external jugular veins (EJV). Only local anesthesia was given and no antibiotic prophylaxis was provided before the intervention. The 3 groups were compared regarding age, sex, primary tumor site, procedure time, and complications. Results: The procedure was significantly longer in the SCV group than the other 2 (43.35 min vs 34.58 and 33.71 min). Removal of the catheter was less common in the IJV group than the other 2 groups. Overall complications in the IJV group were lower than the other 2 groups, especially catheter malposition and pneumothorax rates were lower in the IJV group. Conclusions: In light of the findings of the study implantable port placement via internal jugular vein is safe and had lower complication rates than either the subclavian or external jugular veins. https://cts.tgcd.org.tr/pdf.php?id=58 cancerchemotherapyimplantable venous port eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 128 132 10.26663/cts.2019.00024 59 article Pediatric foreign body aspirations: experience of 263 cases Ozgur Katrancioglu 1 Sule Karadayi 2 Ekber Sahin 2 Department of Thoracic Surgery, School of Medicine, Omer Halisdemir University, Niğde, TurkeyDepartment of Thoracic Surgery, School of Medicine, Cumhuriyet University, Sivas, TurkeyBackground: Foreign body (FB) aspiration is a serious clinical situation due to its life-threatening status and especially common in the childhood period. We aimed to present the diagnosis and treatment of foreign bodies in pediatric age group. Material and Methods: Files of 510 patients aged 16 years and below that underwent rigid bronchoscopy due to suspicion of FB aspiration between June 1994 and November 2017 were retrospectively reviewed. 263 cases were included to the study that underwent foreign body removal. The cases were assessed in terms of gender, age, type and localization of the foreign body, clinical complaint, radiological findings, treatment method, complication and mortality. Results: Among the patients 45.6% were male and 54.4% were female. The aspirated foreign bodies varied from dried nuts to plastic, from hijab needles to beads. The most aspirated foreign body were dried nuts. 51% of them were removed from the right main bronchus, 31.9% from the left main bronchus, and 17.1% from the trachea. 97.8% of the foreign bodies were removed via bronchoscope. Thoracotomy was performed in 6 cases since the foreign bodies were not extractable with a bronchoscope or due to developing complications. No mortality occurred. Conclusions: FB aspiration can lead to life-threatening complications in children aged 3 years or below. Bronchoscopy should be performed in all cases of foreign body aspiration, including suspicious cases. Notably, the bronchoscopy procedure should be carried out by a well-trained, experienced anesthesiologist-endoscopy team and with appropriate tools. https://cts.tgcd.org.tr/pdf.php?id=59 childhood period foreign body aspirationstracheabronchus eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 133 137 10.26663/cts.2019.00025 60 article Evaluation of characteristics of the patients who undergo surgical treatment for lung hydatid cyst Ersin Sapmaz 1 Kuthan Kavaklı 1 Merve Sengul Inan 1 Hakan Isık 1 Okan Karatas 2 Deniz Dogan 3 Hasan Caylak 1 Sedat Gurkok 1 Department of Thoracic Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, TurkeyThoracic Surgery Clinic, Sinop Ataturk State Hospital, Sinop, TurkeyDepartment of Pulmonology, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, TurkeyBackground: Hydatid cyst is a public health problem, particularly where it is endemic. It is a benign disease and usually asymptomatic unless the symptoms and complications develop. Effective treatment is important because this benign disease can cause considerable mortality and morbidity. The aim of this study was to describe the epidemiological and clinical characteristics of HC, localization (bilateral lungs or multiple organ involvement) and perforation characteristics of HC. Materials and Methods: 160 patients were operated on for pulmonary hydatid disease for about approximately 12 years of time period. Patients were evaluated according to their age, gender, distribution of cysts in the lung, extra-pulmonary organ involvements, presence or absence of perforations, and animal contact stories. Results: Number of the cysts, the cyst diameter, gender, location of the cysts and the liver involvement were found unrelated with the perforation status of the cyst. But, there is a significant difference between the localization of the cysts in the lung and the involvement of the liver. The rates of presence of liver cysts in the case of unilateral right, unilateral left and bilateral cysts in the lung were found as 13%, 25% and 50% respectively. Conclusions: Hydatid cyst is a public health problem and elimination is possible with rigorous work. In case of bilateral pulmonary cysts and the multiple number of cysts, the likelihood of a cyst in the liver is increased. It was concluded that there was no relationship between the presence of cysts in the liver and the absence of perforation in the lung cysts. However, it should be kept in mind in terms of the possible complications that may occur at high perforations in patients who received preoperative albendazole therapy. https://cts.tgcd.org.tr/pdf.php?id=60 albendazole monohydrochloridecystic echinococcosishydatid cystperforation of cyst eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 138 141 10.26663/cts.2019.00026 61 article An extraordinary bullet embolism after gunshot injury: a case report Cenk Balta 1 Thoracic Surgery Clinic, Şanlıurfa Training and Research Hospital, Şanlıurfa, TurkeyGunshot injuries are the second most common cause of death following motor vehicle accidents. Embolization due to gunshot bullet is rarely reported in the literature. A 20-year-old male patient admitted to hospital due to chest pain where radiologic examinations demonstrated a bullet in his thorax. We learned that he was shot from his leg in Syrian civil war one year ago. This very interesting case of bullet embolism with its migration to left ventricle was reported. https://cts.tgcd.org.tr/pdf.php?id=61 gunshotbullet embolismtrauma eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 142 144 10.26663/cts.2019.00027 62 article Intradiaphragmatic bronchogenic cyst: a very rare diaphragmatic mass Goktan Temiz 1 Ozgur Omer Yildiz 2 Omer Cenap Gulyuz 3 Nurettin Karaoglanoglu 4 Department of Thoracic Surgery, Adana City Education and Research Hospital, Adana, TurkeyDepartment of Thoracic Surgery, Yildirim Beyazit University, Yenimahalle Education and Research Hospital, Ankara, TurkeyDepartment of Thoracic Surgery, Adiyaman University Education and Research Hospital, Adiyaman, TurkeyDepartment of Thoracic Surgery, Yildirim Beyazit University, Faculty of Medicine, Ankara, TurkeyBronchogenic cysts are generally asymptomatic and are detected incidentally by radiographic imaging as a smooth homogeneous mediastinal/pulmonary lesion. Isolated intradiaphragmatic bronchogenic cysts are extremely rare. Here, we report a case of intradiaphragmatic bronchogenic cyst mimicking a left lower lobe mass in a 56-year-old man suffering from chest pain. Imaging studies of the chest, including plain chest radiography and computerized tomography revealed a left sided mass in the lower zone. The patient underwent surgical resection of the mass. Intradiaphragmatic bronchogenic cyst was diagnosed by pathology. https://cts.tgcd.org.tr/pdf.php?id=62 bronchogenic cystdiaphragmamass eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 145 147 10.26663/cts.2019.00028 63 article Thoracic splenosis: a very rare cause of chest pain Celal Bugra Sezen 2 Salih Bilen 1 Cem Emrah Kalafat 2 Cemal Aker 3 Celalettin Ibrahim Kocaturk 4 Department of Thoracic Surgery, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Mardin State Hospital, Mardin, TurkeyDepartment of Thoracic Surgery Burdur State Hospital, Burdur, TurkeyDepartment of Thoracic Surgery, İstinye University, Liv Hospital, Istanbul, TurkeyIntrathoracic splenosis presents a rare thoracic lesion occurring after splenectomy or abdominal trauma as a consequence of heterotopic autotransplantation and implantation of splenic tissue. We present a 38- yearold man with intrathoracic splenosis. He was admitted to hospital with chest pain. In computed tomography homogenous, smooth-edged multiple lesions were found. The patient was not able to be diagnosed with transthoracic fine needle aspiration biopsy. On the exploration, there were multiple lesions at the thoracic cavity and the masses were excised. Definitive pathology was reported as splenosis. https://cts.tgcd.org.tr/pdf.php?id=63 thoracic splenosismedical historyabdominal traumachest painsplenectomy eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 148 151 10.26663/cts.2019.00029 64 article Bilateral pulmonary nodular amyloidosis with positive fdg uptake Koray Dural 1 Berkant Özpolat 1 Nesimi Günal 1 Ekin Zorlu 1 Salih Kür 1 Pınar Atasoy 2 Department of Thoracic Surgery, Kırıkkale University Faculty of Medicine, Kırıkkale, TurkeyDepartment of Pathology, Kırıkkale University Faculty of Medicine, Kırıkkale, TurkeyAmyloidosis is a disease characterized by extracellular accumulation of protein in fibrillary structure (amyloid protein) in various organs and soft tissues. Although the involvement of respiratory system is encountered in systemic amyloidosis, localized pulmonary amyloidosis has rarely been reported. The radiologic findings are nonspecific and show variations according to involvement pattern of amyloidosis. Here we present a 62-year-old female diagnosed as pulmonary nodular amyloidosis with the help of relevant literature. https://cts.tgcd.org.tr/pdf.php?id=64 multiple pulmonary nodulemetastatic diseasepulmonary lesionamyloidosis eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 152 0 10.26663/cts.2019.00030 65 article Intraoperative findings of spontaneous hemopneumothorax Kuthan Kavakli 1 Hakan Isik 1 Gokhan Ayberik 1 Alper Gozubuyuk 1 Department of Thoracic Surgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara, Turkey https://cts.tgcd.org.tr/pdf.php?id=65 hemopneumothoraxspontaneousthoracoscopic surgery eng Turkish Society of Thoracic Surgery Current Thoracic Surgery 2548-0316 2019-01-04 3 3 153 158 10.26663/cts.2019.00031 66 article Surgical approach for malignant pleural effusion Hasan Akin 1 Ali Kilicgun 2 Department of Thoracic Surgery, Yedikule Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, TurkeyDepartment of Thoracic Surgery, Bolu Abant Izzet Baysal University, Bolu, TurkeyIn this review, the causes of pleural effusion were discussed. Pleural reactions and tumors were explained in the tables. Subsequently, radiographic findings and their role of guidance in the interventional procedures were briefly mentioned. Surgical diagnosis and treatment methods were explained. Malignant mesothelioma was discussed under a separate title. In the end, pleurodesis, a commonly used method in patients with malignant pleural effusion, was discussed. https://cts.tgcd.org.tr/pdf.php?id=66 malignant pleural effusionsurgerypleural fluid