Risk factors and prognostic significance of early postoperative complications for patients who underwent pneumonectomy for lung cancer.

BACKGROUND: Although pneumonectomy has relatively high mortality and morbidity rates, it remains valid in the surgical treatment of lung cancer. This study aims to evaluate the prognostic significance of postoperative complications after pneumonectomy and demonstrate the risk factors related to early postoperative complications. METHODS: Patients who underwent pneumonectomy for non-small cell lung cancer between January 2008 and May 2021 were included in the study. Factors related to the development of early postoperative complications and overall survival were evaluated by univariate and multivariate analyses. RESULTS: A total of 136 patients were included in the study. Early postoperative complications were seen in 33 (24.3%) patients and late postoperative complications in 7 (5.1%) patients. The amount of cigarette smoking, and the operation side were the independent variables that affect the development of early postoperative complications. In multivariate analysis, smoking amount and pericardial invasion were associated with the development of postoperative hemorrhage, and advanced age was associated with the development of postoperative pneumonia. CONCLUSIONS: Early postoperative complications have a negative effect on the prognosis after pneumonectomy therefore careful patient selection and preoperative risk assessment are essential to minimize the occurrence of complications and improve patient outcomes. TRIAL REGISTRATION: This observational study was approved by the (Ethical Committee of Dr. Suat Seren Chest Diseases and Chest Surgery Education and Research Center) Institutional Review Board of our center (E-49109414-604.02.02-218625439).

The prognostic significance of PD-1 and its ligands in non-small cell lung cancer.

Background: In this study, we aimed to investigate the prognostic value of programmed cell death protein 1 (PD-1), programmed cell death ligand 1 (PD-L1), and programmed cell death ligand 2 (PD-L2) expressions on immune and cancer cells in terms of survival in patients with lung adenocarcinoma, squamous cell carcinoma, and large cell carcinoma. Methods: Between January 2000 and December 2012, a total of 191 patients (172 males, 19 females; mean age: 60.3±8.4 years; range, 38 to 78 years) who were diagnosed with non-small cell lung cancer and underwent anatomic resection and mediastinal lymph node dissection were retrospectively analyzed. The patients were evaluated in three groups including lung squamous cell carcinoma (n=61), adenocarcinoma (n=66), and large-cell carcinoma (n=64). The survival rates of all three groups were compared in terms of immunohistochemical expression levels of PD-1, PD-L1, and PD-L2. Results: The mean follow-up was 71.8±47.9 months. In all histological subtypes, PD-1 expressions on tumor and immune cells were observed in 33% (61/191) and in 53.1% (102/191) of the patients, respectively. Higher expression levels of PD-L1 and PD-L2 at any intensity on tumor and immune cells were defined only in lung adenocarcinomas, and PD-L1 and PD-L2 values were detected in 36.4% (22/64) of these patients. The PD-L1 expressions on tumor and immune cells were observed in 41.7% (10/24) and 25% (6/24) of the patients, respectively. The PD-L2 expressions on tumor and immune cells were detected in 16.7% (4/24) and 8.4% (2/24) of the patients, respectively. Univariate and multivariate analyses revealed that PD-1 expression in tumor cells was an independent prognostic factor in all histological subtypes. Conclusion: Our study results suggest that PD-1 expression is a poor prognostic factor for overall survival in patients with completely resected adenocarcinoma, squamous cell carcinoma, and large cell carcinoma.

Surgical resection of a giant mass pushing the boundaries of the chest wall: An Askin's tumor.

Intrathoracic masses may arise from the chest wall, mediastinum, pleura, and pulmonary parenchyma. Primary malign tumors of the chest wall and pleura usually present with chest pain; however, the tumor may sometimes remain asymptomatic, until it grows large enough to cause compression-related symptoms. Herein, we present a 35-year-old female case with a giant intrathoracic mass. The patient was diagnosed with an Askin"s tumor and underwent extended surgical resection.

Pulmonary metastases in urogenital cancers: Surgical treatment and outcomes.

INTRODUCTION: Metastasis is remaining one of the major problems in cancer treatment. Like many other malignancies, urogenital tumors originating from kidney, prostate, testes, and bladder tend to metastasize to the lungs. The aim of this retrospective study is to evaluate the operative results and prognosis of pulmonary metastasectomy in patients with primary urogenital tumors. METHODS: This study was approved by the local ethical committee. We retrospectively analyzed the surgical and oncological results of patients who underwent lung resections for urogenital cancer metastases in our department between 2002 and 2018. Demographic data and clinicopathological features were extracted from the medical records. Survival outcomes according to cancer subtypes and early postoperative results of VATS and thoracotomy were analyzed. RESULTS: 22 out of 126 patients referred for pulmonary metastasectomy to our department had metastases from urogenital tumors. These patients consisted of 17 males and five females. Their metastasis originated from renal cell carcinoma (RCC; n=9), bladder tumor (n=7), testis tumors (n=4), and prostate cancer (n=2). There was no intraoperative complication. Postoperative complications were seen in 2 patients. CONCLUSIONS: Although pulmonary metastasectomy in various types of tumors is well known and documented, the data is limited for metastases of urogenital cancers in the literature. Despite the limitations of this study, we aim to document our promising results of pulmonary metastasectomy in patients with primary urogenital tumors and wanted to emphasize the role of minimally invasive approaches.

Analysis of prognostic factors in pT1-2 N1 lung cancer patients in the light surgical results.

Nodal metastasis status is an important parameter affecting the prognosis in lung cancer. Although surgical treatment is possible in most cases of N1 positive non-small cell lung cancer, this group of patients is clinically, radiologically and histologically heterogeneous. The aim of our study is to investigate the prognostic factors affecting survival in patients with pT1-2 N1 who underwent lung resection. From January 2010 to December 2019, patients who underwent lobectomy, bilobectomy or pneumonectomy for pT1-T2 N1 NSCLC in our center were included in the study. The preoperative, intraoperative and postoperative data of the patients were recorded by accessing the patient files and hospital records. The mean follow-up time was 39.8 months. The mean overall survival was 73.8 ± 3.6, and the mean disease-free survival was 67.5 ± 3.8. In multivariate analysis, age, N1 nodal metastasis pattern (occult vs obvious) and histology were found as independent variables affecting survival. In our study, age, histology, and clinical N1 status were found to be independent variables effective on overall survival.

Novel method for bronchial stump coverage for prevents postpneumonectomy bronchopleural fistula: pedicled thymopericardial fat flap.

BACKGROUND: Bronchopleural fistula (BPF) is a serious complication with high mortality and morbidity that can be seen after lung resections. Although several methods have been described to prevent postoperative BPF it is still unclear which method is the best. In this study, we have used tymopericardial fat flap (TPFF) to cover the bronchial stump in patients after pneumonectomy and aim to show its feasibility and efficacy to prevent BPF. METHODS: Between January 2013 and June 2021, 187 patients with lung cancer underwent pneumonectomy at our institution. Among them, 53 patients underwent bronchial stump coverage with TPFF. In other 134 patients there wasn't used any coverage method. Patient characteristics, preoperative status, surgical procedures, perioperative course, pathological findings, and long-term prognoses were evaluated retrospectively. RESULTS: Postoperative BPF was observed in 16 (%8.5) patients. It was observed that TPFF was applied in only 1 of the patients who developed BPF. A statistically significant difference was detected between TPFF-coverage with non-coverage groups in terms of postoperative BPF rates (p = 0.044). Other factors associated with the development of postoperative BPF in univariate analysis were right sided pneumonectomy, and re-operation. CONCLUSION: Bronchial stump coverage with TPFF is a feasible and effective method to prevent postpneumonectomy BPF.

Pitfalls in the surgical treatment of undiagnosed lung lesions and cystic pulmonary hydatidosis.

BACKGROUND: Hydatid cysts can mimic many lung pathologies radiologically, as well as some malignant or benign lung tumors may show hydatid cyst-like radiological features. The aim of our study is to present our clinical experience and recommendations by analyzing the cases that create diagnostic difficulties by presenting a common radiological pattern with a pulmonary hydatid cyst. METHODS: The patients who were operated on with a preliminary diagnosis of hydatid cyst but were diagnosed differently, and who were operated on with different prediagnoses and unexpectedly diagnosed with hydatid cyst were included in the study. The clinical and radiological features of the patients were documented, and the features of the cases that could cause difficulties in diagnosis and treatment for the surgeon were revealed. RESULTS: A total of 20 patients who were radiologically suggestive of hydatid cyst but were diagnosed differently or unexpectedly diagnosed as hydatid cyst were included in the study. Lung cancer, bronchogenic cyst, or bronchiectasis were detected in 13 patients who were radiologically suggestive of hydatid cyst. There were 7 patients who were diagnosed with hydatid cysts, although they did not have specific radiological findings. CONCLUSIONS: While hydatid cysts can mimic many lung pathologies, many benign or malign parenchymal lung pathologies may exhibit hydatid cyst-like radiological features. Therefore, in regions where a hydatid cyst is endemic, the surgeon should consider all possibilities while managing the cases. CLINICAL REGISTRATION NUMBER: Institutional Review Board of the Dr Suat Seren Chest Diseases and Chest Surgery Education and Research Center (No. 49109414-604.02).

Extended resection for unexpected invasion of the left sided lung cancer into the liver: combined lung, diaphragm, and liver resection.

Complete anatomic lung resection remains the best curative option in patients with early-stage lung cancer. In some cases, extended lung resections are required to achieve R0 resection. Although diaphragmatic invasion and resection is a well-known condition in lung cancer, direct invasion of the diaphragm and liver in lung cancer is rare. We report a 66-year-old man with left-sided lung cancer. Preoperative evaluation revealed the risk of diaphragm invasion, but the liver invasion was detected intraoperatively. In addition to left pneumonectomy, left-sided partial liver and diaphragm resection was performed. At 24 months from the operation, the patient is alive without any disease progression. We believe that combined resection including lung, diaphragm, and liver may have survival benefits in selected cases.

Surgery in congenital lung malformations: the evolution from thoracotomy to VATS, 10-year experience in a single center.

BACKGROUND: Congenital lung malformation is an umbrella term and consist of various kind of parenchymal and mediastinal pathologies. Surgical resection is often required for diagnosis and curative treatment. We aimed to review our experience in surgical treatment for congenital lung disease and present the role of minimally invasive surgery. METHODS: Surgical resections performed for benign lesions of the lung and mediastinum between January 2009 and May 2019 were retrospectively analyzed. Patients who were found to have congenital lung malformation as a result of pathological examination were included in our study. Distribution characteristics of the patients according to congenital lung malformation subtypes, differences in surgical approach and postoperative results were investigated. RESULTS: A total of 94 patients who underwent surgical resection and were diagnosed with the bronchogenic cyst, sequestration, bronchial atresia, congenital cystic adenomatoid malformation (CCAM), or enteric cyst as a result of pathological examination were included the study. There were no significant differences between pathological subtypes in the postoperative length of hospital stay and drainage duration however, perioperative complication rate was higher in the sequestration group. In addition, in the first three days postoperatively, the mean pain score was found to be lower in the VATS group compared to thoracotomy. CONCLUSIONS: Congenital lung malformations consist of a heterogeneous group of diseases and the surgical treatment in these patients can range from a simple cyst excision to pneumonectomy. Video-assisted thoracoscopic surgery should be considered as the first choice in the surgical treatment of these patients in experienced centers.

ERS International Congress 2020: highlights from the Thoracic Surgery and Transplantation Assembly.

The Thoracic Surgery and Lung Transplantation Assembly of the European Respiratory Society is delighted to present the highlights from the 2020 Virtual International Congress. We have selected four sessions that discussed recent advances in a wide range of topics. From the use of robotic surgery in thoracic surgery and extracorporeal life support as a bridge to lung transplantation, to lung transplantation in the era of new drugs. The sessions are summarised by early career members in close collaboration with the assembly leadership. We aim to give the reader an update on the highlights of the conference in the fields of thoracic surgery and lung transplantation.

Pleural complications in patients with coronavirus disease 2019 (COVID-19): how to safely apply and follow-up with a chest tube during the pandemic?

OBJECTIVES: Severe acute respiratory syndrome coronavirus 2, a novel coronavirus, affects mainly the pulmonary parenchyma and produces significant morbidity and mortality. During the pandemic, several complications have been shown to be associated with coronavirus disease 2019 (COVID-19). Our goal was to present a series of patients with COVID-19 who underwent chest tube placements due to the development of pleural complications and to make suggestions for the insertion and follow-up management of the chest tube. METHODS: We retrospectively collected and analysed data on patients with laboratory-confirmed COVID-19 in our hospital between 11 March and 15 May 2020. Patients from this patient group who developed pleural complications requiring chest tube insertion were included in the study. RESULTS: A total of 542 patients who were suspected of having COVID-19 were hospitalized. The presence of severe acute respiratory syndrome coronavirus 2 was confirmed with laboratory tests in 342 patients between 11 March and 15 May 2020 in our centre. A chest tube was used in 13 (3.8%) of these patients. A high-efficiency particulate air filter mounted double-bottle technique was used to prevent viral transmission. CONCLUSIONS: In patients with COVID-19, the chest tube can be applied in cases with disease or treatment-related pleural complications. Our case series comprised a small group of patients, which is one of its limitations. Still, our main goal was to present our experience with patients with pleural complications and describe a new drainage technique to prevent viral transmission during chest tube application and follow-up.

Video-Assisted Thoracoscopic Surgery vs Thoracotomy for Non-Small Cell Lung Cancer Greater Than 5 cm: Is VATS a feasible approach for large tumors?

BACKGROUND: VATS lobectomy is a recommended surgical approach for patients with early-stage lung cancer. However, it is still controversial in locally advance disease. This study was conducted to compare intraoperative and postoperative results of VATS and thoracotomy in patients with tumors greater than 5 cm. METHODS: From January 2014 to December 2018, 849 patients underwent lobectomy or pneumonectomy for the treatment of non-small-cell lung cancer at our center. The inclusion criterion of this study was patients who underwent anatomic lung resection for lung cancer with tumors larger than 5 cm((≥ T3). The patients were divided into two groups: those who underwent video-assisted thoracoscopic surgery (n = 24) and those who underwent thoracotomy (n = 36). Patient characteristics, intraoperative and postoperative results were evaluated by review of the hospital records. RESULTS: In the VATS group, mean drainage time and postoperative length of hospital stay were significantly shorter than the thoracotomy group. Kaplan-Meier survival curves showed that overall and recurrence-free survival was longer in the VATS group and this result was statistically significant. CONCLUSIONS: According to the results of this study, we emphasize that VATS is a feasible surgical procedure for tumors larger than 5 cm.

A rare complication of video-assisted thoracoscopic surgery: lung herniation retrospective case series of three patients and review of the literature.

INTRODUCTION: Lung herniation is defined as a protrusion of the lung parenchyma with its pleura through the intercostal space. It is a rare condition and usually occurs after thoracic trauma and surgical interventions. A few cases of lung herniations have been reported after video-assisted thoracoscopic surgery (VATS) but only two cases have been reported after VATS lobectomy. AIM: The VATS procedure has become the dominant method of lung cancer surgery, but there is no case series about the complications of lung herniation in the literature. We aim to define some risk factors and possible ways of prevention of lung herniation after VATS resection. MATERIAL AND METHODS: This study retrospectively analyses 650 (550 anatomic, 100 non-anatomic sublobar resections) patients who underwent lung resections for lung cancer in our department between 2012 and 2018. We detected lung herniation in 3 patients after VATS resection. RESULTS: Asymptomatic lung hernias may be managed by close observation but because of the risk of incarceration of the pulmonary parenchyma, surgery is often necessary. The main steps of treatment involve: identification of the hernia, freeing of all adhesions, reduction of the lung tissue back into the thoracic cavity and repairing the defect of the chest wall. CONCLUSIONS: By this retrospective case series, we defined some patient-related and surgeon-related risk factors and some basic recommendations for prevention of this complication.

Rare cause of superior vena cava syndrome: a giant bulla.

Superior vena cava syndrome (SVCS) is a group of symptoms caused by obstruction of superior vena cava. External compression caused by benign or malign processes is the most common physiopathology. We aim to present a 29-year-old man with non-productive cough, facial plethora and venous distention of the neck. Right apical tense bulla which was compress superior vena cava was detected and video-assisted thoracoscopic surgery applied. Our extensive search found out that only one report of SVCS secondary to bulla is available on Medline.

Atypical deep somatic soft-tissue leiomyoma of extrathoracic chest wall: first case of the literature.

Leiomyomas are benign soft-tissue tumours which take origin from the smooth muscles. Pleura and chest wall are uncommon location for such tumours. Here, we report a case of a 26-year-old female patient presented with 3 months history of chest pain. Chest X-ray and CT showed a calcified mass of 6×12 cm in size in the left lateral of the chest wall. After resection of the mass, pathological examination diagnosed it as atypical deep somatic soft-tissue leiomyoma of extrathoracic chest wall. No pathological finding was detected during follow-up.

Rare complication of central venous catheter placement: bilateral hydrothorax.

Central venous catheters (CVCs) are very useful tools in clinical medicine. It is important not only for the administration of medications or fluids but also the measurement of haemodynamic variables, especially in intensive care patients. CVC placement is a relatively safe procedure but may occasionally be associated with complications, such as pneumothorax, haemothorax, cardiac tamponade, sepsis and thrombosis. We aim to report an extraordinary case of bilateral hydrothorax due to CVC placement.