Is there a change in the view of treatment for primary spontaneous pneumothorax?: The effect of thoracic CT and autologous blood pleurodesis: a retrospective cohort study.

This study investigated recurrence rates and treatment efficacy based on tomographic findings during a long-term follow-up after primary spontaneous pneumothorax (PSP) treatment. We retrospectively analyzed patients with PSP treated at our hospital between 2003 and 2020. Patients were categorized into 2 groups based on computed tomography (CT) findings: group 1 (no bulla/bleb) and group 2 (bullae-bleb <3 cm). Data on demographics, recurrence, treatment methods, and outcomes were also collected and compared. A total of 251 PSP cases were evaluated, predominantly male (93.6%) with a mean age of 29.23 ±â€…1.14 years. Most cases (57%) occurred on the right side. Recurrence rates were highest within the first year (77.8%), with the first and second recurrences occurring at rates of 26% and 27.3%, respectively. In group 1 (n = 117), conservative treatment was applied in 15 cases, tube thoracostomy in 81, autologous blood pleurodesis (ABP) in 19, and surgery in 12. Recurrence rates were 46.6%, 21%, 5.3%, and 8.3%, respectively. In group 2 (n = 134), the recurrence rates were 50%, 32.7%, 20%, and 3.1%, respectively (P < .001). No mortality was observed for any patient. The treatment groups included conservative (n = 19), thoracostomy (n = 179), ABP (n = 34), and surgical (n = 44) groups. Recurrence rates were 47.3%, 27.4%, 11.8% (group 1: 5.3%, group 2: 20%, P = .035), and 4.5% (0% vs 6.3%), respectively. ABP effectively reduced recurrence in group 1 PSP patients without bullae or blebs on CT, potentially avoiding surgery. Video-assisted thoracoscopic surgery should be preferred in group 2 cases with bullae or blebs to minimize recurrence. These results underscore the importance of tailoring treatment strategies based on CT findings to optimize PSP management outcomes.

Selection of the appropriate treatment for the combination of interstitial lung disease and lung cancer: A retrospective observational study.

Interstitial lung disease (ILD) independently heightens the risk of lung cancer (LC), often necessitating chemoradiotherapy (CRT) due to advanced disease stages. However, CRT may compromise survival through complications such as ILD exacerbation or radiation pneumonitis. The aim of this study was to determine the optimal surgical or nonsurgical treatment approaches for patients with concurrent ILD and LC. Over a 10-year period, a retrospective evaluation was conducted on 647 patients with confirmed diagnoses of LC and ILD from a total of 4541 patients examined in the polyclinic. This assessment included a comprehensive review of demographic, treatment, and survival records. Study groups included those treated for both ILD and LC with surgical treatment (ST), chemotherapy (CT), radiotherapy (RT), or CRT. A control group comprised ILD-only cases. In the whole sample of 647 patients with complete data, the length of stay in hospital and respiratory intensive care unit was significantly shorter in the ST group and longer in the CT group. Significant differences in discharge status (P < .001) were observed, with higher recovery rates in the ST and RT groups. The CT group showed an increased rate of transfer to other centers, in-hospital mortality was determined to be higher in the CRT group, and the control group exhibited no change in discharge. No statistically significant difference was determined between the groups with respect to the 24- and 48-month survival rates (P = .100). Although no disparity was found in 2- and 4-year survival rates, there were seen to be advantages in survival and quality of life with the addition of radiotherapy to regions aligning with surgical margins for LC patients with ILD, evaluated as radiological N0, undergoing wedge resection. This underscores the need for personalized treatment strategies to balance effective cancer control and to minimize ILD-related complications.

The role of adjuvant chemotherapy in resected stage I non - small cell lung cancer: A Turkish Oncology Group Study.

PURPOSE: The benefit of adjuvant chemotherapy for tumors smaller than 4 cm is not clear. We aimed to evaluate the prognostic impact of adjuvant platin-based chemotherapy in high-risk stage I patients with non-small cell lung cancer (NSCLC). METHODS: This cooperative group study included 232 NSCLC patients who underwent curative surgery for stage I disease with tumor size 2-4 cm. Re ults: Median age at presentation was 63 years (range 18-90). The mean tumor size was 29.6 ± 7.3 mm. The frequency of patients with specified risk factors were: visceral pleural effusion (VPI): n: 82 (36.6%); lymphovascular invasion (LVI): n: 86 (39.1%); Grade 3: n: 48 (32.7%); Solid micropapillary pattern (SMP): n: 70 (48.3%). Adjuvant platin-based chemotherapy was administered to 51 patients. During a median follow-up period of 50.5 months 68 patients (29.3%) developed recurrence, 54 (23.3%) died from any cause and 38 (16.4%) of them died of lung cancer. Patients who received chemotherapy compared with the non-chemotherapy group had a longer 5-years relapse-free survival (RFS) (84.5 vs 61.1%). Also on multivariate analysis, adjuvant chemotherapy was a significant independent prognostic factor for RFS. CONCLUSION: Adjuvant platin-based chemotherapy should be considered for patients with small tumors with adverse risk factors. Key words: adjuvant chemotherapy, lung cancer, oncology, lymphovascular invasion, solid-micropapillary pattern, platinum-based therapy.

Retrospective study of the effect of sarcopaenia on post-operative outcomes in patients undergoing thoracic surgery.

Background & objectives: Sarcopaenia refers to the pathological loss of muscle mass that may be observed in malnutrition, immobility, chronic disease, particularly chronic obstructive pulmonary disease and malignancies. A relationship has been identified between sarcopaenia and thoracic surgery. The aim of the present study was to investigate the relationship between density and area of the psoas major muscle (PSM), the pectoralis major and minor muscles (PEC) and the post-operative morbidity, mortality and survival of patients undergoing anatomic lung resection. Methods: A retrospective review of the medical record data of the patients who underwent lung resection was conducted in between 2009 and 2018. The study included patients who underwent upper abdominal computed tomography (CT) for the measurement of PSM and thoracic CT for PEC. The demographic data, laboratory test results, radiological findings and the survival data of the patients were recorded. Results: Evaluation was made of 161 patients with available CT data. With the exception of mean PEC density, the PEC parameters (P=0.013-0.026), and PSM density (P=0.015) were significantly lower in the non-survivors than in the survivors. In general, the mean measurements of the PSM and PEC were seen to affect mortality (P=0.001-0.024). Interpretation & conclusions: The mean area and density measurements in the PSM, and particularly in the PEC, were determined to be significantly higher in patients who survived after lung cancer surgery, suggesting that sarcopaenia could be a useful predictor of post-operative mortality risk and survival.

The Effectiveness of Sterile Wound Drapes in the Prevention of Surgical Site Infection in Thoracic Surgery.

BACKGROUND: The rate of surgical site infections (SSIs) has decreased in parallel to advances in sterilization techniques. Such infections increase morbidity and hospitalization costs. The use of iodine-impregnated sterile wound drapes (SWDs) is recommended to prevent or reduce the incidence of these infections. However, there is a paucity of data regarding their use in thoracic surgical procedures. The aim of the present study was to evaluate the effectiveness of sterile wound drapes in the prevention of these infections and the effects on hospitalization costs. METHODS: Perioperative iodine-impregnated SWDs have been used since January 2015 in the Thoracic Surgery Clinic of our hospital. A retrospective evaluation was made of patients who underwent anatomic pulmonary resection via thoracotomy with SWD in the period January 2015-2017, compared with a control group who underwent the same surgery without SWD in the 2-year period before January 2015. Factors that may have increased the risk of surgical site infection were documented and the occurrence of SSI was recorded from postoperative follow-up data. The cost analysis was performed as an important criterion to investigate the benefits of SWD. RESULTS: Evaluation was made of 654 patients in the study group (n:380) using SWD, the operation time was significantly longer, and perioperative blood transfusion was significantly higher, whereas treatment costs (p=0.0001) and wound culture positivity (p=0.004) were significantly lower and less surgical wound debridement was performed (p=0.002). CONCLUSION: The findings suggest that the use of sterile wound draping in thoracic surgery procedures reduces surgical site infections and hospitalization costs.

Long-term outcomes of completion pneumonectomy for non-small cell lung cancer.

Background: Completion pneumonectomy (CP) is the removal of remaining lung tissue after initial resection. Our aim in this study was to investigate the factors affecting mortality, morbidity, and survival after CP. Methods: Patients who underwent CP in our clinic between January 2000 and December 2015 were evaluated retrospectively. The patients' demographic information, morbidity, mortality, histopathological characteristics, and 2-, 5-, and 10-year survival were evaluated. Results: Of the 32 non-small cell lung cancer patients in the study, 31 (96.9%) were male and one (3.1%) was female. The postoperative mortality rate was 9.4% and the morbidity rate was 46.9%. The most common complication was atrial fibrillation (31.3%). Median survival time was 67 ± 10.3 months; 5- and 10-year survival rates were 50.3 and 31.2%, respectively. Conclusion: Completion pneumonectomy involves an acceptable mortality rate but high morbidity rate. Based on the results of this study, the interval between initial resection and CP does not affect survival time.

Is the Outcome of Pulmonary Resections due to Non-Small Cell Lung Cancer in Octogenarian Patients Worse?

PURPOSE: Lung cancer is one of the major sources of mortality in the elderly. This study was undertaken to assess the early and long-term results of surgical resection in patients older than 70 years of age by comparing the results of patients aged 70-79 years (group 1) with patients older than 80 years of age (group 2). METHODS: Data on patient age, gender, spirometry values, side, size, histology and stage of the tumor, surgical procedures, postoperative complications, Charlson comorbidity scores (CCS), and survival were collected. RESULTS: After 1-2 propensity score matching group 1 (70-79 years) included 84 and group 2 (age over 80) 42 cases. The multivariate analysis showed that CCS was the only significant factor affecting the development of complications (p = 0.003). The overall median and 5-year survival of all patients were 55 months and 42.5%, respectively. Although the survival of the elderly group 2 was higher than the first group, the difference did not reach significance (50 vs. 49 months, respectively). CONCLUSION: The outcomes of surgery in terms of morbidity and mortality rates do not differ between the two age groups. The safety of pulmonary resections in the elderly group is comparable to patients under 70 years if the comorbidities are appropriately controlled. In addition, surgery provides satisfactory survival rates in both age groups.

Which is the Best Minimal Invasive Approach for the Treatment of Spontaneous Pneumothorax? Uniport, Two, or Three Ports: A Prospective Randomized Trail.

OBJECTIVE: Video-assisted thoracoscopic surgery (VATS) has become the standard treatment method for primary spontaneous pneumothorax. Concerns about lesser pain and better cosmesis led to the evolution of uniportal access. This study prospectively compared the results of the uniportal, two-port, and three-port thoracoscopic surgery. MATERIAL AND METHODS: One hundred and thirty-five patients were randomized into three groups according to the port numbers. The groups were compared regarding the operation time, hospital stay, amount of drainage, area of pleurectomy, complications, recurrences, and pain scores. RESULTS: Except for the amount of drainage (p = 0.03), no factors were found to be statistically significant. The overall recurrence rate was 5%. Although the first and second week pain scores were not statistically significant, the single-incision group patients had significantly less pain at 4, 24, and 72 hours (p < 0.05). CONCLUSION: The study indicated that uniportal VATS approach is less painful and has better cosmetic results, besides it is as efficient as two- or three-port VATS approach.

Surgical approach to posterior mediastinal lesions and long-term outcomes.

Background Posterior mediastinal lesions are classified as solid lesions and cysts. The treatment for both types is surgery. We evaluated the surgical outcomes and recurrence rates after video-assisted thoracic surgery and thoracotomy for posterior mediastinal lesions. Methods Data of 66 resections for posterior mediastinal masses between 2000 and 2014 were reviewed retrospectively. Twenty-two patients were treated by video-assisted thoracic surgery (group V) and 44 underwent thoracotomy (group T); 29 (43.9%) were female and 37 (56.1%) were male, the mean age was 45.9 ± 14.7 years. Results Bronchogenic cyst was the most common cystic lesion (10/12, 83.3%), and benign schwannoma was the most common solid lesion (32/54, 59.2%). The mean diameter of solid lesions was 5.19 ± 2.4 cm (group V 3.98 ± 1.8 vs. group T 5.78 ± 2.5 cm, p = 0.006). The tumor diameter was 4.06 ± 1.9 cm in asymptomatic patients and 6.93 ± 2.2 cm ( p < 0.001) in symptomatic patients. In group V, hospital stay and duration of drainage were significantly shorter than in group T ( p = 0.02, p = 0.01). Local recurrence was detected in 4 (6.1%) patients. Cystic lesions had a higher recurrence rate than solid lesions ( p = 0.01). There was no significant difference in recurrence rates in groups V and T ( p = 0.59). Conclusion Video-assisted thoracic surgery is a safe method for surgical treatment of posterior mediastinal lesions, with a shorter drainage time and postoperative hospitalization and similar recurrence rates. More recurrences are seen in patients with cystic lesions.

Experience with Vacuum-Assisted Closure in the Management of Postpneumonectomy Empyema: An Analysis of Eight Cases.

BACKGROUND: The treatment of postpneumonectomic empyema is challenging. The aim of this study was to test the efficacy of vacuum-assisted closure (VAC) in the treatment of patients with open window thoracostomy (OWT). METHODS: Between January 2010 and April 2014, eight patients developed empyema following pneumonectomy for malignant diseases in our department and then underwent an OWT with subsequent VAC therapy; their cases were retrospectively studied. Each session of VAC therapy lasted 72 hours, and therapy was completed after approximately 6 sessions. RESULTS: OWT in six patients resulted in either decreased size or complete closure after VAC treatment. Five patients had a bronchopleural fistula (BPF), which was closed either with a tracheal stent (three patients), primary suture, or omentoplasty. The BPF in one of these patients closed during VAC therapy. The treatment failed in two patients due to the microfistula becoming obvious in one and persistence of the fistula in the other. CONCLUSION: We believe that the use of VAC in the treatment of postpneumonectomy empyema is effective, except for patients with BPF.

The palliative treatment with intrapleural streptokinase in patients with multiloculated malignant pleural effusion: a double-blind, placebo-controlled, randomized study.

Expansion of the lung is necessary for successful pleurodesis therapy in patients with malignant pleural effusion (MPE). However, this is often impossible in multiloculated MPEs. The aim of this study was to investigate the effect of the fibrinolytic agent, streptokinase, on pleurodesis therapy used in the management of multiloculated MPE. Forty patients with multiloculated MPEs were randomly assigned to two groups: fibrinolytic and control. In the fibrinolytic group, 250,000 IU of streptokinase in 50 ml saline was applied into the pleural space at 24-36-48-60 h after opening a tube thoracostomy. In the control group, the same procedure was carried out using only 50 ml saline solution. Both groups were compared based on the following: (1) volume of pleural drainage at 24-48, 48-72, and 24-72 h, (2) chest computer tomography images before and after therapy, (3) dyspnea symptoms after therapy, and (4) recurrence rate. The mean drainage volumes for the fibrinolytic and control groups were 493 and 248 cc at 24-48 h, 446 and 198 cc at 48-72 h, and 939 and 446 cc at 24-72 h (P < 0.001). Comparison of the two groups by computer tomography revealed that 17 patients (85 %) in the fibrinolytic group had greater than 40 % improvement, whereas only 7 patients (35 %) in the control group had the same degree of improvement (P = 0.001). The dyspnea symptoms disappeared in 90 % of the patients in the fibrinolytic group and in 55 % of the patients in the control group (P = 0.03). Recurrence rate was 11 % in fibrinolytic group and 45 % in control group (P = 0.07). Streptokinase is a reliable treatment option in obtaining effective pleural drainage and increasing lung expansion in patients with multiloculated MPE.

The impact of the type of resection on survival in patients with N1 non-small-cell lung cancers.

OBJECTIVE: Complete resection is the therapy of choice in non-small-cell lung cancer (NSCLC). There is no agreement on the type of resection, especially when interlobar N1 disease is present. The present study explored the effect of the type of resection on survival in the presence of N1 disease. METHOD: Medical records of 195 patients with NSCLC who underwent resection between 1998 and 2006 and whose histopathological examination showed N1 disease were reviewed retrospectively. This study included 162 patients with T status of T1, T2 or T3, who had complete resection (excluding superior sulcus tumours). The patients were divided into three groups, namely hilar N1 (n=15, 9.3%), interlobar N1 (N1-i) (n=54, 33.3%) and lobar N1 (n=93, 57.4%). Frequency comparisons were carried out by chi-square test. Survival rates were calculated by the Kaplan-Meier method and compared by log-rank test after patients who had operative mortality (n=10, 6.2%) were excluded. RESULTS: Seventy-seven patients (47.5%) had lobectomy, 14 (8.6%) had bilobectomy (BL) and 71 (43.8%) had pneumonectomy (PN). Twenty-one of these patients (13.0%) had sleeve lobectomy and 19 had (11.7%) additional interventions (such as resection of the diaphragm or thoracic wall). Among all N1 patients, 5-year survival rate was 56.9% in patients who had BL or PN and 46.8% in patients who had lobectomy, a difference not statistically significant (p=0.09). Similarly, there was no significant difference between patients who had sleeve resection and PN (p=0.58). The type of resection was not found related to survival in the presence of interlobar (p=0.75). Similarly, type of resection was not significantly associated with survival in patients with hilar N1 (p=0.86). CONCLUSION: Those who had PN or BL had a higher survival rate, which was statistically insignificant. Further studies are required to determine whether or not the type of resection should be changed as a result of N1 only.