Endoscopic and Surgical Treatment of Benign Tracheal Stenosis: A Multidisciplinary Team Approach.

PURPOSE: Surgical resection and reconstruction are considered the most appropriate approaches to treat post-intubation tracheal stenosis (PITS). Bronchoscopic methods can be utilized as palliative therapy in patients who are ineligible for surgical treatment or who develop post-surgical re-stenosis. We investigated treatment outcomes in patients with benign tracheal stenosis. METHODS: A retrospective review was performed in patients who were diagnosed with PITS. Tracheal resection was performed for operable cases, whereas endoscopic interventions were preferred for inoperable cases with a complex or simple stenosis. RESULTS: In total, 42 patients (23 treated by bronchoscopic methods, 19 treated by surgery) took part in this study. No significant differences were observed in segment length, the proportion of obstructed airways, or vocal cord distance between the two groups. In all, 15 patients in the bronchoscopic treatment group received a stent. Following the intervention, the cure rates in the bronchoscopic and surgical treatment groups were 43.47% and 94.7%, respectively. A multidisciplinary approach resulted in a cure or satisfactory outcome in 90.5% of the patients while failure was noted in 9.5% of the patients. CONCLUSION: Bronchoscopic methods are associated with a lower cure rate compared to surgery. A multidisciplinary approach was helpful for treatment planning in patients with PITS.

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.

GST M1 and CYP1A1 gene polymorphism and daily fruit consumption in Turkish patients with non-small cell lung carcinomas.

BACKGROUND: In general, the metabolism of carcinogens involves two pathways. The oxidative pathway, which enhances carcinogenesis (phase I), and the protective pathway, in which carcinogens are conjugated with a series of substances such as glutathione to achieve detoxification (phase II). It has been suggested that an increased phase I enzyme activity (CYP1A1) and a decreased phase II enzyme activity (GST M1) could each individually cause an increase in the risk of cancer. MATERIALS AND METHODS: In the present study we explored the association between genetic polymorphisms of CYP 1A1 and GST M1 and non-small cell lung cancer (n = 55) and controls(n = 60) in Turkish subjects. We used PCR methods and enzyme restriction for determining polymorphism. A standard food questionnaire was used to determine daily fresh fruit consumption. RESULTS AND CONCLUSION: We found that CYP1A1 mutant variant (Ile/Val) was more highly expressed in Turkish patients and controls than in other Caucasian populations. Our findings were similar to Far Eastern populations (32.7% for patient group, 43.1% for controls). Inspite of the similarity between the groups regarding GST M1 polymorphism, in the patient group, patients with GST M1 null genotype had a statistically significant positive history of exposure to carcinogens other than smoking, such as asbestos, petrochemicals and/or other chemicals (p = 0.01). The patients, who had CYP 1A1 mutant variant, had increased risk of adenocarcinoma (p = 0.046) of lung (8 out of 18 patients) and 6 of them also had GST M1 (-) gene variants together. The patients who consumed less fruit daily had a greater risk of epidermoid carcinoma of lung (p = 0.019). However this study showed that there were no differences between the patient and control groups regarding genetic polymorphism of genes.