Publications by authors named "Cagatay Tezel"

36 Publications

Lung Cancer Surgery in Patients With a History of Coronary Artery Bypass Graft: A Multicentre Study.

Heart Lung Circ 2021 Mar 4;30(3):454-460. Epub 2020 Jul 4.

Department of Thoracic Surgery, Istanbul Medical School, Istanbul University, Istanbul, Turkey; Department of Thoracic Surgery, Istanbul Bilim University Medical Faculty and Group Florence Nightingale Hospitals, Istanbul, Turkey.

Background: Lung cancer surgery may be required for patients with a history of coronary artery bypass graft (CABG). In this study, we evaluated the general characteristics of patients, the difficulties experienced during and after lung cancer surgery and complications and mortality rates.

Method: Patients who were operated on for primary lung cancer between January 2012 and July 2017 in the participating centres were analysed retrospectively (n=7,530). Patients with a history of CABG (n=220) were examined in detail. This special group was analysed and compared with other patients operated on for lung cancer who did not have CABG (n=7,310) in terms of 30-day mortality and revision for haemorrhage.

Results: Of the 7,530 patients operated on for primary lung cancer, 2.9% were found to have undergone CABG. Surgical revision was required in the early postoperative period for 6.8% of those who had CABG and 3.5% in those who did not have CABG (p=0.009). Thirty-day (30-day) mortality was 4.5% in those who had CABG and 2.9% in those who did not have CABG (p=0.143). Further analysis of patients who had undergone CABG demonstrated that video-assisted thoracoscopic surgery (VATS) resulted in fewer complications (p=0.015). Patients with a left-sided left internal mammary artery (LIMA) graft had a higher number of postoperative complications (p=0.30).

Conclusions: Patients who had CABG suffered postoperative haemorrhage requiring a revision twice as often, and a tendency towards higher mortality (non-statistically significant). In patients with a history of CABG, VATS was demonstrated to have fewer complications. Patients with a LIMA graft who had a left-sided resection had more postoperative complications.
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http://dx.doi.org/10.1016/j.hlc.2020.05.109DOI Listing
March 2021

Prognostic significance of pathological complete response in non-small cell lung cancer following neoadjuvant treatment.

Turk Gogus Kalp Damar Cerrahisi Derg 2020 Jan 23;28(1):166-174. Epub 2020 Jan 23.

Department of Thoracic Surgery, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Background: This study aims to investigate the factors associated with pathological complete response following neoadjuvant treatment and to examine the prognostic value of pathological complete response in patients with non-small cell lung cancer undergoing surgical resection.

Methods: Between February 2009 and January 2016, a total of 112 patients (96 males, 16 females; mean age 60±8 years; range, 37 to 85 years) with the diagnosis of non-small cell lung cancer who underwent anatomical pulmonary resection after neoadjuvant treatment were retrospectively analyzed. Demographic, clinical, radiological, and pathological characteristics of the patients were recorded. The patients were classified as pathological complete response and nonpathological complete response according to the presence of tumors in the pathology reports. Predictive factors for pathological complete response and its prognostic significance were analyzed.

Results: The mean follow-up was 35±20 (range, 0 to 110) months. Of the patients, 30 (27%) achieved a pathological complete response. Reduction rate in tumor size was significantly higher in the responsive group (32.5±21.6% vs. 19.2±18.8%, respectively) and was a predictor of pathological complete response independent from the T and N factors (p=0.004). Survival of the responsive patients was significantly longer than unresponsive patients (75±9 vs. 30±4 months, respectively; p<0.001). During follow-up, tumor recurrence was seen in 30 patients. Recurrence was observed in only one patient in the responsive group, while 29 patients in the unresponsive group had recurrence or metastasis.

Conclusion: Tumor shrinkage rate after neoadjuvant treatment in non-small cell lung cancer is a predictive factor for pathological complete response. Survival of patients with a pathological complete response is also significantly longer than unresponsive patients.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2020.18240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7067008PMC
January 2020

Results of surgical resection in lung cancer with synchronous brain metastasis.

Turk Gogus Kalp Damar Cerrahisi Derg 2019 Apr 24;27(2):192-198. Epub 2019 Apr 24.

Department of Thoracic Surgery, Süreyyapaşa Chest Disease and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey.

Background: This study aims to investigate the factors affecting the survival of operated non-small cell lung cancer patients with synchronous brain metastasis.

Methods: Clinical outcomes of a total of 16 patients (14 males, 2 females; mean age 60 years; range, 41 to 71 years) who were diagnosed with non-small cell lung cancer and concomitant solitary/oligo brain metastasis and who underwent an intervention primarily for cranium, followed by lung resection in our clinic between January 2012 and January 2016 were retrospectively analyzed. Cranial surgery or gamma-knife radiosurgery was performed in the treatment of brain metastases.

Results: Twelve patients with solitary brain metastasis underwent cranial surgery, while four patients with solitary/oligo metastases underwent gamma-knife radiosurgery prior to pulmonary resection. Definitive pathological examination revealed adenocarcinoma in 13 patients and squamous-cell lung carcinoma in three patients. Mean survival time was 15.3±8.6 months. One-year and two-year survival rates were 56.2% and 32%, respectively. The number of brain metastases, treatment type, tumor cell type, resection type, and status of lymph nodes were not statistically significantly associated with survival (p>0.05).

Conclusion: Cranial surgery or gamma-knife radiosurgery followed by aggressive lung resection can be effectively applied in selected non-small cell lung cancer patients with synchronous brain metastasis. However, the suitability of the primary tumor and brain metastases for complete resection is of utmost importance in patient selection.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2019.15427DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7021390PMC
April 2019

Thoracoscopic Diagnosis of Follicular Lymphoma Relapsing after 13 Years.

Surg J (N Y) 2019 Jan 14;5(1):e5-e7. Epub 2019 Feb 14.

Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Relapse in lymphoproliferative malignancies is not an exceptional entity and generally occurs within the first 2 or 3 years following the primary treatment. Lymph node biopsy is essential for the diagnosis of relapse and treatment. A 64-years-old woman was referred to our clinic for back pain and dyspnea. Chest X-ray and computed tomography (CT) showed pleural thickening in the right hemithorax and pleural effusion. Hereby, we report a patient with a history of follicular lymphoma treatment 13 years ago, presenting with unilateral pleural effusion and being diagnosed, unpredictably, with relapsing lymphoma by video-assisted thoracoscopic surgery pleural biopsy.
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http://dx.doi.org/10.1055/s-0038-1661416DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375731PMC
January 2019

Spontaneous pneumothorax in the elderly: a sign of a malignancy?

Asian Cardiovasc Thorac Ann 2019 May 12;27(4):294-297. Epub 2019 Feb 12.

2 Thoracic Surgery Clinic, University of Health Sciences, Sureyyapasa Training and Research Hospital, Istanbul, Turkey.

Background: Spontaneous pneumothorax usually occurs as a result of rupture of a subpleural bleb or emphysematous bulla. Spontaneous pneumothorax, which is more common in younger age groups, might be the first sign of pulmonary malignancy, especially when it manifests in older patients.

Methods: Data of all patients who were treated for spontaneous pneumothorax in our clinic between June 2013 and June 2017 were examined retrospectively. The demographic characteristics, diagnostic methods, pathologic subtypes, and treatment protocols applied in patients diagnosed with malignancy during the treatment period were investigated.

Results: Out of 1187 patients, 9 (0.8%) had incidental pulmonary malignancies. Metastatic lung cancer was detected in 2 of 9 patients, while primary lung cancer was detected in the other 7. Six patients were operated on and the other 3 were referred for oncologic treatment for various reasons.

Conclusions: We suggest that cases of spontaneous pneumothorax in advanced age should be evaluated in a more detailed fashion, and further investigations should be carried out with suspicion of an underlying pulmonary malignancy.
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http://dx.doi.org/10.1177/0218492319831840DOI Listing
May 2019

Prognostic Importance of the Lymph Node Factor in Surgically Resected Non-Small Cell Lung Cancer.

Thorac Cardiovasc Surg 2020 03 2;68(2):183-189. Epub 2018 Nov 2.

Department of Thoracic Surgery, Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Background: Patients with N1 non-small cell lung cancer represent a heterogeneous population. The aim of this study is to determine the difference of survival rate between subtypes of N1 disease in surgically resected non-small cell lung cancer patients and to compare the survival in these patients with multi-N1 and single N2 (skip metastasis) disease.

Methods: Patients who underwent anatomical pulmonary resection in our institution between 2007 and 2014 with a pathological diagnosis of N1 and single N2 positive non-small cell lung cancer were included in the study. N1 positive patients were divided into three groups as single hilar; single interlobar, lobar, or segmental; and multiple N1 positive patients. These groups were compared among themselves as well as with incidentally found single N2 patients.

Results: A total of 1,742 patients who had non-small cell lung cancer underwent anatomical lung resection. The survival was better in single hilar lymph nodes than other subtypes of N1 disease ( = 0.015). There was no statistically significant difference in terms of survival between the other subtypes of N1 disease ( = 0.332). The difference in survival for single N2 disease compared with multi-N1 was not statistically significant ( = 0.054). Also, when we divided the groups as single and multi-N1, there was a significant difference in survival ( = 0.025).

Conclusion: Single hilar lymph nodes with direct invasion have better survival rate than other subtypes of N1. Also, patients with multiple N1 positive lymph nodes have similar survival results compared with single N2 patients. Our results should be confirmed with larger series to better explain N1 disease.
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http://dx.doi.org/10.1055/s-0038-1675345DOI Listing
March 2020

Correlation between meteorological changes and primary spontaneous pneumothorax: Myth or fact?

Turk Gogus Kalp Damar Cerrahisi Derg 2018 Jul 3;26(3):436-440. Epub 2018 Jul 3.

Department of Thoracic Surgery, Süreyyapaşa Chest Diseases and Thoracic Surgery Training and Research Hospital, İstanbul, Turkey.

Background: This study aims to investigate the relationship between meteorological changes and the development of primary spontaneous pneumothorax.

Methods: Medical records of 1,097 patients ( 975 males, 122 females; mean age 23.5±4.2 years; range, 17 to 32 years) admitted to our hospital with a diagnosis of primary spontaneous pneumothorax between January 2010 and January 2014 were evaluated retrospectively. Daily mean values for air temperature, wind speed, humidity rate and atmospheric pressure values obtained from the local meteorological observatory were recorded. The four-year study period was separated into two groups as days with at least one primary spontaneous pneumothorax development (group 1) and days without any primary spontaneous pneumothorax development (group 2).

Results: Within the study period of a total of 1,461 days, 1,097 cases were recorded in 759 days during which primary spontaneous pneumothorax was observed. Eighty-nine percent of the patients were male. There was no significant difference between the groups in terms of mean air temperature, humidity rate, and wind speed. Atmospheric pressure was significantly lower in group 1 (p<0.001). Decrease in atmospheric pressure with respect to the previous day increased the risk of primary spontaneous pneumothorax development significantly (p<0.001).

Conclusion: In our study, low atmospheric pressure and significant pressure decreases showed a strong correlation with primary spontaneous pneumothorax. Temperature, wind speed, and humidity values did not influence primary spontaneous pneumothorax development.
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http://dx.doi.org/10.5606/tgkdc.dergisi.2018.15494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7018269PMC
July 2018

Primary Pulmonary Malignant Fibrous Histiocytoma.

Turk Thorac J 2017 Apr 1;18(2):54-56. Epub 2017 Mar 1.

Department of Thoracic Surgery, Süreyyapaşa Chest Diseases and Thoracic Surgery Training Hospital, İstanbul, Turkey.

Malignant fibrous histiocytoma (MFH) cases are classified within the group of nonclassified sarcomas. The etiopathogenesis is unclear; however, MFH commonly develops in scar tissue and in areas exposed to radiation. MFH is the most common soft tissue sarcoma in adults and may be borne in the lungs, chest wall, mediastinum, or other tissues. Primary MFH of the lung constitutes less than 0.2% of all pulmonary neoplasms; thus, an optimal treatment strategy has not yet been elucidated. We aimed to report a case of MFH of the lung with subsequent treatment administration.
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http://dx.doi.org/10.5152/TurkThoracJ.2017.16039DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5783081PMC
April 2017

The Feasibility of Thoracoscopic Resection in Bronchiectasis.

Surg Laparosc Endosc Percutan Tech 2017 Jun;27(3):194-196

*Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital †Department of Thoracic Surgery, Marmara University Pendik Training and Research Hospital, Istanbul, Turkey.

Introduction: Minimally invasive surgery is the treatment of choice in early-stage lung cancer. However, experience in infectious lung disease, primarily bronchiectasis, is limited probably because of the presence of dense pleural adhesions, multiple lymph nodes, and spiral bronchial arteries. The present study shows our experience of video-assisted thoracoscopic surgery (VATS) lobectomy and segmentectomy in the treatment of bronchiectasis.

Materials And Methods: Patients who underwent VATS lobectomy or segmentectomy in our clinic between April 2008 and 2015 were retrospectively evaluated. Surgery was indicated in patients with radiologic localized bronchiectasis who also had a history of recurrent lower respiratory tract infection or expectorating mucopurulent secretion. The patients were analyzed in terms of age, sex, thoracotomy conversion rate, postoperative drainage amount, chest tube removal time, length of hospital stay, morbidity, and mortality.

Results: A total of 44 patients initially underwent VATS pulmonary anatomic resection and 41 procedures were completed on 40 patients. One patient had bilateral resection. Fifteen patients were male individuals and 26 were female individuals. The average age was 31.4 (15 to 57) years. Forty lobectomies and 1 segmentectomy were performed. The conversion rate was 6.8%. VATS was performed on 28 patients by 3 ports, 8 patients by 2 ports, and 5 patients by a single port. In terms of anatomic resections, 18 patients underwent left lower lobectomy, 8 right lower lobectomy, 8 middle lobectomy, 6 right upper lobectomy, and 1 patient underwent lingular segmentectomy. No major postoperative complication or mortality was observed. Prolonged air leak was observed in 2 patients and subcutaneous emphysema occurred in 2 patients. The average postoperative drainage amount, chest tube removal time, and length of hospital stay were 320 mL, 3.1 (1 to 11) days, and 4.6 (2 to 11) days, respectively.

Conclusions: VATS pulmonary resection is a safe, feasible, and effective treatment in the surgery of bronchiectasis with low morbidity and mortality rates. Moreover, because of cosmetic results, patients with benign diseases such as bronchiectasis could be initiated by minimally invasive surgery options just like patients with malignancies.
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http://dx.doi.org/10.1097/SLE.0000000000000408DOI Listing
June 2017

Another Reason to Omit Induction Radiotherapy: Save It for Last.

Balkan Med J 2016 Nov 1;33(6):714-715. Epub 2016 Nov 1.

Department of Thoracic Surgery, Süreyyapaşa Chest Diseases and Throracic Surgery Training and Research Hospital, İstanbul, Turkey.

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http://dx.doi.org/10.5152/balkanmedj.2016.160898DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5142804PMC
November 2016

The Most Minimally Invasive Lobectomy: Videomediastinoscopic Lobectomy.

Surg Laparosc Endosc Percutan Tech 2016 Aug;26(4):e73-4

Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Transcervical approaches are well-described procedures. However, they are performed in a limited number of experienced centers. Transcervical lobectomies are even rarer. However, these lobectomy cases defined in the literature are performed through a collar incision with the aid of a sternal retractor. The case presented here describes the first right upper lobectomy through videomediastinoscopy without sternal elevation.
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http://dx.doi.org/10.1097/SLE.0000000000000292DOI Listing
August 2016

Comparison of Mid-Term Clinical Outcomes of Different Surgical Approaches in Symptomatic Diaphragmatic Eventration.

Ann Thorac Cardiovasc Surg 2016 Aug 14;22(4):224-9. Epub 2016 Apr 14.

Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Purpose: There is no data comparing different surgical techniques for diaphragmatic re-positioning for hemi-diaphragmatic eventration in adults. Our aim was to verify the potential pros and cons of two major surgical techniques in symptomatic eventration patients.

Methods: Patients undergoing thoracotomy for diaphragmatic elevation repair either by un-opened (accordion placation) or by opened (double-breasted placation) diaphragmatic technique between January 2007 and August 2013 were analyzed retrospectively, and compared in terms of operative outcomes on 12th and 24th months.

Results: Forty-two patients underwent accordion (n = 23) or double-breasted (n = 19) plication. Postoperative drainage was significantly increased (215 ± 66 ml vs. 114 ± 48 ml; P = 0.0082) in double-breasted group. Although the corrected diaphragm was radiologically better preserved in this group, this divergence showed no additional effect on postoperative pulmonary functions or the dyspnea score on 12th or 24th months. No complication particularly related to both techniques or recurrence was noted during follow-up of 28 ± 12 months.

Conclusions: Radiological prospect of corrected diaphragm is better preserved with double-breasted plication, but the significant and permanent improvement of respiratory functions was similar. Since the clinical outcome is equivalent, incision of the diaphragm is not essential.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045849PMC
http://dx.doi.org/10.5761/atcs.oa.16-00018DOI Listing
August 2016

Have You Seen My Teeth? A Case with an Extraordinary Radiologic Finding.

Surg J (N Y) 2016 Mar 14;2(1):e49-e50. Epub 2016 Mar 14.

Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

A 55-year-old man was admitted to the emergency department with severe dyspnea and hoarseness, starting immediately after a hypotensive syncope attack at home. Pulmonary auscultation revealed generalized stridor and right-sided wheezing, with no finding in the upper airway on direct laryngoscopy. Chest X-ray and computed thorax tomography revealed a high-density foreign body on the carina, causing partial obstruction in the right main bronchus. The fractured dental plate, probably aspirated during the syncope attack, was successfully removed by rigid bronchoscopy. The postoperative period was uneventful and the patient was discharged on the same day. Rapid physical and radiologic examination of patients with severe acute dyspnea is vital for determining the treatment modality and preventing any potential mortality.
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http://dx.doi.org/10.1055/s-0036-1580707DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5553460PMC
March 2016

Double segmentectomy for T4 lung cancer in a pulmonary-compromised patient.

Ann Transl Med 2015 Dec;3(22):361

1 Department of Thoracic Surgery, 2 Department of Chest Diseases, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Complete resection is the optimal treatment for primary lung cancer. The choice of surgical methods varies depending on tumor size, tumor location, and each patient's respiratory reserve. Currently, lobectomy with lymph node dissection is the gold standard for the surgical management of lung cancer. However, many thoracic surgical candidates also have chronic obstructive pulmonary disease or emphysema and thus present with minimal lung reserve. In the past few years, more reports have been published on the outcomes of patients who underwent anatomic segmentectomy for lung cancer. Herein we report the surgical outcomes of a patient with limited respiratory reserve, who underwent double segmentectomy.
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http://dx.doi.org/10.3978/j.issn.2305-5839.2015.12.29DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701516PMC
December 2015

A Case of Traumatic Flail Chest Requiring Stabilization with Surgical Reconstruction.

Thorac Cardiovasc Surg Rep 2015 Dec 20;4(1):8-10. Epub 2015 Aug 20.

Department of Thoracic Surgery, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Background Flail chest is the most serious complication that may occur after thoracic trauma. In this article, we present a case of flail chest caused by blunt chest trauma, which presented dramatic clinical improvement following rib fixation and chest wall reconstruction. Case Description A 53-year-old male patient with flail chest because of the trauma who had been followed in intensive care unit for mechanical ventilatory support underwent chest wall stabilization with titanium reconstruction plate and screws. Conclusion The main objective is surgical stabilization of the chest wall in cases of flail chest with a parenchymal damage because of the severe rib fracture, which need prolonged mechanical ventilation.
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http://dx.doi.org/10.1055/s-0035-1558433DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4670308PMC
December 2015

Is single port enough in minimally surgery for pneumothorax?

Surg Endosc 2016 Jan 24;30(1):59-64. Epub 2015 Mar 24.

Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, Istanbul, Turkey.

Background: Video-assisted thoracoscopic surgery is a widespread used procedure for treatment of primary spontaneous pneumothorax patients. In this study, the adaptation of single-port video-assisted thoracoscopic surgery approach to primary spontaneous pneumothorax patients necessitating surgical treatment, with its pros and cons over the traditional two- or three-port approaches are examined.

Methods: Between January 2011 and August 2013, 146 primary spontaneous pneumothorax patients suitable for surgical treatment are evaluated prospectively. Indications for surgery included prolonged air leak, recurrent pneumothorax, or abnormal findings on radiological examinations. Visual analog scale and patient satisfaction scale score were utilized.

Results: Forty triple-port, 69 double-port, and 37 single-port operations were performed. Mean age of 146 (126 male, 20 female) patients was 27.1 ± 16.4 (range 15-42). Mean operation duration was 63.59 ± 26 min; 61.7 for single, 64.2 for double, and 63.8 min for triple-port approaches. Total drainage was lower in the single-port group than the multi-port groups (P = 0.001). No conversion to open thoracotomy or 30-day hospital mortality was seen in our group. No recurrence was seen in single-port group on follow-up period. Visual analog scale scores on postoperative 24th, 48th, and 72nd hours were 3.42 ± 0.94, 2.46 ± 0.81, 1.96 ± 0.59 in the single-port group; significantly lower than the other groups (P = 0.011, P = 0.014, and P = 0.042, respectively). Patient satisfaction scale scores of patients in the single-port group on 24th and 48th hours were 1.90 ± 0.71 and 2.36 ± 0.62, respectively, indicating a significantly better score than the other two groups (P = 0.038 and P = 0.046).

Conclusions: This study confirms the competency of single-port procedure in first-line surgical treatment of primary spontaneous pneumothorax.
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http://dx.doi.org/10.1007/s00464-015-4161-6DOI Listing
January 2016

Pulmonary resection in the treatment of life-threatening hemoptysis.

Ann Thorac Cardiovasc Surg 2015 2;21(2):125-31. Epub 2015 Mar 2.

Sureyyapasa Pulmonology and Thoracic Surgery Training and Research Hospital, Department of Thoracic Surgery, Istanbul, Turkey.

Purpose: Massive hemoptysis is a life threatening situation with high mortality rates. Surgery is effective, however generally an avoided treatment. We report our experience with patients undergoing lung resection for life-threatening hemoptysis.

Methods: Records of all surgically treated patients for hemoptysis between June 2009 and June 2012 were reviewed and analyzed retrospectively.

Results: Anatomical resection was performed on 31 (15.3%) patients out of 203 patients referred to our intensive care unit for life-threatening hemoptysis. 25 (80.6%) were male and six (19.4%) were female; with mean age of 46.4 ± 13.7 (21-77). Pneumonectomy was performed in four (12.9%), lobectomy in 24 (77.4%), segmentectomy in two (6.5%) and bilobectomy in one case. Postoperative complications developed in eight (25.8%), and mortality was observed in two (6.5%) patients. Etiology was bronchiectasis in 13 (42.0%), tuberculosis in eight (25.8%), carcinoma in four (12.9%), aspergilloma in four (12.9%), hydatid cyst in one (3.2%) and lung abscess in one (3.2%) of the cases.

Conclusions: Although lung resection in the treatment of massive hemoptysis is accompanied with high morbidity and mortality rates, surgery is the only permanent curative modality. Acceptable results can be achived in the company of a multidisciplinary approach, through avoidance of pneumonectomy and urgent surgery.
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http://dx.doi.org/10.5761/atcs.oa.14-00164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4990091PMC
January 2016

Chondrosarcoma of the anterior chest wall: surgical resection and reconstruction with titanium mesh.

J Thorac Dis 2014 Oct;6(10):E230-3

Department of Thoracic Surgery, Sureyyapasa Training and Research Hospital, Istanbul, Turkey.

Primary malignant tumors of the chest wall are uncommon. Chondrosarcoma is the most common malignancy of the sternum. The current therapy for chondrosarcoma requires adequate surgical excision. A 52-year-old man presented with a lower-sternal mass. Thorax computed tomography (CT) revealed a well-lineated, hypodense and round mass, which highly suggested the sarcoma of the chest wall. The tumor involved 1/3 distal part of the corpus sterni. Incisional biopsy of the mass was reported as chondrosarcoma. In order to obtain disease-free surgical margins, 1/3 distal part of the sternum with costochondral junctions was resected and reconstruction of anterior chest wall was performed with titanium mesh. The postoperative course was uneventful. The titanium mesh provided the essential rigidity and minimal elasticity over the surgical wound. Our findings show that this technique is adequate even for reconstructing extensive defects of the anterior chest wall.
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http://dx.doi.org/10.3978/j.issn.2072-1439.2014.09.30DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4215132PMC
October 2014

One-port videothoracoscopic surgical intervention.

Surg Laparosc Endosc Percutan Tech 2015 Feb;25(1):40-2

Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Educational and Research Hospital, Istanbul, Turkey.

Background: One-port video-assisted thoracic surgery (VATS) has recently been proposed as an alternative to conventional 3-port VATS. To reduce pain, chest wall paresthesia, and hospital stay, lesser ports are the current direction.

Materials And Methods: From 2007 to 2010, 98 patients underwent 1-port VATS procedure. The charts were retrospectively evaluated. A 2.5 cm long incision was made at the sixth intercostal space in the median axillary line. A single flexible port was used. Both the camera and the endoinstruments were introduced through the port. Patient characteristics, visual analog score, and postoperative paresthesia scores were evaluated.

Results: The study enrolled 38 women and 60 men with the mean age of 49.1±1.5 years (range, 19 to 75 y). Thirty-one patients (28.6%) were diagnosed with malignant pleural effusion. Perioperative pleurodesis with talc was performed in 81% of them. One-port VATS approach was used for pleura biopsies in 77 (78.6%), wedge resection in 4 (3.8%), pleurectomy in 13 (12.4%), and biopsy with talc chemical pleurodesis in 4 (3.8%) instances. The mean operation time was 24.4 minutes (range, 15 to 50 min). No major cardiorespiratory or surgical complications were noted. The median observation time was 60 months (range, 36±81 mo). Among benign pathology patients, 56 (82.3%) of them did not complain about any pain; however, 12 patients had prolonged discomfort (2 pinprick, 6 numbness, and 4 pruritus).

Conclusions: One-port VATS in selected patients are feasible and seems to be safe in thoracic surgical interventions instead of conventional 3 ports that was presented in this series.
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http://dx.doi.org/10.1097/SLE.0000000000000013DOI Listing
February 2015

Comparative analysis of the protective effects of caffeic acid phenethyl ester (CAPE) on pulmonary contusion lung oxidative stress and serum copper and zinc levels in experimental rat model.

Biol Trace Elem Res 2013 Jan 27;151(1):50-8. Epub 2012 Sep 27.

Department of Thoracic Surgery, Istanbul Medeniyet University Medical School, Istanbul, Turkey.

The aim of this study was to investigate the effects of caffeic acid phenethyl ester (CAPE) in the lungs by biochemical and histopathological analyses in an experimental isolated lung contusion model. Eighty-one male Sprague-Dawley rats were used. The animals were divided randomly into four groups: group 1 (n = 9) was defined as without contusion and without CAPE injection. Group 2 (n = 9) was defined as CAPE 10 μmol/kg injection without lung contusion. Group 3 (n = 36) was defined as contusion without CAPE-administrated group which consisted of four subgroups that were created according to analysis between days 0, 1, 2, and 3. Group 4 (n = 27) was defined as CAPE 10 μmol/kg administrated after contusion group divided into three subgroups according to analysis on days 1, 2, and 3. CAPE 10 μmol/kg was injected intraperitoneally 30 min after trauma and on days 1 and 2. Blood samples were obtained to measure catalase (CAT) and superoxide dismutase (SOD) activities and level of malondialdehyde (MDA) and for blood gas analysis. Trace elements such as zinc and copper were measured in serum. The lung tissue was also removed for histopathological examination. Isolated lung contusion increased serum and tissue SOD and CAT activities and MDA levels (p < 0.05). Both serum and tissue SOD, MDA, and CAT levels on day 3 were lower in group 4 compared to group 3 (p < 0.05). Further, the levels of SOD, MDA, and CAT in group 4 were similar compared to group 1 (p > 0.05). CAPE also had a significant beneficial effect on blood gases (p < 0.05). Both serum zinc and copper levels were (p < 0.05) influenced by the administration of CAPE. Histopathological examination revealed lower scores in group 4 compared to group 3 (p < 0.05) and no significant differences compared to group 1 (p > 0.05). CAPE appears to be effective in protecting against severe oxidative stress and tissue damage caused by pulmonary contusion in an experimental setting. Therefore, we conclude that administration of CAPE may be used for a variety of conditions associated with pulmonary contusion. Clinical use of CAPE may have the advantage of prevention of pulmonary contusion.
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http://dx.doi.org/10.1007/s12011-012-9505-7DOI Listing
January 2013

Superiority of video-assisted to standard mediastinoscopy in non-small-cell lung cancer staging.

Thorac Cardiovasc Surg 2012 Dec 12;60(8):541-4. Epub 2012 Mar 12.

Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching Hospital, Istanbul, Turkey.

Background: We compared the efficiency of videomediastinoscopy (VM) and standard mediastinoscopy (SM) in detecting mediastinal lymph node (MLN) metastasis in non-small-cell lung cancer (NSCLC) patients.

Methods: By SM method a surgeon sampled bilateral paratracheal and subcarinal lymph node stations and then by VM method, another surgeon resampled all lymph node stations once more through the same incision in the same operative setting. Results of the pathologic examinations of two methods were compared.

Results: Twenty-seven consecutive mediastinoscopies were included. The numbers of nodal stations biopsied in SM and VM were 97 and 103, respectively. Lymph node metastasis was found in six patients with SM and nine patients with VM. Lymph node dissection by thoracotomy revealed metastases, which were not found by mediastinoscopy, in two patients. Our study showed an accuracy of 92.3% for VM versus 80.7% for SM and corresponding negative predictive values of 88.2% and 75%, respectively (p = 0.002; Fig. 1).

Conclusion: This study showed that VM is superior to SM in detecting MLN metastasis in patients with NSCLC.
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http://dx.doi.org/10.1055/s-0031-1299577DOI Listing
December 2012

Spontaneous pneumomediastinum: report of two cases.

Ulus Travma Acil Cerrahi Derg 2011 Jul;17(4):368-70

Süreyyapaşa Chest Diseases and Thoracic Surgery Training Hospital, İstanbul, Turkey.

Spontaneous pneumomediastinum (SPM) is an uncommon, benign, self-limited disorder that usually occurs in young adult males without any apparent precipitating factor or disease. SPM responds extremely well to conservative treatment, without recurrence in the great majority of cases. In this report, two patients who were admitted for SPM are discussed together with the associated literature.
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http://dx.doi.org/10.5505/tjtes.2011.22755DOI Listing
July 2011

[A rare cause of hemopneumothorax: an aberrant systemic artery].

Ulus Travma Acil Cerrahi Derg 2011 May;17(3):280-2

Süreyyapaşa Chest Diseases and Thoracic Surgery Training Hospital, İstanbul, Turkey.

Spontaneous hemopneumothorax is a rare situation that can be life-threatening in young patients presenting hemodynamic instability due to hypovolemic shock. One of the extraordinary causes of hemopneumothorax is rupture of an apically located aberrant artery after pneumothorax, which is noticed as a third etiological factor in the literature. This case is presented in order to highlight this uncommon etiological factor together with the literature.
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http://dx.doi.org/10.5505/tjtes.2011.36633DOI Listing
May 2011

Streptokinase for malignant pleural effusions: a randomized controlled study.

Asian Cardiovasc Thorac Ann 2011 Jun;19(3-4):238-43

Department of Thoracic Surgery, Acibadem University Medical School, Istanbul, Turkey.

Effective palliative treatment in malignant pleural effusion can only be carried out when the lung is fully expanded after drainage of effusion. We investigated the efficacy of intrapleural fibrinolytics for lysing fibrin deposits and improving lung reexpansion in patients with malignant pleural effusion. We randomly allocated 47 patients with malignant pleural effusion into 2 groups: a fibrinolytic group of 24 were given 3 cycles of 250,000 U intrapleural streptokinase; the control group of 23 received pleural drainage only. Pleurodesis with 5 mg of talc slurry was performed in all patients who had lung reexpansion after drainage. Patient characteristics, pleural drainage, lung expansion assessed by chest radiography, and pleurodesis outcomes were compared between the 2 groups. Patient characteristics were similar in both groups. Lung reexpansion was adequate for performing talc pleurodesis in 96% of patients in the fibrinolytic group and 74% in the control group. In the fibrinolytic group, the mean volume of daily pleural drainage before streptokinase administration was 425 mL, and it increased significantly to 737 mL after streptokinase infusion. Intrapleural administration of streptokinase is advisable for patients with malignant pleural effusion.
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http://dx.doi.org/10.1177/0218492311410874DOI Listing
June 2011

Recurrent pneumothorax diagnosed as catamenial after videothoracoscopic examination of the pleural cavity.

Surg Laparosc Endosc Percutan Tech 2011 Apr;21(2):e81-3

Department of Thoracic Surgery, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

We describe a case of catamenial pneumothorax due to a diaphragmatic defect that was confirmed and treated through the thoracoscopic approach. The patient was a 34-year-old woman who had 3 episodes of right chest pain and shortness of breath, each time starting on the day preceding her menstruation. During thoracoscopy, pathologic changes in the central tendon were apparent, as a 2-mm defect in the diaphragm was discovered. The defect was sutured. Apical pleurectomy and chemical pleurodesis were applied. According to the literature, suspicion of catamenial pneumothorax requires detailed examination of the diaphragm. Every effort, such as pleurectomy and pleurodesis, with postoperative hormonal therapy, should be added to treatment, owing to the high probability of recurrence.
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http://dx.doi.org/10.1097/SLE.0b013e31820af7f9DOI Listing
April 2011

1-year follow-up with an hourglass-shaped stent.

Authors:
Cagatay Tezel

Ann Thorac Surg 2010 Sep;90(3):1062

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http://dx.doi.org/10.1016/j.athoracsur.2010.02.086DOI Listing
September 2010

An unusual presentation of Castleman's disease.

Respirology 2010 Aug 12;15(6):1012-4. Epub 2010 Jul 12.

Department of Thoracic Surgery, Sureyyapasa Chest Diseases and Thoracic Surgery Teaching Hospital, Istanbul, Turkey.

Castleman's disease is one of the heterogeneous group of lymphoproliferative disorders of unknown aetiology. It commonly presents as a mediastinal mass. It can be unicentric involving only a single site, or multicentric involving multiple sites. We report a patient with unicentric Castleman's disease, in which the mass was located in the posterior mediastinum and accompanied by a massive pleural effusion, which is extremely rare in unicentric disease. This case report highlights the imaging techniques used in the differential diagnosis and surgical considerations due to the hypervascular nature of the tumour.
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http://dx.doi.org/10.1111/j.1440-1843.2010.01805.xDOI Listing
August 2010

The autologous pleural buttressing of staple lines in surgery for bullous lung disease.

Eur J Cardiothorac Surg 2010 Dec 23;38(6):679-82. Epub 2010 Jun 23.

Sureyyapasa Chest Diseases and Thoracic Surgery Teaching Hospital, Istanbul, Turkey.

Objective: Prolonged air leak remains as one of the most common complications after surgery for bullous lung disease. Reinforcement of the staple line with either prosthetic material or bovine pericardial strips has been advocated to avoid this problem. We used the patients' own parietal pleural layer to cover the staple lines to prevent air leak and subsequently assessed the comparative results.

Methods: A total of 22 patients underwent thoracotomy for bullous lung disease, mainly due to lobe-dominance bullae combined with emphysema, between November 2006 and November 2008. A case-control study was set from the surgical data of patients who were operated on using stapling devices without any buttressing material (group I=12) and were compared with the group of patients who were operated on using staplers buttressed with an autologous pleural layer (group II=10). Patient characteristics, chest-tube removal time and length of hospital stay were prospectively recorded in group II. The outcomes of the two groups were analysed based on postoperative complications, chest-tube removal time and postoperative length of hospital stay.

Results: There was no statistically significant difference between both the groups in preoperative characteristics including age, sex, co-morbid factors, and respiratory functions, heterogeneity of emphysema, intra-operative adhesion density and length of staple line. However, the chest tube was removed significantly earlier in patients whose bullae were resected by stapling devices buttressed with autologous-parietal pleura (p=0.04).

Conclusions: Autologous pleural reinforcement of the staple line in surgery for bullous lung disease is a safe, effective and cost-free procedure that precipitates the early removal of the chest tube.
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http://dx.doi.org/10.1016/j.ejcts.2010.05.008DOI Listing
December 2010

The role of integrated positron emission tomography and computed tomography in the assessment of nodal spread in cases with non-small cell lung cancer.

Interact Cardiovasc Thorac Surg 2010 Feb 19;10(2):200-3. Epub 2009 Nov 19.

Department of Thoracic Surgery, Sureyyapasa Chest Disease and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.

Integrated positron emission tomography and computed tomography (PET/CT) scanning has become the standard for oncologic imaging. We sought to determine the role of PET/CT in mediastinal non-small cell lung cancer staging. One hundred and twenty-seven consecutive patients were enrolled in the study where PET/CT was performed due to pathologically defined non-small cell carcinoma from a single center. They all underwent complete resection with a thoracotomy and systemic lymph node dissection (SLND) between October 2005 and January 2007. Postoperative pathology results of lymph node stations regarding the nodal spread and stage were compared with clinical stage obtained by PET/CT. The sensitivity, specificity, accuracy, negative predictive value (NPV) and positive predictive value (PPV) of PET/CT in N2 cases were determined to be 72.0%, 94.4%, 92.7%, 97.7% and 49.2%, respectively. Maximum standard uptake (SUV(max)) cut-off value for mediastinal N2 involvement in PET/CT was obtained by applying 'receiver operating characteristic' (ROC) analysis that was set to 5.2. Correct stage with PET/CT was established in 76.3% of cases. Staging of non-small cell lung cancer (NSCLC), according to the PET/CT for which we determined 97.79% NPV, we consider that thoracotomy without preoperative mediastinal invasive staging in cases of negative mediastinal involvement in PET/CT can be certainly performed.
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http://dx.doi.org/10.1510/icvts.2009.220392DOI Listing
February 2010

Bronchogenic cysts of the lung: report of 29 cases.

Heart Lung Circ 2009 Jun 31;18(3):214-8. Epub 2008 Dec 31.

Sureyyapasa Chest Disease and Chest Surgery Traning and Research Hospital, Department of Thoracic Surgery, Ataturk cad. Murat Apt. 46/16, 34734 Erenkoy, Istanbul, Turkey.

Background: Intrapulmonary bronchogenic cysts are congenital anomalies of the tracheobronchial tree and foregut. The aim of this retrospective study was to review the diagnosis, clinical and histological features, operative techniques, outcomes and follow-up of intrapulmonary bronchogenic cysts treated in a single institute.

Methods: Twenty-nine patients with intrapulmonary bronchogenic cysts were treated surgically between 1990 and 2005. There were 17 female and 12 male patients and their ages ranged from 7 to 68 years. Patients were divided into two groups according to surgical procedure. Resection (lobectomy or wedge resection) was performed on Group I (n=18), and partial excision with de-epithelisation was performed on Group II (n=11).

Results: Twenty-five patients (86.2%) were symptomatic. Cough and sputum were the most common symptoms. Twenty-four of the 29 BCs were simple cysts (82.7%) whereas 5 (17.3%) were complicated cysts. Postoperative hospital stay was 4.55+/-0.86 days in group I and 6.54+/-3.34 days in group II (P=0.172). Complications in Group I were pneumonia in one case and wound infection in two cases; prolonged air leakage were observed in two cases of Group II. No statistical difference was determined between the complication rates of the two groups (P=0.91). However a significant difference was determined between the complication rates of simple and complicated cysts (P=0.026). Two cases in Group II showed recurrence, whereas no recurrence occurred in Group I. (P=0.065) No postoperative mortality was observed in any of the groups.

Conclusions: All bronchogenic cysts should be treated surgically. We believe that partial excision with de-epithelisation may be an alternative to resection in symptomatic patients with limited respiratory capacity.
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http://dx.doi.org/10.1016/j.hlc.2008.10.011DOI Listing
June 2009