Background:This study aimed to evaluate the relationship between Shamblin classification, operative parameters, and postoperative neurological outcomes in patients undergoing carotid body tumor (CBT) surgery, and to assess the potential benefit of preoperative embolization. Methods:A retrospective analysis was conducted on 52 patients (41 males, 11 females; mean age 47.2±14.8 years) who underwent CBT resection between January 2008 and June 2023 at a tertiary care center. Demographic, clinical, and perioperative variables were reviewed. Tumors were classified according to the modified Shamblin system. Postoperative neurological complications, operation time, blood loss, and hospital stay were analyzed. Statistical comparisons were performed using appropriate parametric and non-parametric tests, with p<0.05 considered significant. Results:Nineteen patients (36.5%) had Shamblin class I, 25 (48.1%) class II, and 8 (15.3%) class III tumors. Preoperative embolization was performed in one patient. Neurological complications occurred in 11 patients (21.2%), including hypoglossal and vagus nerve injuries. A significant correlation was observed between higher Shamblin class and increased operation time, intraoperative blood loss, and postoperative neurological deficits (p<0.01). Hospital stay was also significantly longer in patients with neurological complications. Conclusion:Advanced Shamblin classification is associated with greater surgical complexity and higher neurological morbidity. While preoperative embolization may reduce bleeding, its neuroprotective effect remains uncertain. Surgical resection remains the cornerstone of CBT management, with careful dissection crucial to minimizing complications.
Background: Cardiac surgery has seen significant improvements, but reducing complications like vasoplegic syndrome remains a priority. Vitamin B12 is emerging as a treatment for vasoplegia. We investigated if preoperative serum vitamin B12 levels could predict the need for postoperative inotropic support in patients undergoing coronary artery bypass grafting (CABG). Methods: This was a retrospective study of 166 patients who underwent isolated elective conventional CABG between 2019 and 2023. We collected patient demographics, comorbidities, and preoperative vitamin B12 levels. Postoperative data on the need for inotropic agents (adrenaline, dopamine, dobutamine) and cardiac assist devices were also analyzed. Mann-Whitney U tests with Bonferroni correction for multiple comparisons and multivariable logistic regression adjusting for confounders were performed. Results: Patients who required adrenaline, dopamine, or dobutamine support had significantly lower median preoperative vitamin B12 levels compared to those who did not. Specifically, adrenaline-dependent patients had a median B12 level of 97.00 (84.00-107.00) pg/mL, while non-dependent patients had 259.00 (187.50-385.00) pg/mL (p<0.001, effect size r=0.87). After Bonferroni correction, low B12 levels remained significantly associated with adrenaline (p<0.001) and dopamine (p=0.0005) requirements. In multivariable analysis adjusting for age, sex, left ventricular ejection fraction, comorbidities, and operative times, vitamin B12 remained independently associated with adrenaline requirement (odds ratio=0.781 per 10 pg/mL, 95% confidence interval: 0.708-0.861, p<0.001). Conclusion: Low preoperative serum vitamin B12 levels are independently associated with the need for postoperative inotropic support after CABG, particularly adrenaline requirement. These findings suggest that preoperative B12 levels may be a valuable predictive marker for identifying high-risk patients and could guide prophylactic strategies. Further research is needed to explore this relationship in more detail.
Background: To examine how pathological variables affect prognosis in patients undergoing surgery for epithelioid pleural mesothelioma (PM). Methods: The study examined 64 patients treated surgery for PM between January 2007 and October 2019, retrospectively. Clinicopathological variables including age, surgical procedure, tumor stage, and detailed histopathological features (nuclear atypia, mitotic count, necrosis, nuclear grading, and tumor grade) were evaluated. Overall survival was analyzed using Kaplan-Meier and Cox proportional hazards regression models. To avoid multicollinearity among interrelated pathological parameters, two separate multivariate Cox models were constructed. Results: The 5-year survival rate was 8 percent, compared to 62 percent in the first year. Individuals 65 and older had no 5-year survival, whereas patients 65 and younger had a rate of 11 percent (p=0.046). In comparison to groups with mild and moderately high mitotic scores, those with a high mitotic score (p=0.019) had significantly lower median survival and 5-year survival rates. Variables (p<0.15) included in the univariate survival analysis were patients who 65 years and older, type of operation, mitosis, necrosis, tumor stage, nuclear grading, and grade of mesotheliomas. In multivariate analysis, high nuclear grade (Model 1: Hazard ratio [HR]=2.48, 95% confidence interval [CI]: 1.09-5.62, p=0.030) and high tumor grade (Model 2: HR=2.36, 95% CI: 1.05-5.31, p=0.037) were independently associated with worse overall survival. Conclusion: Pathological grading, represented by either nuclear grade or tumor grade, is the strongest independent prognostic factor for survival in patients with epithelioid PM.
Background:Surgical resection in non-small cell lung cancer (NSCLC) is a potentially curative option in selected patients. Current TNM staging systems emphasize the prognostic role of pathological N (pN) status, and in the 9th TNM system pN2 disease is subdivided into single- (pN2a) and multiple-station (pN2b) N2 involvement. This study aimed to evaluate the impact of nodal status and other prognostic factors on survival in patients with stage IIB-IIIB NSCLC reclassified according to the 8th and 9th TNM systems. Methods:A total of 824 patients aged ≥18 years who underwent lung resection for NSCLC between 2007 and 2021 and were stage IIB, IIIA, or IIIB according to the 8th TNM system were included. Demographic, histopathologic, surgical, and survival data were retrospectively analyzed. All cases were restaged according to both the 8th and 9th TNM criteria, and the effects of lymph node status and pathological factors on survival were investigated. Results:The mean age was 59.7±8.58 years; 10.4% of patients were female. Squamous cell carcinoma (61.7%) and adenocarcinoma (32.5%) were the most common histologies. Lobectomy, pneumonectomy, and segmentectomy were performed in 52.3%, 46.8%, and 0.8% of patients, respectively. Age >70 years (p<0.001) and adenocarcinoma histology (p<0.001) were associated with worse survival, whereas gender and type of resection were not. pN2 disease had significantly worse survival than pN1 (p<0.001). In the 9th TNM system, pN2b had worse survival than pN1 and pN2a (p<0.001), while pN1 and pN2a did not differ significantly (p=0.088). Stage IIA/IIB patients had better survival than those with more advanced stages (p<0.001). Conclusion:pN status, particularly pN2 subgroups in the 9th TNM system, is a key determinant of survival in surgically treated stage IIB-IIIB NSCLC.
Background:Left atrial invasion is classified as T4 non-small cell lung cancer (NSCLC). Surgical outcomes vary in selected patients. This study presents outcomes of left atrial resection at our center. Methods:Between August 2008 and May 2022, surgical outcomes of 41 NSCLC patients with left atrial invasion were retrospectively analyzed. Demographics, tumor characteristics, surgical procedures (pneumonectomy, lobectomy), nodal status (N0, N1, N2), and margin status (complete [R0], incomplete [R1]) were recorded. In-hospital mortality, morbidity, and long-term survival were evaluated. Cox proportional hazards regression model was used to assess all-cause mortality. Results:Mean age was 61.8 (±11.6) years, and 90.2% of patients were male. Median tumor diameter was 4.5 cm (interquartile range, 3.5-5.5 cm), 53.7% of tumors were right-sided. Squamous cell carcinoma was the predominant subtype (78%). Pathological nodal status was N0 in 25 patients and N1/N2 in 8 patients each. Complete resection was achieved in 35 patients (85.4%). In-hospital mortality was 4.8%, and long-term mortality was 70.8%. Median overall survival was 2.11 years (95% confidence interval [CI], 1.17-3.05). Multivariate Cox regression analysis identified N2 disease and incomplete (R1) resection as independent predictors of poor survival (N2: hazard ratio [HR], 3.7; 95% CI, 1.22-11.19; p=0.021; incomplete R1 resection: HR, 4.46; 95% CI, 1.42-14; p=0.010). Age (≥65 vs. <65), smoking, tumor size, side of surgery and neoadjuvant therapy were not significant in either univariate or multivariate analyses (all p>0.05). Conclusion:In NSCLC with left atrial invasion, surgery is feasible in selected patients, and long-term survival depends on excluding N2 disease and achieving complete resection.
Background:Hypotension during anesthesia induction is a clinically significant event linked to perioperative complications. This study aimed to assess if arterial stiffness and stiffness index, measured by Doppler ultrasonography (USG), can predict hypotension during anesthesia induction in cardiac surgery patients. Secondary objectives included exploring the relationship between arterial stiffness parameters and intraoperative hemodynamics, vasoactive drug use, length of hospital and intensive care unit (ICU) stays, and mortality. Methods:This prospective, single-center observational study included patients undergoing elective open cardiac surgery between 1st October 2022, and 1st May 2023. Arterial stiffness was assessed preoperatively using carotid-femoral pulse wave velocity (PWV) and β-index via Doppler USG. The primary outcome was the development of hypotension during anesthesia induction. Results:A total of 121 patients were enrolled. The mean PWV was 8.1±3.2 m/s and the median β-index was 8 (range: 1-67). No significant association was found between PWV or β-index and the incidence of induction-related hypotension (p>0.05). PWV showed weak positive correlations with age (r=0.204; p=0.025) and minimum carotid diameter (r=0.219; p=0.016), while the β-index was positively correlated with baseline systolic pressure (ρ=0.260; p=0.004) and minimum carotid diameter (ρ=0.278; p=0.002). No significant correlation was observed with vasoactive drug use, ICU/hospital stay, or mortality (10%). Conclusion:Preoperative arterial stiffness and stiffness index measured by Doppler USG did not predict anesthesia induction hypotension in cardiac surgery patients. Their clinical utility in this context appears limited, warranting further investigation.
Background: Pleurodesis is a widely used technique in thoracic surgery aimed at preventing the recurrence of pleural effusion and pneumothorax. Although chemical sclerosing agents such as talc are effective, their use is often limited by significant adverse effects, prompting interest in safer and more biocompatible alternatives. This experimental study evaluates the pleurodesis-inducing potential of three autologous biological agents-autologous blood (AB), platelet-rich plasma (PRP), and injectable platelet-rich fibrin (i-PRF)-in a rat model. Methods: Twenty-eight adult Wistar albino rats were randomly divided into four groups: control (saline), AB, PRP, and i-PRF. Each agent was administered intrathoracically, and the animals were observed over a 21-day period. Subsequently, pleural and pulmonary tissues were examined histopathologically. Results: PRP induced the most pronounced pleurodesis response, with significant pleural thickening, extensive fibrous adhesions, and dense collagen deposition. i-PRF, though less potent than PRP, showed a biocompatible and structurally organized fibrotic effect, with moderate collagen formation and minimal inflammation. AB elicited a modest, inconsistent pleurodesis response, with limited fibrotic remodeling. Conclusion: These findings suggest that platelet-based products, particularly PRP, may serve as effective and physiologically compatible alternatives to conventional chemical agents in pleurodesis. Furthermore, i-PRF represents a promising candidate in scenarios where minimizing inflammation is critical. This study is the first to evaluate i-PRF in pleurodesis and supports its potential translational application. Further clinical studies are warranted to validate these findings in human subjects.
Background:To investigate prognostic significance of systemic inflammation-related parameters in patients undergoing cytoreductive surgery and hyperthermic intrathoracic chemotherapy for malignant pleural mesothelioma (MPM). Methods:Data from 55 patients were analyzed retrospectively. Demographic characteristics, survival outcomes and inflammation-related parameters (neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio [PLR], lymphocyte/monocyte ratio [LMR] and pan-immune inflammation value [PIV]) were evaluated. Results:Overall survival (OS) was 61.26±13.03 (3-79) months in patients with low NLR, whereas, it was 23.18±3.53 (1-147) months in patients with high NLR (p=0.012). No statistically significant differences in OS were detected according to LMR, PLR and PIV. In addition, OS was 24.40±4.91 (3-92) months in men and 52.8±10.92 (1-147) months in women (p=0.031). Conclusion:In this study, NLR was found to be associated with survival in agreement with the existing literature, thereby distinguishing it from other inflammatory markers as a prognostic factor. In clinical practice, predicting patient prognosis based on pre-treatment NLR may provide a valuable guidance for treatment decision-making.
Background:Aortic root thrombosis (ART) in left ventricular assist device (LVAD) patients has gained attention due to potential clinical consequences. This study aims to assess the clinical outcomes associated with ART in LVAD patients. Methods:We retrospectively evaluated adult patients who received LVAD implants at our center between January 2020 and March 2022. Pre-operative data, including demographics, laboratory values, and echocardiographic assessments, were similar between the ART and non-ART groups. Composite outcomes such as cerebrovascular events, pump thrombosis, myocardial infarction, embolic events, bleeding, right ventricular (RV) failure, and mortality post-discharge were examined. Results:The study included 44 outpatients (36 HeartMate 3, 8 HeartWare). ART was identified in 20 patients (45%) post-discharge. The "no ART" group had a mean age of 47±10 years (23 of 24 patients were male, 95.8%), while the "ART" group had a mean age of 48±12 years (15 of 20 patients were male, 75%), with no significant age difference (p>0.05). Thrombosis occurred at a median of 59 days post-implantation, primarily affecting the non-coronary cusp in 50% of the ART group. The median follow-up period was 416 days. No significant differences were found in composite outcomes (p=0.276), mortality (p=0.814), bleeding (p=0.808), or RV failure (p=0.197). Conclusion:ART may be under-recognized in LVAD patients, potentially leading to cardiac and end-organ damage. While ART does not significantly impact mortality, it emphasizes the need for careful management of LVAD patients.
Background:This study aimed to evaluate the effects of perioperative dexmedetomidine administration on opioid consumption and extubation timing in pediatric patients undergoing congenital heart surgery. Methods:In this single-center, retrospective cohort study, 112 pediatric patients (aged >1 month to <14 years) undergoing congenital cardiac surgery between January 2021-January 2022 were reviewed. Patients were divided into two groups; dexmedetomidine group (n=55) and a control group (n=57). Primary outcome measures included postoperative opioid consumption and mechanical ventilation duration. Secondary outcomes included high-flow oxygen therapy requirement, non-invasive ventilation, intensive care unit stay length, and reintubation rates. Results:Demographic characteristics were comparable between groups, although the Dex group had a higher proportion of complex surgical cases (risk adjustment for congenital heart surgery-1 category III: 34.5% vs. 25.9%, p=0.034). Mechanical ventilation duration was significantly longer in the Dex group (1.9±3.4 vs. 0.9±0.8 days, p=0.024), as was the requirement for high-flow oxygen therapy (56.4% vs. 31.0%, p=0.007). No significant differences were observed in non-invasive ventilation use, reintubation rates, or mortality. Conclusion:Perioperative dexmedetomidine was paradoxically associated with prolonged mechanical ventilation and increased postoperative respiratory support requirements. These findings suggest that dexmedetomidine should be employed as an adjunct rather than a substitute for opioids, particularly in patients undergoing complex procedures. Prospective randomized trials are warranted to refine dexmedetomidine's role in fast-track extubation protocols in this high-risk population.
Background: The neutrophil-lymphocyte ratio (NLR) has been suggested as a valuable indicator of poor outcomes in patients undergoing cardiac surgery. However, its prognostic role in pediatric patients undergoing open-heart surgery is unclear. This study aimed to evaluate the correlation between the perioperative NLR and clinical outcomes after pediatric open-heart surgery under cardiopulmonary bypass (CPB). Methods: A literature search was conducted from their inception to July 19, 2024 in PubMed Central, ProQuest, Sage, ScienceDirect and Ovid. We included studies that investigated the perioperative value of NLR as a predictor of outcomes after pediatric cardiac surgery under CPB. A meta-analysis was performed according to preferred reporting items for systematic reviews and meta-analyses guidelines. The Newcastle-Ottawa scale was used to assess the study quality, while JAMOVI statistical software was used to perform the meta-analysis. Results: A total of six studies were included based on our eligibility criteria; however, only four were included for meta-analysis. The results showed a significant correlation between postoperative NLR with hospital (r=0.34 [95% confidence interval [CI] 0.10-0.58]) and intensive care unit (r=0.25 [95% CI 0.04-0.46]) length of stay. Conclusion: NLR has shown potential as a simple and affordable inflammatory marker in pediatric cardiac surgery under CPB. However, its moderate to weak correlation with clinical outcomes necessitates cautious interpretation. Further research in the form of impact studies is warranted to strengthen these findings.
Background: Infective endocarditis continues to pose a significant challenge in cardiovascular surgery, with high morbidity and mortality rates despite advancements in diagnosis and treatment. This study aimed to identify predictors of in-hospital mortality among patients undergoing surgical intervention for active infective endocarditis, with a particular focus on frailty. Methods: A retrospective analysis was conducted on fifty-five consecutive patients who underwent surgery for active infective endocarditis between October 2022 and April 2025. Clinical variables, operative data, and outcomes were also collected. Frailty was assessed using the clinical frailty scale. Univariate and multivariate logistic regression analyses were performed. Results: The in-hospital mortality rate was 25.5%. Patients who did not survive were significantly older (median age 65.7 vs. 56.2 years) and had higher clinical frailty scale scores (mean 7.1 vs. 5.4) than those who survived. Frailty emerged as the sole independent predictor of mortality (odds ratio =3.41; 95% confidence interval: 1.20-9.65; p=0.021). Conclusion: Frailty is a key predictor of early mortality in patients with surgical infective endocarditis. Preoperative frailty assessment and targeted interventions may enhance outcomes in this high-risk population.
This case report describes a 44-year-old man with midaortic syndrome and resistant hypertension, presenting a diagnostic challenge due to overlapping features of Behçet's disease and Takayasu arteritis. Imaging studies revealed severe aortic stenosis accompanied by aortic wall thickening, findings typically associated with Takayasu arteritis; however, the patient's clinical history and a positive pathergy test supported a diagnosis of Behçet's disease. Immunosuppressive therapy led to symptomatic improvement, and surgical management with thoracic endovascular aortic repair was successfully performed to address the aortic stenosis. This report discusses the possibility of Behçet's disease presenting with aortic stenosis-a rare vascular complication-or the coexistence of Behçet's disease and Takayasu arteritis.
Background: Left ventricular assist device inflow cannula malposition can contribute to numerous negative outcomes after device implantation. We analyzed the impact of position changes in the inflow cannula angle in HeartMate II (HM II) and HeartMate 3 (HM 3) patients. Methods: Between January 2012 and December 2023, patients who underwent HM II and HM 3 implantation were reviewed. Among them, patients with suitable chest X-rays for angle calculation at both 1-2 months and 6-12 months post-implantation were identified. Results: The study cohort consisted of 66 (82.5%) HM 3 and 14 (17.5%) HM II patients. The median age of the cohort was 57.6 years (Interquartile range [IQR], 47.4-63.2), and the majority were males (n=73, 91.2%). Operative data and demographics were similar between the groups except for the body surface area (p<0.01), body mass index (p=0.01) and hypertension (p=0.02). A significant increase in the inflow cannula coronal angle was observed in the HM 3 group (p=0.03), while the pump depth distance remained similar (p=0.37). In contrast, the HM II group showed no significant changes in the inflow cannula angle (p=0.39) or the pump body angle (p=0.32). The HM 3 group exhibited a significant increase in pump power and pulstility index over time (p<0.01 and p=0.02, respectively). Conclusion: A significant increase in the coronal angle of the inflow cannula over time was observed in HM 3 patients. Proper assessment of pump positioning at implantation is important, especially in hypertensive and overweight patients, as changes in pump angle over time may influence pump parameters.
Background:Sericin is a natural, macromolecular, adhesive protein that is derived from the cocoons of silkworm. There has been no study to date in literature evaluating the potential for neurotoxicity associated with sericin pleurodesis. Methods:Adult, male, Wistar-Albino rats aged 12-week-old, weighing 211-256 gr (n=22) were divided randomly into two groups, each comprising 11 rats. A left thoracotomy was performed following intramuscular anesthesia. The A group was administrated sericin 30 mg and B group constituted by sham thoracotomy group. The rats were fed ad-libitum, all were sacrificed on day 13. The brain and cerebellum were excised en-bloc; T9-L3 segment was excised, and a sampling was made from sciatic nerve. Results:A subarachnoid hemorrhage was observed in the brain specimens of four rats (36.4%) in the control group and six rats (54.5%) in the sericin group (p=0.416). A capillary hemorrhage in the cerebellum was observed in six rats (54.5%) in the control group and in one rat (9.1%) in the sericin group (p<0,.05; p=0.024). A hemorrhage was observed in the central canal in three rats (27.3%) in the control group, whereas no hemorrhage was observed in the sericin group (p=0.082). Congestion in the fibers of the sciatic nerve was observed in five rats (45.5%) in the control group and in seven rats (63.6%) in the sericin group (p=0.416). The observation of capillary hemorrhage in the cerebellar specimens was significantly more common in the control group. Conclusion:The administration of intrapleural sericin does not cause neurotoxicity in rats and can be safely used in pleurodesis procedures.
Background:The shortage of donor hearts has led to the increased use of left ventricular assist devices (LVADs) as an alternative treatment for advanced heart failure. As the population of LVAD recipients grows, so does the demand for non-cardiac surgical interventions in this group. This study aims to share our experience with non-cardiac surgeries performed in patients supported by long-term LVADs. Methods:We retrospectively analyzed 72 patients who underwent LVAD implantation at our clinic between 2017 and 2024. Among them, 53 received the HeartMate 3 (Abbott Inc., Chicago, IL) and 19 received the HeartWare (Medtronic Inc., Minneapolis, MN). Results:Patients were followed for a mean duration of 48.5 months (range: 1-78 months). During this period, 19 non-cardiac surgical procedures were performed in 13 patients; some patients underwent more than one procedure. A total of 12 procedures were conducted under general anesthesia, while 7 was performed under sedation. No perioperative deaths, thromboembolic events, or device malfunctions occurred. Minor complications included one case of re-intubation and one surgical site infection, associated with repeated amputations in a patient with peripheral arterial disease. Conclusion:Non-cardiac surgery in patients with long-term LVAD support appears to be safe when carefully planned. Larger studies are warranted to validate these findings.
Background:Intraoperative transit time flow (TTF) measurement provides quantitative information regarding graft patency and anastomotic quality. However, limited data exist on the relationship between SYNTAX scores and intraoperative graft flow dynamics during coronary artery bypass grafting (CABG). This study aimed to evaluate the predictive value of SYNTAX scores for intraoperative graft flow parameters, as assessed by TTF measurements of the left internal mammary artery (LIMA) grafted to the left anterior descending (LAD) artery. Methods:Patients with critical LAD disease who underwent CABG at a single tertiary referral center between February and October 2019 were prospectively evaluated. For each patient, the SYNTAX score, SYNTAX II score, and the LAD-specific contribution to the SYNTAX score (LAD-SYNTAX) were calculated. Correlations between these scores and TTF parameters-including mean graft flow (MGF), diastolic flow (DF), and pulsatility index (PI)-were analyzed. Results:The SYNTAX score demonstrated a negative correlation with MGF (r =-0.118, p=0.313) and DF (r =-0.026, p=0.828), and a positive correlation with PI (r =0.131, p=0.264). Similarly, the SYNTAX II score showed negative correlations with MGF (r=-0.040, p=0.735) and DF (r=-0.246, p=0.037), and a positive correlation with PI (r=0.168, p=0.149). Consistent trends were observed with LAD-SYNTAX, with MGF and DF showing negative correlations and PI showing a positive correlation; notably, the correlation between LAD-SYNTAX and MGF was statistically significant (r=-0.288, p=0.012). Conclusion:SYNTAX scores are associated with intraoperative TTF measurements of the LIMA-LAD graft. These findings suggest that both the atherosclerotic burden of the target vessel and patient-specific factors may influence LIMA graft flow dynamics during CABG.
Background:Adenocarcinoma is the most common subtype of lung cancer. Histopathologically, lung adenocarcinoma is classified into five distinct patterns: lepidic, acinar, papillary, solid, and micropapillary. In 80-90% of cases, heterogeneous histopathological patterns are observed. This study aimed to evaluate the impact of predominant histological patterns on survival in surgically treated patients, as well as to identify other clinical, demographic, and histopathological factors affecting prognosis. Methods:In this retrospective cohort study, 499 patients who underwent surgery for primary lung adenocarcinoma were evaluated. Survival data were obtained from electronic medical records. Demographic, clinical, and histopathological parameters were analyzed for both surviving and deceased patient groups. Univariate and multivariate Cox regression analyses were conducted to determine independent predictors of mortality. Results:A total of 499 patients who underwent anatomical resection for primary lung adenocarcinoma and had complete medical data were retrospectively analyzed. The mean age was 61±8.1 years, and 77.6% of patients were male. The median tumor size was 3.5 cm (range: 2.30-5.20 cm), and the median Charlson comorbidity index was 3 (range: 2-4). The 5-year overall survival (OS) rate was found to be 64.5%. The 5-year OS was 59.8% in males and 77.7% in females (p=0.001). Regarding the side of surgery, the 5-year OS was 57.8% for left-sided resections and 67.9% for right-sided resections (p=0.024). The presence of a micropapillary pattern and acinar predominance were both identified as negative prognostic factors for survival (p=0.017, p=0.024, respectively). Additionally, lymphatic invasion and postoperative complications were found to be independent prognostic factors adversely affecting survival in multivariate analysis (p=0.014, p=0.011). Conclusion:This study demonstrates that predominant histological patterns significantly influence survival in lung adenocarcinoma. The presence of a micropapillary component and acinar predominance were identified as negative predictive factors in multivariate analysis. We believe that relying solely on the TNM staging system may be insufficient for survival prediction; factors such as predominant histological pattern, lymphatic invasion, gender, Charlson comorbidity index, and postoperative complications should also be taken into account. These criteria may also be considered in planning oncological treatment strategies.
Background:This study aimed to evaluate the prognostic value of the Naples prognostic score (NPS) in patients undergoing isolated coronary artery bypass grafting (CABG). Methods:Patients undergoing isolated CABG were retrospectively analyzed. Patients were stratified into three groups based on preoperative NPS values. Thirty-day and one-year mortality, postoperative atrial fibrillation (AF), intensive care unit (ICU) and ward length of stay were recorded. Logistic regression analysis was used to assess the independent predictive value of NPS. Its contribution to the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) model was evaluated using ROC curves and Nagelkerke R². Results:A total of 1.195 patients were included. Higher NPS was significantly associated with 30-day (odds ratio [OR] =1.838) and 1-year mortality (OR=1.620) (p<0.001). Postoperative AF was significantly more common in higher NPS groups (p=0.010). NPS was significantly associated with both ICU length of stay (p<0.001) and ward length of stay (p=0.029). The addition of NPS to EuroSCORE improved the predictive performance for both 30-day and 1-year mortality. Patients with higher NPS had significantly lower survival during follow-up. Conclusion:The NPS is an independent and significant predictor of short- and long-term mortality in patients undergoing isolated CABG. As a simple, objective score reflecting both inflammatory and nutritional status, NPS enhances the predictive capacity of established risk models when integrated preoperatively.
Background:This study aims to evaluate preoperative, perioperative, and postoperative parameters in patients with primary spontaneous pneumothorax (PSP) to minimize recurrence and improve predictability. Methods:This single-center retrospective cohort study included 207 patients who underwent surgery for PSP between 2016 and 2020. Recurrence data were obtained from the national electronic health record system and the institutional hospital information system. Pneumothorax size was calculated preoperatively on posteroanterior chest radiographs using the Collins method. Results:The mean age of the patients was 24.54±6.98 years and 87% of the patients were male. The overall recurrence rate was 9.7%. A higher Collins percentage (p<0.001), age ≤20 years (p=0.015), and continued smoking postoperatively (p=0.036) were found to be significantly associated with increased recurrence. Conclusion:The findings suggest that a high Collins percentage on posteroanterior chest radiography, young age at the time of surgery, and continued smoking postoperatively are significant risk factors for recurrence.
