Background:The anterior mediastinum is the compartment where mediastinal lesions are most frequently seen. Both subxiphoid approaches (SVATS) and lateral intercostal approaches (LVATS) are used in anterior mediastinal lesions. In this study, we aimed to compare the outcomes and advantages of SVATS and LVATS. Methods:Between January 2013 and December 2024, the patients who underwent minimally invasive surgery for anterior mediastinal lesions were retrospectively analyzed. The study's main objectives were the characteristics of the patients, operation time, length of hospital stay, drain type, drain duration, postoperative complications, and visual analogue scale (VAS) analysis. Results:A total of 79 patients were included in this study. Of these, 58.2% (n=46) cases were operated via LVATS and 41.8% (n=33) via SVATS. No significant difference was found in operation time, length of hospital stay, and complication. The most common postoperative complication was serous wound drainage. In one patient in the LVATS group, hence hemothorax was seen on postoperative day 1, revision surgery had to be done. Drain removal time was shorter in the subxiphoid group, but no statistical difference was found (p=0.059). In patients whose drain removal time was under 2 days, the length of hospital stay was also significantly shorter (p<0.001). The mean VAS was 2.24±1.25 in the SVATS group and 4.22±1.31 in the LVATS group. Conclusion:This study shows that SVATS significantly affected VAS. However, no süperiority was observed between SVATS and LVATS regarding operation time, length of hospital stay, and perioperative complications. Therefore, SVATS may be preferred over LVATS in anterior mediastinal lesions and may improve patients' quality of life with less pain.

Lobectomy is the standard surgical approach for early-stage non-small cell lung cancer (NSCLC), while segmentectomy has gained increasing attention as a parenchyma-sparing alternative. Recent randomized prospective trials have demonstrated comparable survival outcomes between the two procedures in patients with peripherally located, node-negative NSCLC ≤ 2 cm. This study aimed to compare survival outcomes between segmentectomy and lobectomy in patients with T1N0 NSCLC. We conducted a retrospective, multicenter study using data from six thoracic surgery clinics across Türkiye. Initially, 317 patients who underwent segmentectomy and 252 who underwent lobectomy were identified. After 1:1 propensity score matching with a 20

Background/aim:The prognostic significance of the volumetric extent of lung resection in nonsmall cell lung cancer remains uncertain. Three-dimensional computed tomography allows quantitative assessment of resected lung parenchyma, but the relationship between resection volume ratios and oncologic outcomes has not been clearly established. The aim in this study was to evaluate the prognostic value of three-dimensional computed tomography-derived resection volume ratios for disease-free survival after surgery for nonsmall cell lung cancer. Materials and methods:This single-center retrospective study included 141 patients who underwent anatomical resection with systematic mediastinal lymph node dissection between 2010 and 2021. Resection volume, ipsilateral lung volume, total lung volume, and derived ratios were calculated from preoperative computed tomography images. The early- and advanced-stage subgroups were analyzed separately. Receiver operating characteristic analysis was used when appropriate, whereas median values were used for exploratory survival comparisons when no meaningful threshold was identified. Disease-free survival was evaluated using Kaplan-Meier and Cox's regression analyses. Results:In the Kaplan-Meier analysis, a higher resection-to-total lung volume ratio was associated with better disease-free survival in early-stage disease (75.6% vs. 53.4%, p = 0.015) but worse disease-free survival in advanced-stage disease (25.0% vs. 47.8%, p = 0.009). In the multivariable continuous Cox's analysis, the resection-to-total lung volume ratio was not independently associated with disease-free survival in the early-stage patients. In contrast, in the advanced-stage patients, each 0.1 increase in this ratio was independently associated with worse disease-free survival (hazard ratio = 4.32, 95% confidence interval: 1.16-16.12, p = 0.029). No independent association was observed in the pooled multivariable model. Conclusion:The prognostic effect of the resection-to-total lung volume ratio appears to be stage-dependent in nonsmall cell lung cancer. Although favorable unadjusted associations were observed in early-stage disease, these were not confirmed in multivariable continuous analysis. In advanced-stage disease, however, higher values were independently associated with worse disease-free survival.

Renal cell carcinoma is the most common malignancy of the urinary system, and nearly half of patients develop lung metastases at the time of diagnosis or during follow-up. Endotracheal metastases from renal cell carcinoma are exceedingly rare but may be life-threatening due to acute airway obstruction. In such cases, therapeutic interventions are primarily directed toward maintaining airway patency rather than achieving oncological control. Here, we report a case of endotracheal metastasis successfully excised using rigid bronchoscopy under general anesthesia with jet ventilation in a patient who had undergone nephrectomy for renal cell carcinoma three years earlier. The patient remained recurrence-free in the trachea at one-year follow-up.

Robotic surgery has become increasingly adopted in minimally invasive thoracic procedures because of its advantages, including three-dimensional intraoperative visualization, reduced tissue trauma, and reduced intraoperative bleeding. In line with Enhanced Recovery After Surgery (ERAS) principles, drainless surgical approaches have recently gained attention as they may help reduce postoperative pain and support earlier discharge. In this case series, we describe retrospective cases of three patients who underwent drainless robotic resection of mediastinal lesions at our institution. With careful patient selection, this approach may offer several potential benefits, including reduced postoperative pain, shorter hospital stay, and faster recovery. Nevertheless, close postoperative monitoring remains essential, and the potential need for thoracic drainage should always be kept in mind.

The preferred treatment for non-small cell lung cancer is surgical resection, and pneumonectomy may be necessary for centrally located tumors. Adequate pulmonary reserve is critical for pneumonectomy; otherwise, nonsurgical treatment options should be considered. Some patients who are initially inoperable due to insufficient pulmonary function may become surgical candidates after rehabilitation interventions. Here, we present a case of right bullectomy followed by left pneumonectomy successfully performed in a patient with bilateral giant bullous lung disease and a left hilar mass. The patient has remained complication- and recurrence-free for 2 years.

Background:Currently, clinical T staging in non-small cell lung cancer (NSCLC) is based on the largest radiological diameter observed on computed tomography (CT). Under this system, tumors with varying shapes-such as spherical, amorphous, or spiculated tumors- can be assigned the same T stage even with different volumes. We aimed to propose a 3-dimensional (3D) volumetric staging system for NSCLC as an alternative to diameter- based T staging and to conduct comparative survival analyses between these methods. Methods:We retrospectively analyzed data from patients who underwent surgery for pT1-4N0M0 primary NSCLC between January 2018 and May 2022. Digital Imaging and Communications in Medicine data from patient CT scans were uploaded to 3D Slicer software for volumetric tumor measurement. Using the paired samples t-test or the Wilcoxon test, we compared the expected tumor volumes, calculated by tumor diameter, with the actual volumes measured by 3D Slicer. Receiver operating characteristic analysis was employed to determine the cut-off value for tumor volume. Kaplan-Meier analysis was utilized to assess overall survival, while the log-rank method was applied to compare survival differences between groups. The significance of changes in T stage was evaluated using the marginal homogeneity test. Results:The study included 136 patients. Significant differences were observed between expected and actual tumor volumes (p=0.01), and associated changes in T stage were also significant (p=0.04). The survival analysis performed using tumor volume (p=0.009) yielded superior results compared to that based on diameter (p=0.04) in paients with early tumor stage. Conclusion:T-factor staging based on tumor volume could represent an alternative staging method for NSCLC.

Video-assisted thoracoscopic surgery (VATS) has become a preferred approach for lung resection due to its ability to reduce thoracotomy-related complications and improve patient comfort. Nevertheless, significant morbidity and even mortality may still occur. Recent evidence suggests that inflammation-based indices, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), and lymphocyte-to-monocyte ratio (LMR), may serve as useful predictors of adverse outcomes. This study aimed to evaluate the predictive significance of these markers obtained during the preoperative and postoperative periods in patients undergoing VATS pulmonary resections. We retrospectively reviewed the records of patients who underwent VATS lobectomy or segmentectomy between January 2018 and December 2023. NLR, PLR, SII, and LMR were calculated from blood samples obtained preoperatively and on postoperative days 1 and 2. Receiver operating characteristic (ROC) analysis was used to determine optimal cut-off values, and patients were stratified into high and low groups accordingly. Associations between these groups and major complications were analyzed using Pearson’s chi-square or Fisher’s exact test. Among 359 patients (32.0

Anatomical and physiological changes impair pulmonary function, respiratory muscle strength, and physical activity in patients who underwent pneumonectomy for lung cancer (LC). No study investigated upper extremity exercise capacity and muscle oxygenation in these patients. The main objective of the study was to compare the long-term upper extremity exercise capacity and muscle oxygenation; the secondary objective was to assess pulmonary function, respiratory muscle strength and endurance, and physical activity levels in patients who underwent pneumonectomy for LC and healthy individuals. Nineteen patients who underwent pneumonectomy for LC and 19 healthy controls were included. Pulmonary function (spirometry), upper extremity functional exercise capacity (6-min pegboard and ring test (6-PBRT)), muscle oxygenation (near-infrared spectroscopy), respiratory muscle strength (maximal inspiratory (MIP) and expiratory (MEP) pressures) and endurance (incremental threshold loading), and physical activity (activity monitor) were evaluated. Patients’ pulmonary function, 6-PBRT score, muscle oxygen saturation (SmO2), MIP, MEP, and respiratory muscle endurance were lower (p < 0.05) than controls. While the patients’ deltoid muscle resting and recovery SmO2 decreased, the total hemoglobin levels were similar in groups. Patients’ total active energy expenditure, physical activity duration, average METs, and number of steps were lower than controls (p < 0.05). Upper extremity functional exercise capacity and muscle oxygenation are impaired in patients who underwent pneumonectomy for LC. Pulmonary function and physical activity levels are decreased. Inspiratory and expiratory muscles are weakened, and respiratory muscle endurance is reduced. It is crucial to evaluate patients in the early postoperative period and to incorporate cardiopulmonary rehabilitation to improve these severe impairments. It is recommended that the effects of upper extremity exercise training be investigated. ClinicalTrials.gov registration: NCT04807153/19.03.2021.

Waldenstr & ouml;m macroglobulinemia (WM) is a rare hematological disease that accounts for 1-2% of non-Hodgkin lymphomas. WM is a variant of lymphoplasmocytic lymphoma and is characterized by bone marrow involvement as well as immunoglobulin M monoclonal gammopathy. It occurs as 3 to 4 cases per million each year. Extramedullary involvement of this entity is rare, and lung involvement may present radiologically as a mass, nodular lesion, diffuse infiltration, or pleural effusion. The diagnosis can be made by performing a biopsy of the pulmonary parenchyma, bronchoalveolar lavage, or cytological examination of pleural fluid. Here, we aimed to present a case of WM mimicking primary lung carcinoma radiologically.

Although minimally invasive methods have become widespread, pulmonary resections due to lung cancer continue to be an important cause of postoperative morbidity. Herein, we have investigated the predicting efficacy of modified frailty index-5 (MFI-5) for postoperative complications in patients who underwent pulmonary resection by VATS for non-small cell lung cancer (NSCLC). We retrospectively reviewed the data of patients who underwent VATS lobectomy/segmentectomy for NSCLC. MFI-5 score was calculated according to hypertension, diabetes mellitus, chronic obstructive pulmonary disease, congestive heart failure, and functional independence status. Major postoperative complications were determined based on Clavien–Dindo classification. The predictive efficacy of MFI-5 score for major complications was tested by univariate and multivariate logistic regression analysis. A total of 336 patients were included in the study. The mean age was 65.6 ± 9.8 years. MFI-5 score was zero in 126 (37.5

In endoscopic thoracic sympathectomy (ETS) surgery, a chest drain is inserted into the pleural space after the procedure for lung expansion and is quickly removed after lung hyperinflation. A horizontal mattress suture, also named U-suture, is quickly knotted around the chest drain to prevent air from entering the pleural space. The U-suture may cause poor cosmetic appearance because of excessive scar tissue development. In this study, we aimed to investigate the new embedded U-suture technique using polyglactin suture, which is an absorbable material, and its cosmetic results. In this retrospective study, we collected data on patients who underwent ETS performed with a new technique. A total of 30 patients were included in the study. Neither serious wound complications nor excessive scar formation was observed in the follow-ups of the patients. The embedded U-suture technique in ETS surgery has some advantages such as good cosmetic results, no need for the removal of sutures, and applicability in both genders.

Video-assisted thoracic surgery (VATS) is now being used with increasing frequency for a wide variety of indications in pediatric patients. Although there is no high level of evidence for the advantages of VATS in the pediatric patient group, the proven benefits of this method in the adult patient group have encouraged thoracic surgeons to perform VATS in this patient population. In this study, the procedures performed in pediatric patients under 18 years of age and their results were reviewed with the help of articles obtained as a result of searches using relevant keywords in the English literature (PubMed, Web of Science, EMBASE, and Cochrane). The frequency, indications, and results of the procedures performed differed according to age groups.

Evoked from asbestos-induced inflammation, pleural mesothelioma represents a fatal diagnosis. Therapy ranges from nihilism to aggressive multimodality regimens. However, it is still unclear who ultimately benefits from which treatment. We aimed to re-challenge inflammatory-related biomarkers’ prognostic value in times of modern immune-oncology and lung-sparing surgery. The biomarkers (leukocytes, hemoglobin, platelets, neutrophils, lymphocytes, monocytes, neutrophil–lymphocyte ratio (NLR), lymphocyte–monocyte ratio (LMR), platelet–lymphocyte ratio (PLR), C-reactive protein (CRP)) and clinical characteristics (age, sex, histology, therapy) of 98 PM patients were correlated to overall survival (OS). The median OS was 19.4 months. Significant OS advantages (Log-Rank) were observed in multimodal treatment vs. others (26.1 vs. 7.2 months, p < 0.001), surgery (pleurectomy/decortication) vs. no surgery (25.5 vs. 3.8 months, p < 0.001), a high hemoglobin level (cut-off 12 g/dL, 15 vs. 24.2 months, p = 0.021), a low platelet count (cut-off 280 G/L, 26.1 vs. 11.7 months, p < 0.001), and a low PLR (cut-off 194.5, 25.5 vs. 12.3 months, p = 0.023). Histology (epithelioid vs. non-epithelioid, p = 0.002), surgery (p = 0.004), CRP (cut-off 1 mg/dL, p = 0.039), and platelets (p = 0.025) were identified as independent prognostic variables for this cohort in multivariate analysis (Cox regression, covariates: age, sex, histology, stage, CRP, platelets). Our data verified the previously shown prognostic role of systemic inflammatory parameters in patients treated with lung-sparing surgery within multimodality therapy.

Background:This study aimed to investigate whether there is a correlation between some serum inflammatory markers and the survival of patients with malignant pleural effusions (MPEs). Methods:The prospective study included 125 patients (67 males, 58 females; median age: 62 years; range, 40 to 92 years) who underwent thoracentesis for pleural effusion between January 2020 and December 2021. An overall survival analysis was performed, and survival differences between the groups were investigated. The cutoff value of the inflammatory parameters associated with mortality was determined by receiver operating characteristic analysis. Results:Median survival after detection of MPE was six months, and three- and five-year overall survivals were 16% and 4%, respectively. There was a significant correlation between the ECOG (Eastern Cooperative Oncology Group) score of the patients and the median survival. Serum C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), fluid albumin, and serum lactate dehydrogenase (LDH)-to-pleural LDH ratio and survival had a statistically significant relationship in receiver operating characteristic analysis. Threshold values were determined accordingly. Poor prognostic factors that were found to be statistically significant were high CRP (p=0.001), high NLR (p=0.001), high PLR (p=0.02), and high serum LDH-to-pleural LDH ratio (p=0.04). Conclusion:Some serum inflammatory markers, including high CRP, high NLR, high PLR, and high serum LDH-to-pleural LDH ratio, can be a simple and inexpensive method in predicting prognosis in patients with MPE.