Surgery in locally advanced lung cancer can be performed safely with neoadjuvant treatment preparation. Perioperative and postoperative characteristics and survival data of patients differ with changing parameters in neoadjuvant treatment modalities. We aimed to analyze the pathological response, complication and survival data with different combinations of neoadjuvant therapy.

Detecting lung cancer at an early stage has become easier due to the developing diagnostic methods, the treatment modalities of patients with locally advanced stages differ. It is desired that minimally invasive methods can be used to provide local control and to perform surgery on these patients with treatment methods such as neoadjuvant chemotherapy (CT), radiotherapy (RT) and immunotherapy (ImT). In our study, we compared thoracotomy and thoracoscopic method in patients who had advanced stage non-small cell surgery who received neoadjuvant therapy.

Pathological response is an indicator of prognosis in patients with non-small cell lung cancer after neoadjuvant chemotherapy if the tumor viability is below 10%. We aimed to investigate the effects of up to 50% tumor viability on overall survival in pathological examinations after lung surgery.

IASLC has proposed to subdivide N descriptors of TNM Staging for lung cancer into N1a (single N1 station), N1b (multiple N1 stations), N2a1 (skip metastases), N2a2 (single N2 with N1 involvement) and N2b (multiple N2 stations). The lymph nodes (LNs) on resection specimens have been dissected and reported separately according to their stations in our department over the years. The aim of this study is to evaluate the survival differences between pathologically confirmed subdivided N descriptors and to examine the value of other parameters related to N1 LNs such as the number of metastasis in a single LN station, size of the largest metastasis, extranodal invasion, and metastasis defined by direct infiltration of the primary tumor.

Non-small-cell lung cancer staging is the most important factor affecting both the potential treatment and the prognosis. The evaluation of non-small cell lung carcinoma staging uses the TNM classification (tumor, node, metastasis). The N factor plays a more critical role in staging than T and M factors, because of its unpredictability. We know that undiagnosed micrometastatic nodal disease has a poor prognosis. Detecting micrometastasis is expensive and time consuming, so that’s why we aimed to investigate the factors predicting micrometastatic mediastinal disease. We collected all the lymph nodes from the patients that we operated between July 2012 and July 2013. We excluded all the patients who had an induction treatment and preoperatively diagnosed with mediastinal metastasis. We studied the expressions of three biomarkers; EpCAM, CEACAM5 and KRT19 using quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) in lymph nodes and compared the expressions with healthy controls. If all three of them are positive, we have accepted it as micrometastasis. We compared the presence of micrometastasis with the pathological data to identify possible predictive factors. We analyzed 86 lymph nodes from 32 patients. Twenty seven out of 86 lymph nodes (%31.4) were positive for micrometastasis. Eighteen out of 32 patients (%56.3) became micrometastatic and 16 out of 32 patients are upstaged. Four of them are upstaged from N1 to N2 and 12 of them are upstaged from N0 to N2. Micrometastatic patients tend to have poorer survival compared to non-micrometastatic patients but without an statistical significance. However micrometastasis was found significantly higher in tumors with less than 2 cm (p: 0.03) and lower in tumors without lymphovasculary invasion (p: 0.03). In our study tumors with smaller than 2cm in diameter and without lymphovascular invasion have significantly higher micrometastatic potential. In order to validate these parameters as predictive markers this experiment should be performed in a larger cohort with increased control population.

Adjuvant chemotherapy is accepted as a standard treatment for suitable patients who have undergone surgery for T2N0 non-small cell lung cancer with tumors larger than 4 cm. Despite similar relapse rates, the benefit of adjuvant chemotherapy for smaller tumors with high risk features is not clear. In this retrospective analysis our aim was to evaluate the prognostic impact of adjuvant platin-based chemotherapy in high-risk stage 1 NSCLC patients. This cooperative group study included 250 NSCLC patients who underwent curative surgery for stage 1 NSCLC with tumor size 2-4 cm and adverse prognostic factors consisting of visceral pleural invasion (VPI), lympho-vascular invasion (LVI), high grade, presence of solid-micropapillary(SMP) components or STAS. Records of patients were analyzed to investigate the prognostic impact of adjuvant chemotherapy in this cohort. DFS was defined as the time from surgery to the last follow-up, until relapse or death, CSS; time from surgery to death related to cancer or last known contact, OS; time from diagnosis to death or last known contact. Statistical analysis was performed using SPSS 20.0 software (SPSS Inc, Chicago, USA). Median age at presentation was 63 years (range 18-90). The mean tumor size was 29.4 ± 7.4 mm. The frequency of patients with specified risk factors were: VPI: n: 92 (36.8%); LVI: n: 91 (36.4%); Grade 3:n: 49 (19,6%); SMP:n: 76 (30.4%); STAS:n: 15 (6%). A total of 51 patients had received adjuvant platin-based chemotherapy. There were significantly more patients who received chemotherapy in the younger age group (<65 years old, ≥65 years old) and those with larger tumors (2 – 3 cm, 3 – 4 cm). During a median follow-up period of 91.8 months; 79 patients (31.6%) experienced recurrence, 62 patients (24.8%) have died, 144 patients (57.6%) were alive without disease and 24 patients (9.6%) were alive with disease. 5-year and 10-year OS rates were 72.7% (± 3,5) and 46.8%(± 8), respectively. There was a significant improvement in DFS with adjuvant chemotherapy, especially in groups with VPI (93.3% vs 53.6%, p:0.016) and SMP (92.3% vs 57.3%, p:0.03). There was also a non-significant trend for improved CSS and OS among patients who received CT.Table 1Effects of chemothrapy on survivalChemotherapy Group Events/N Median 5-years DFSNon - treatment Group Events/N Median 5-years DFSP ValueDFS12/51 NE % 74.9 ± 6.381/190 71.1 months % 54 ± 4.20,032*CSS4/49 NE % 89 ± 541/179 91.8 months % 76.9 ± 3.80,078OS10/49 NE %77.4 ± 6.451/179 88.9 months % 72.1 ± 40,541*All values are stratified, respecting to significant confounding factors such as age, gender and tumor size. Open table in a new tab *All values are stratified, respecting to significant confounding factors such as age, gender and tumor size. Adjuvant platin-based chemotherapy should be considered for this subset of patients having high grade tumors, or those with VPI, LVI or solid-micropapillary components. Prospective, randomized trials incorporating clinical and molecular risk factors are required to clarify the role of adjuvant chemotherapy for stage 1 NSCLC patients.

In this study we aim to investigate predictability of alveolar spread in primary lung cancer by using preoperatively scanning methods In order to re-evaluate alveolar spread, pathology preparations of 45 patients had operated for primary lung cancer diagnosis and scanned preoperatively with PET CT all in our hospital which interpreted by same nuclear medicine specialists implicated in this study. As using the patients pet CT findings, CTV (computerized tomography volume), MTV (metabolic tumor volume), TLG(total lesion glycolysis), SUDmax, SUDort values and their relation with alveolar spread analyzed Preoperatively PET-CT scanned all in our hospital 45 patients has included and cause of couldn't reach their pathological preparations, 6 of them exluded from the study. 21 of 39 patients were men (53.8%) , 18 of them were women (46.2%) and mean age was 66.67/+-7.88 (42-80). We didn't detect any relation between CTV, MTV, TLG, SUDmax, SUDort values and alveolar spread (p>0.05). However when the CTV/ MTV ratio analyzed, alveolar spread was statistically more common in the group of patients had ratio lower than 1. (62.9% versus 0%, p:0.01) High local recurrence risk in sublober rejected patients with alveolar spread has indicated in various studies. Regarding this matter, we recommend re-evaluation of the patients for sublober rejections whose CTV/MTV ratio is lower than 1.

STAS (Spread through air spaces) defined as spreading of tumor cells to the adjacent pulmonary parenchyma by using air spaces, is a new invasion indicator adenocarcinoma lung cancers. In our study we aim to investigate relation between survey and lymph node existence as considering STAS We evaluate the adenocarcinoma lung cancer patients had lobectomized or pneumonectomized in American Hospital and Koc University Hospital between 2000 -2016. Locally advanced cases and patients some may be prognostic positive factors other than STAS didn't considered. According to these criteria totally 171 patients counted in our study. STAS existence statistically analyzed in terms of lymph node metastasis and survey relation. In survey analysis we examined the data of patients had operated before November 2011, owing to significance of follow up time 103 of 171 patients were men (60,2%) and 68 of them were women (39,8%). Characteristic specialties and dermographic data of them has demonstrated in 1st chart. Lymph node invasion (N1-N2) and alveolar spread togetherness was in statistically significant ratio comparing with the cases who hasn't alveolar spread (38.33% vs 24.32% p: 0.05) When in last 5 years operated patients were excluded from study, 66 left. And 42 of them were men (63.6%), 24 of them were women (36.4%) Mean age were 61.82/+-10.26 (36-84). Mean follow up time has detected as 58.98 months. Average survey was 71.47 months in patients has alveolar spread and 79.8 months at patients who haven't. There weren't statistically significant difference between these two groups (p=0.66) When we analyzed survey of lymph node negative cases, we detected patients with alveolar spread had statistically worse survey (62.53 months versus 90.63 months, p=0.05) Instead of sublober rejections in lymph node negative patients with alveolar spread, low survey and high recurrence probability must be considered while to approach lober rejections. And in only STAS existence even if lymph nodes are negative, adjuvant therapy is recommended.

Background: The aim of the study was to compare the effects of conventional posterolateral thoracotomy and muscle-sparing posterolateral thoracotomy on pulmonary and muscle strength. Methods: From January 2003 to December 2004, 50 randomized patients with a diagnosis of primary lung cancer underwent pulmonary resection. The patients were divided into two groups: Group I (n = 25) underwent conventional posterolateral thoracotomy, while Group II (n = 25) had muscle-sparing thoracotomy. The groups were compared in terms of shoulder abduction/adduction isokinetic muscle strength and respiratory muscle strength. Results: A comparison of maximal expiratory pressure and maximal inspiratory pressure preoperatively and postoperatively and of maximal expiratory pressure and maximal inspiratory pressure preoperatively and at 3 months postoperatively showed statistically significant differences (p < 0.05). Conclusion: For the preservation of muscle strength, especially in patients whose jobs involved manual work, muscle-sparing posterolateral thoracotomy should be the first choice rather than conventional thoracotomy. Moreover, if necessary, the latissimus dorsi muscle can be used more extensively as a flap after muscle-sparing posterolateral thoracotomy procedures.

Background: In this clinical randomized study, the effects of four anaesthesia techniques during one‐lung ventilation [total intravenous anesthesia (TIVA) with or without thoracic epidural anaesthesia (TEA) (G‐TIVA‐TEA and G‐TIVA), isoflurane anaesthesia with or without TEA (G‐ISO‐TEA and G‐ISO)] on pulmonary venous admixture (Qs/Qt) and oxygenation (OLV) were investigated.Methods: In 100 patients (four groups, 25 patients in each) undergoing thoracotomy, a thoracic epidural catheter was inserted pre‐operatively. In G‐TIVA‐TEA and G‐ISO‐TEA, bupivacaine 0.1% + 0.1 mg/ml morphine was administered intra‐operatively (10 ml of first bolus + 7 ml/h infusion). Propofol infusion or isoflurane concentration was adjusted to keep a bispectral index (BIS) of between 40 and 50 in all groups. FiO2 was 0.8 during OLV and 0.5 before and after OLV. Partial arterial and central venous oxygen pressures (PaO2 and PvO2), arterial and venous oxygen saturations and Qs/Qt values were recorded before, during and after OLV.Results: During OLV, PaO2 was significantly higher and Qs/QT significantly lower in G‐TIVA‐TEA and G‐TIVA compared with G‐ISO‐TEA and G‐ISO (PaO2: 188 ± 36; 201 ± 39; 159 ± 33; 173 ± 42 mmHg, respectively; Qs/Qt: 31.2 ± 7.4; 28.2 ± 7; 36.7 ± 7.1; 33.7 ± 7.7%, respectively). No statistical changes were observed in patients with TEA compared with without TEA in any measurement.Conclusion: During OLV, TEA does not significantly affect the oxygenation and Qs/Qt and can be used safely regardless of whether TIVA or inhalation techniques are used.

BACKGROUND:The objective of this study was to assess the role of a modified stair climbing test in predicting postoperative cardiopulmonary complications.METHODS:A consecutive series of 150 patients who had undergone pulmonary resection for lung carcinoma formed the prospective database of this study. All patients performed a preoperative modified stair climbing test. Univariate and multivariate analyses were performed to identify predictors of postoperative cardiopulmonary complications.RESULTS:With univariate analysis, the patients with complications had a lower pre-exercise and postexercise percentage of oxygen saturation. PaO (2) levels were found to be lower and a greater change in oxygen desaturation during exercise was noted. Logistic regression analysis showed that the percent of oxygen saturation pre-exercise and the change in percent of oxygen desaturation during exercise were independent and reliable predictors of cardiopulmonary morbidity.CONCLUSIONS:A modified stair climbing test is a safe, economical and simple test capable of predicting cardiopulmonary complications.

BACKGROUND:This study was designed to compare the early effects of docetaxel and paclitaxel on pulmonary physiology after isolated lung perfusion.METHODS:Rats underwent isolated left lung perfusion with docetaxel in group 1 (n = 5), paclitaxel in group 2 (n = 5), and 0.9 %NaCl in the control group (n = 5). Ventilation pressures, compliance of the lungs, blood gas analysis and histopathological results were compared between the groups.RESULTS:In group 1 and group 2, the decrease in PaO (2) (p = 0.008) and increase in ventilation pressures were significantly higher than in the control group ( P = 0.016). In group 2, pCO (2) retention was higher compared to the docetaxel perfusion group ( P = 0.016). In the histochemical assessment, intra-alveolar hemorrhage and mononuclear cell infiltration were dense and perivascular edema was not present in group 1. In group 2, perivascular and intraalveolar edema were found to be dense.CONCLUSION:Perfusion by either of the chemotherapeutics resulted in an alteration of lung physiology in rat lungs. If isolated lung perfusion is administered using chemotherapeutics from the taxanes group, it is suggested that docetaxel could be the first choice for isolated lung perfusion.

Ulke, Z. S.; Baskan, I.; Eren, M.; Ozden, E.; Dilege, S.; Senturk, M. Author Information

A 76-year-old woman was found to have a large, substernal, intrathoracic goiter. During excision, the trachea was found to be malacic. The trachea was sutured to a 16-mm ringed Gore-Tex (Gore & Associates, Arizona, USA) graft with Vicryl (Ethicon, Johnson & Johnson, USA) sutures. The graft was placed on the external surface of the trachea and surrounded the trachea almost 300 degrees. The patient was discharged on postoperative day seven without complications. She was seen at follow-up six months later and found to be free of complications.

A 41-year-old man with myasthenia gravis was referred to our clinic to undergo a thymectomy by video-assisted thoracic surgery. After physical examination of the thorax and evaluation by computed tomography, a mass lesion was noticed in the neck and thymectomy was performed by partial sternotomy combined with a cervical incision. The cervical thymoma was discontinuous with the thymus. Thymoma in the neck has rarely been reported. In this case report we emphasize the possible presence of thymoma in the neck and the importance of neck evaluation in patients with myasthenia gravis.

7303 Background: The objectives of this ongoing, open-label, single-arm, phase II trial were to evaluate the efficacy and safety of gemcitabine/cisplatin as neoadjuvant chemotherapy in patients with operable, early stage NSCLC. Methods: Chemonaive patients >18 to 70 years old with stage IB, IIA-B, and IIIA NSCLC and an ECOG performance status (PS) of 0–1 received gemcitabine (1000 mg/m2; iv) on days 1 and 8 plus cisplatin (75 mg/m2; iv) on day 1. The treatment was administered on a 21-day treatment cycle for 3 cycles, followed by surgery or radiotherapy if medically unfit for surgery. The follow-up period was 12 months after surgery. Results: At the time of this analysis, 43 patients, with a median age of 55.8 years, were enrolled. Most patients (47%) had stage IB, while 26% of the patients had stage II and 28% had stage IIIA disease. N0 and N2 nodal disease was observed in 74% and 26% of the patients, respectively. Overall, 70% of the patients had T2 primary tumors, 26% had T3, and 2% of the patients each had T1 and T0. At baseline, 19 patients had a PS of 0 and 24 patients had a PS of 1. The PS of the patients improved in each visit during the follow-up period; 33 (77%) patients were fully active and asymptomatic (PS 0) at the final visit. Of the 38 patients evaluable for clinical tumor response, 21 (55%) had partial response and 15 (40%) had stable disease, while only 2 (5%) had progressive disease. NCI-CTC grade 3–4 hematologic toxicities included neutropenia in 24 (56%) patients and thrombocytopenia in 6 (14%) patients. Non-hematologic toxicities were acceptable. Data on 24 of 43 patients were analyzed for surgery. The tumor resection rate was 88% (21 of 24). Two of 24 patients (8%) received radiotherapy following chemotherapy. Conclusion: Preliminary results show that the combination of gemcitabine/cisplatin is an effective and tolerable neoadjuvant treatment for patients with operable, early stage NSCLC. The final analysis of the data, including pathological complete response rate as well as the expression and correlation of the prognostic factors erbB-2, VEGF, Ki67, and p53 with efficacy parameters, will be presented at the meeting. No significant financial relationships to disclose.

An 8-year-old girl, who had been mechanically ventilated for 2 days, was referred to our clinic with total atelectasis of the right lung. Bronchoscopic examination showed an endobronchial mass lesion which was located on the right side of the carina. Carinal resection was performed and the patient was discharged on postoperative day 7. We presented this case report because of the rarity of tracheal tumors in childhood and to discuss the recommended surgical technique for pediatric carinal resection.