Adnan Sayar

Publications (23)26.97 Total impact

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  Available from: Necati Çıtak

  Article: Size of Pneumothorax can be a New Indication for Surgical Treatment in Primary Spontaneous Pneumothorax: A Prospective Study.

  Adnan Sayar, Abdulaziz Kök, Necati Citak, Muzaffer Metin, Songül Büyükkale, Atilla Gürses
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  ABSTRACT: Purpose: Surgical treatment of primary spontaneous pneumothorax (PSP) is usually performed in cases of prolonged air leak (PAL) or recurrence. We investigated the effect of the size of pneumothorax in surgically treated PSP cases.Methods: Between 2007 and 2008, 181 patients hospitalized with the diagnosis of PSP were prospectively recorded. The size of pneumothorax was calculated in percentages by the method defined by Kircher and Swartzel. Patients were divided into two groups, according to pneumothorax size: Group A (large pneumothorax, ≥50%), and Group B (small or moderate pneumothorax, <50%).Results: The mean size of pneumothorax was 80.5 ± 10.4% in Group A (n = 54, 29%) and 39.5 ± 6.5% in Group B (n = 127, 71%). History of smoking and smoking index were significantly higher in Group A patients (p = 0.02, p <0.001, respectively). Fifty-five patients (29.3%) required surgery because of PAL or ipsilateral recurrence. The rate of patients requiring surgical operation was significantly higher in Group A (51.9%) than in Group B (n = 25; p <0.001). Rates of PAL and recurrence were higher in Group A than in Group B (p = 0.007, p = 0.004, respectively).Conclusion: The size of pneumothorax is larger in those with a smoking history and a higher smoking index. Surgical therapy can be considered in cases with a pneumothorax size ≥50% after the first episode immediately.
  Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 04/2013;
• Source

  Available from: Alper Çelikten

  Dataset: Kikuchi-Fujimoto Disease Presenting with Supraclavicular Lymphadenopathy: A Case Report

  Alper Çelikten, Muzaffer Metin, Adnan Sayar, Nur Büyükpınarbaşılı, Atilla Pekçolaklar, Necati Çitak, Abdülaziz Kök, Atilla Gürses
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  ABSTRACT: A 34-year-old female who had supraclavicular lymphadenopathy applied to our clinic. Patholo-gical examination of the lymph node excised via biopsy was reported as Kikuchi-Fujimoto disease (KFD) also called histiocytic necrotising lymphade-nitis. The clinical course was self limited with lymph node excision and nonsteroid anti-inflammatory drugs. Spontaneous resolution was seen within two months as reported in the literature. KFD's etiology is unknown and it is one of the reasons of benign lymphadenopathy. It is important because of the possibility of misdiagnosis with many diseases including lymphoma.
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  Available from: Necati Çıtak

  Article: Sleeve karinal rezeksiyon ve rekonstrüksiyon: Malign tümörlerin karinal invazyonunun cerrahi endikasyonu ve sonuçları Sleeve carinal resection and reconstruction: surgical indication and results of carinal invasion by malignant tumors

  Adnan Sayar, Necati Çıtak, Songül Büyükkale, Muzaffer Metin, Mehmet Zeki Günlüoğlu, Serda Kanbur, Adalet Demir, Levent Dalar, Mehmet Akif Özgül, Filiz Koşar, Saadettin Çıkrıkçıoğlu, Atilla Gürses, Yedikule Göğüs, Cerrahisi Ve, Göğüs Hastalıkları, Eğitim Ve, Araştırma Hastanesi, Göğüs Cerrahisi Kliniği, İstanbul Türkiye, Göğüs Hastalıkları Kliniği
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  ABSTRACT: Türk Göğüs Kalp Damar Cerrahisi Dergisi 2013;21(2):392-401 Sleeve karinal rezeksiyon ve rekonstrüksiyon: Malign tümörlerin karinal invazyonunun cerrahi endikasyonu ve sonuçları Sleeve carinal resection and reconstruction: surgical indication and results of carinal invasion by malignant tumors Amaç: Bu çalışmada karinal invazyon nedeni ile karinal rezeksi-yon ve rekonstrüksiyon uyguladığımız malign tümörlü hastaların klinik sonuçları incelendi. Ça­ lış­ ma­pla­ nı:­Ocak 2002 -Mayıs 2011 tarihleri arasında kari-nal invazyon nedeni ile karinal rezeksiyon ve rekonstrüksiyon uygulanan malign tümörlü 19 hasta (18 erkek, 1 kadın; ort. yaş 54.8±10.0 yıl; dağılım 29-73 yıl) ameliyat tekniği, komplikas-yon, ameliyat endikasyonları ve uzun dönem takipleri açısından incelendi. Trakea ve bronş rezeksiyonu sonrası, sol ana bronş, ameliyat sahasına alınan steril spiralli entübasyon tüpü ile entübe edildi. Bul gu lar: İkisi ikinci primer olmak üzere, 14 hastada küçük hücreli dışı akciğer karsinomu (KHDAK), üç hastada adenoid kistik karsinom vardı. On hastaya karinal sleeve pnömonekto-mi (ikisi tamamlayıcı olmak üzere), sekiz hastaya lobektomi ile kombine karina rezeksiyonu ve rekonstrüksiyonu ve bir hastaya izole karina rezeksiyonu ve rekonstrüksiyonu sağ pos-terolateral torakotomi ile uygulandı. Adenoid kistik karsinom nedeni ile ameliyat edilen iki hasta dışında tüm hastalarda komplet rezeksiyon yapıldı (komplet rezeksiyon oranı: %89.4). Cerrahi mortalite ve morbidite oranı sırası ile %10.5 (n=2) ve %26.3 (n=5) idi. Mortalite oranı açısından rezeksiyon tipleri arasında fark yok iken, karinal sleeve pnömonektomi uygu-lanan hastalarda, diğer hastalara kıyasla, daha fazla komp-likasyon (%40'a kıyasla %11.1) geliştiği saptandı. Ortalama 45.4±37.6 ay (medyan 34 ay) takip edilen hastaların üç yıllık sağkalımı %72.9 idi. So­ nuç:­ Karinal rezeksiyon ve rekonstrüksiyon, seçilmiş hasta-larda kabul edilebilir mortalite, morbidite ve iyi uzun dönem takip sonuçları ile güvenle uygulanabilir. Anah tar söz cük ler: Karinal invazyon; rekonstrüksiyon; sleeve karinal rezeksiyon; cerrahi. Background:­This study aims to analyze the clinical outcomes
  Turkish Journal of Thoracic and Cardiovascular Surgery 01/2013; 21(2):392. · 0.09 Impact Factor
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  Available from: Necati Çıtak

  Article: The rare congenital anomaly of pulmonary sequestration experience and review of literature

  Atilla Pekçolaklar, Necati Çitak, Muzaffer Metin, Abdülaziz Kök, Alper Çelikten, Adnan Sayar, Atilla Gürses
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  ABSTRACT: Objective Pulmonary sequestration is rare lung anomaly which had very major theories of origin. The aim of this study was to treat this rare congenital anomaly, pulmonary sequestration, which was not diagnosed of preoperatively, in our centre. Methods A retrospective analysis of 10 cases of pulmonary sequestration operated at the centre between 2000 and 2010. A review of the extralobar and intralobar types of sequestration is discussed. All patients were not diagnosed preoperatively. Results Pulmonary sequestration is found more commonly in women (6 patients). In all patients, the diagnosis was made by exploratory thoracotomy. Six patients had intra-lobar (one was apical) and 4 were extralobar (one apical). Lobectomy for intralobar and sequestrectomy for extralobar sequestration were performed. Conclusions Although rare, some radiological features are sufficiently suggestive of diagnosis of pulmonary seques-tration. We believe that pulmonary sequestration should be considered when intrathoracic masses cannot be differenti-ated through invasive and non-invasive evaluation. In difficult cases methods such as aortagraphy, doppler angiography and Magnetic Resonance (MR) angiography may be used.
  Indian Journal of Thoracic and Cardiovascular Surgery 04/2012; 26(4).
• Source

  Available from: Levent Dalar

  Article: Carinal resection and reconstruction for respiratory tumors using Miyamoto's technique.

  Adnan Sayar, Okan Solak, Muzaffer Metin, Alper Celikten, Necati Cıtak, Erdoğan Çetinkaya, Levent Dalar, Atilla Gürses
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  ABSTRACT: Surgical processes that involve the carina pose a serious challenge to thoracic surgeons. Although techniques to allow resection and reconstruction have been developed, few institutions have accumulated sufficient experience to achieve meaningful results. There is still a debate about the indications and the morbidity and mortality rates for this type of surgery. We have operated on six patients using a modified version of the tracheobronchial end-to-end and bronchial end-to-side anastomosis technique that was developed by Miyamoto and coworkers and reported in the English-language literature by Yamamoto and associates. Five patients underwent tracheal sleeve right upper lobectomy, and one underwent carinal resection only with two main bronchi and the trachea. None of the patients we operated on had any postoperative complications. We concluded that when used with adequate surgical performance this seldom-used technique can be applied safely and provide great benefits in particular cases.
  General Thoracic and Cardiovascular Surgery 02/2012; 60(2):90-6.
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  Available from: Necati Çıtak

  Dataset: Pneumothorax, pneumoretroperitoneum, and subcutaneous emphysema after colonoscopy: a case report and review of the literature

  Atilla Pekçolaklar, Necati Çıtak, Adnan Sayar, Muzaffer Metin, Atilla Gürses
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  ABSTRACT: A 64 years old female had diagnostic colonoscopy for an abdominal pain of one year. Her thorax and abdominal computed tomography scans for shortness of breath and subcutaneous emphysema showed pneumothorax, pneumomediastineum and pneumoperitoneum and patient was referred to our emergency unit. Chest x-ray (CXR) showed a left side pneumothorax, breathing sounds of left lung was nonexistent in auscultation and there was subcutaneous emphysema in physical examination. Tube thoracostomy from 5. intercostal space midclavicular line and waterseal suction drainage was applied. Patient had no extra clinical problems and discharged from the hospital. We just wanted to remind a rare complication.
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  Available from: Necati Çıtak

  Article: Comparison of video-assisted mediastinoscopy and video-assisted mediastinoscopic lymphadenectomy for lung cancer.

  Adnan Sayar, Necati Citak, Muzaffer Metin, Akif Turna, Atilla Pekçolaklar, Abdulaziz Kök, Nur Urer, Alper Celikten, Zeynep Nilgün Ulukol, Atilla Gürses
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  ABSTRACT: We compared the efficacy and complications of video-assisted mediastinoscopy (VAM) and video-assisted mediastinal lymphadenectomy (VAMLA) for mediastinal staging of lung cancer. Between March 2006 and July 2008, a total of 157 patients with non-small-cell lung cancer (NSCLC) underwent VAM (n = 113, 72%) or VAMLA (n = 44, 28%). We studied them retrospectively. Data for the operating time, node stations sampled/dissected, number of biopsies, and the patients who were pN0 by mediastinoscopy and underwent thoracotomy were collected. The false-negative rate was calculated. Demographics and operative complications were analyzed. The overall complication rate was 5.7% (n = 9). The most common complication was hoarseness (n = 8). Complications were seen significantly more often after VAMLA than after VAM (11.3% vs. 2.6%, P = 0.04). There were no deaths. The mean number of removed lymph nodes (8.43 ± 1.08) and the station numbers (4.81 ± 0.44) per patient were higher with VAMLA than with VAM (7.65 ± 1.68, P = 0.008 and 4.38 ± 0.80, P = 0.001, respectively). The mean operating time was 44.8 ± 6.6 min for VAM and 82.0 ± 7.8 min for VAMLA. Patients diagnosed as pN2 numbered 9 in the VAMLA group and 27 in the VAM group. The patients diagnosed as pN0 with mediastinoscopy then underwent thoracotomy (VAM 77, VAMLA 32). When they were investigated for the presence of mediastinal lymph nodes, there were three (3.8%) false-negative results in the VAM group and five (15.6%) in the VAMLA group. Sensitivity, accuracy, and negative predictive values for VAM and VAMLA were 0.90/0.97/0.96 and 0.64/0.87/0.84, respectively. VAMLA was found to be superior to VAM with regard to the number of stations and lymph nodes. Complications after VAMLA were common. The sensitivity and NPV of VAM for mediastinal staging are significantly higher than those of VAMLA.
  General Thoracic and Cardiovascular Surgery 12/2011; 59(12):793-8.
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  Available from: Necati Çıtak

  Article: Spontan pnömotoraks sonrası rutin takipte insidental olarak saptanan akciğer kanseri: olgu sunumu 47-years-old man with spontaneous pneumothorax secondary to non-small cell lung cancer

  Necati Çitak, Muzaffer Metin, Adnan Sayar, Atilla Pekçolaklar, Atilla Gürses
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  ABSTRACT: zet Spontan pnömotoraks en sık apikal bölgedeki bleplerin rüptürü sonucu gelişmesine rağmen bazen altta yattan ikincil bir akciğer hastalığına (amfizem, tüberküloz, eozinofilik granülom ve nadiren de akciğer karsinomuna) bağlı gelişebilir. Bu çalışmamızda küçük hücre dışı akciğer karsinomuna ikincil gelişen spontan pnömotorakslı 47 yaşındaki erkek olgumuzu sunduk. Anahtar Kelimeler: Spontan pnömotoraks, küçük hücre dışı akciğer karsinomu, bilgisayarlı toraks tomografisi Lung cancer incidentally found on routine controls of spontaneous pneumothorax: a case report Abstract Spontaneous pneumothorax are usually caused by subpleural apical bleps but may also be secondary to underlying pulmonary pathology such as emphysema, tuberculosis, eosinophilic granuloma and rarely lung neoplasm (secondary to metastasis to the lung and primary lung cancer). We present a Yazışma Adresi: İnsidansı 5-10/100 bin olan spontan pnömotoraks genç erişkinlerde 1/500 gibi bir oranda daha sık görülür (1). Spontan pnömotoraks en sık apikal bölgedeki bleplerin rüptürü sonucu gelişmektedir. Bazen altta yattan ikincil bir akciğer hastalığına bağlı (sıklıkla amfizem, tüberküloz, eozinofilik granülom ve nadiren de akciğer karsinomu) olarakta gelişebilir (2). Bu çalışmamızda küçük hücre dışı akciğer karsinomuna ikincil gelişen spontan pnömotorakslı 47 yaşındaki erkek olgumuzu sunduk.
  Tıp Araştırmaları Dergisi. 09/2011;
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  Available from: Necati Çıtak

  Article: The role of extended cervical mediastinoscopy in staging of non-small cell lung cancer of the left lung and a comparison with integrated positron emission tomography and computed tomography: does integrated positron emission tomography and computed tomography reduce the need for invasive procedures?

  Muzaffer Metin, Necati Citak, Adnan Sayar, Atilla Pekcolaklar, Huseyin Melek, Abdulaziz Kök, Atilla Gurses
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  ABSTRACT: Extended cervical mediastinoscopy (ECM) is a method for sampling aortopulmonary window (APW) mediastinal lymph nodes. In this study, the efficacy of integrated positron emission tomography/computed tomography (PET/CT) was compared with ECM for the detection of APW lymph node metastasis. Fifty-five patients diagnosed of non-small cell lung cancer in whom APW or hilar lymph nodes had been reported to be positive on PET/CT, and/or who had had central tumor and/or in whom ECM had been performed for mediastinal staging due to the presence of APW lymph nodes larger than 1 cm in diameter on the CT between 2005 and 2009, were retrospectively analyzed. All patients underwent PET/CT scanning. Thirty-eight patients were identified as cN0 by standard cervical mediastinoscopy/ECM, and lobectomy, pneumonectomy, and exploratory thoracotomy were performed on 19, 13, and six of these patients, respectively. Mediastinal lymphadenectomy revealed APW lymph node metastases in four patients (ECM false negative). Seventeen patients identified as cN2 by mediastinoscopy, APW lymph node metastasis was present in nine, whereas eight had mediastinal lymph node metastasis that could only be accessed by standard cervical mediastinoscopy but had no APW lymph node metastasis were excluded from the analysis. Sensitivity, specificity, negative predictive value, positive predictive value, and accuracy of ECM/PET/CT were calculated as 0.69/0.53, 1/0.91, 0.89/0.83, 1/0.70, and 0.91/0.80, respectively. ECM, which is an effective technique used in the determination of APW lymph node metastasis, was enough to rule out nodal disease with negative predictive value. PET/CT does not reduce the need for invasive procedures in detecting APW lymph node metastasis.
  Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer 06/2011; 6(10):1713-9. · 4.55 Impact Factor
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  Available from: Halide Nur Urer

  Article: Prognostic stratification of patients with T3N1M0 non-small cell lung cancer: which phase should it be?

  Ali Kilicgun, Ozgur Tanriverdi, Akif Turna, Muzaffer Metin, Adnan Sayar, Okan Solak, Nur Urer, Atilla Gurses
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  ABSTRACT: In the 1997 revision of the TNM staging system for lung cancer, patients with T3N0M0 disease were moved from stage IIIA to stage IIB since these patients have a better prognosis. Despite this modification, the local lymph node metastasis remained the most important prognostic factor in patients with lung cancer. The present study aimed to evaluate the prognosis of patients with T3N1 disease as compared with that of patients with stages IIIA and IIB disease. During 7-year period, 313 patients with non-small cell lung cancer (297 men, 16 women) who had resection were enrolled. The patients were staged according the 2007 revision of Lung Cancer Staging by American Joint Committee on Cancer. The Kaplan-Meier statistics was used for survival analysis, and comparisons were made using Cox proportional hazard method. The 5-year survival of patients with stage IIIA disease excluding T3N1 patients was 40%, whereas the survival of the patients with stage IIB disease was 66% at 5 years. The 5-year survival rates of stage III T3N1 patients (single-station N1) was found to be higher than those of patients with stage IIIA disease (excluding pT3N1 patients, P = 0.04), while those were found to be similar with those of patients with stage IIB disease (P = 0.4). Survival of the present cohort of patients with T3N1M0 disease represented the survival of IIB disease rather than IIIA non-small cell lung cancer. Further studies are needed to suggest further revisions in the recent staging system regarding T3N1MO disease.
  Medical Oncology 03/2011; 29(2):607-13. · 2.14 Impact Factor
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  Available from: Necati Çıtak

  Article: [Results of surgical treatment for pulmonary aspergilloma with 26 cases in six years: a single center experience].

  Necati Citak, Adnan Sayar, Muzaffer Metin, Atilla Pekçolaklar, Abdulaziz Kök, Neslihan Akanıl Fener, Alper Celikten, Atilla Gürses
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  ABSTRACT: Surgery for pulmonary aspergilloma is reputed to be risky. We analyzed our results of the surgical treatment for pulmonary aspergilloma. Between 2003 and 2009, 26 patients underwent thoracotomy for treatment of pulmonary aspergilloma in our center. Results were evaluated retrospectively. There were 5 female and 21 male patients, with a mean age of 44 ± 11.6 years (28-70). The patients were divided into two groups, group A (simple aspergilloma; n= 8) and group B (complex aspergilloma; n= 18). Major underlying diseases were tuberculosis (61.5%). The most common indication for operation was hemoptysis (57.6%). Of our patients, 23% were complaining of massive hemoptysis or recurrent hemoptysis. Other patients were complaining of mild symptoms and some of them were totally asymptomatic. We performed 15 (57.6%) lobectomies (3 with associated segmentectomies), 8 (30.6%) segmentectomies/wedge resections, 2 (7.6%) pneumonectomies, and 1 (3.8%) cavernoplasty. Postoperative complications occurred in 15 (57.6%) patients. Complications occurred in 72.2% patients of complex aspergilloma, whereas 25% occurred in simple aspergilloma (p= 0.03). Major complications included prolonged air leak, empyema, air space. One patient who underwent lobectomies for complex aspergilloma developed bronchopleural fistula and died of respiratory failure on the 20th postoperative day. Operative mortality was 3.8%. The average postoperative hospital stay was 12.9 days. The mean follow-up period was average 44 months. The actuarial survival at 3 years was 90% and 100% for complex aspergilloma and simple aspergilloma, respectively (p> 0.05). There was two recurrence of disease (8%). But no recurrence of hemoptysis. Low morbidity rate may have been due to the selection of patients with localized pulmonary disease in this study. Surgical resection of asymptomatic or symptomatic pulmonary aspergilloma is effective in preventing recurrence or massive hemoptysis for patients whose condition is fit for pulmonary resection with reasonable mortality, morbidity and survival rates.
  Tuberkuloz ve toraks 03/2011; 59(1):62-9.
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  Available from: Necati Çıtak

  Article: Pulmoner aspergillomada altı yıllık 26 olguluk cerrahi tedavi sonuçları: Tek cerrahi servisinin deneyimi

  Necati Çitak, Adnan Sayar, Muzaffer Metin, Atilla Pekçolaklar, Abdulaziz Kök, Neslihan Akanil Fener, Alper Çelikten, Atilla Gürses, Sb, Yedikule Göğüs, Hastalıkları Ve, Göğüs Cerrahisi, Eğitim Ve, Araştırma Hastanesi, Cerrahi Göğüs, Kliniği, İstanbul, Sb Yedikule, Göğüs Hastalıkları, Patoloji Bölümü
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  ABSTRACT: ZET Pulmoner aspergillomada altı yıllık 26 olguluk cerrahi tedavi sonuçları: Tek cerrahi servisinin deneyimi Pulmoner aspergillomanın cerrahi tedavisi risk açısından nam salmıştır. Cerrahi olarak tedavi ettiğimiz pulmoner aspergillo-malı olgularımızın sonuçlarını inceledik. 2003-2009 yılları arasında kliniğimizde cerrahi olarak tedavi uyguladığımız 26 pul-moner aspergillomalı olguyu ve operasyon sonuçlarını retrospektif olarak inceledik. Yirmi biri erkek, beşi kadın olan olgu-ların yaş ortalamaları 44 ± 11.6 (dağılım: 28-70) yıl idi. Olgular grup A (basit aspergilloma; n= 8), grup B (kompleks aspergilloma; n= 18) olarak iki gruba ayrıldı. En sık altta yatan hastalık %61.5 ile tüberkülozdu. Operasyon için belirlenen en sık endikasyon altısı masif veya tekrarlayan ataklar şeklinde olan 15 (%57.6) olguyla hemoptiziydi. Diğer olgular hafif semptomları bulunan veya asemptomatik seyreden olgulardı. On beş (%57.6) olguya lobektomi, 8 (%30.6) olguya wedge rezeksiyon veya segmentektomi, 2 (%7.6) olguya pnömonektomi, 1 (%3.8) olguya kavernoplasti uygulanmıştı. Postoperatif olarak 15 olguda komplikasyon gelişti. Kompleks aspergillomalı olguların %72.2'sinde komplikasyon izlenirken, basit aspergillomalı olguların %25'inde görüldü (p= 0.03). En çok görülen komplikasyonlar uzamış hava kaçağı, ampiyem ve ekspansiyon kusuruydu. Kompleks aspergilloma için lobektomi uygulanan 1 (%3.8) olguda bronkoplevral fistül gelişti ve postoperatif 20. günde hasta kaybedildi. Ortalama hastanede yatış süresi 12.9 gündü. Olgular ortalama 44 ay takip edildi. Üç yıllık sağkalım basit aspergillomalı olgularda %100 iken, bu oran kompleks aspergillomalı olgularda %90 idi (p> 0.05). Takip sürecinde 2 (%8) olguda hastalığın tekrarladığı saptandı. SUMMARY Results of surgical treatment for pulmonary aspergilloma with 26 cases in six years: a single center experience
  Tuberkuloz ve toraks 01/2011;
• Article: Definition of postresectional residual pleural space.

  Okan Solak, Adnan Sayar, Muzaffer Metin, Akif Turna, Volkan Erdogu, Atilla Pekçolaklar, Atilla Gürses
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  ABSTRACT: Complications of the residual postoperative pleural space (RPPS) after partial pulmonary resections increase hospital stay, cost and morbidity. The objectives of this study were to define and identify the long-term outcome of RPPS. A total of 140 partial pulmonary resections were performed in a 3-year period. Fifty-eight (41.4%) patients who had RPPS on the first postoperative day were followed up. We examined the chest x-rays of these patients on postoperative day 1 and 7 and week 4 and 12, and we documented any complications and reoperations. RPPS persisted in 6 patients (10.4%) and was reabsorbed in 44 patients (75.8%) in the 12th week. Residual spaces were complicated in 8 patients (13.7%), of whom 4 (6.8%) had reoperation and 4 (6.8%) were redrained. Reoperated patients had a mean of 13 (standard deviation [SD] 2.4, range 11-16) days of postoperative hospitalization, whereas redrained patients had a mean of 58.5 (SD 21.7, range 36-88) days of additional hospitalization. We determined air leakage and space infection to be the major complications of the RPPS. Infectious complications were noticed in the postoperative third and fourth weeks (14-30 d), and reoperated patients had a shorter duration of postoperative hospitalization. Early operation is recommended in complicated pleural space patients. The space that is not complicated until the end of the first month can be defined as benign. This study demonstrated that follow-up of a benign space after the first postoperative month is not necessary.
  Canadian journal of surgery. Journal canadien de chirurgie 02/2007; 50(1):39-42. · 1.05 Impact Factor
• Article: Surgical treatment of pulmonary hydatid disease: a comparison of children and adults.

  S Ibrahim Dincer, Adalet Demir, Adnan Sayar, M Zeki Gunluoglu, H Volkan Kara, Atilla Gurses
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  ABSTRACT: Hydatid cyst still remains an important health problem in our country as in many Mediterranean countries. The disease may affect children, and its treatment may be challenging in this age group. Surgery is the primary way of treatment. In the current study, the features unique to childhood pulmonary hydatid disease are emphasized. Between 1992 and 2003, 301 patients were operated on because of pulmonary hydatid cyst in our hospital; 44 of them were 14 years or younger. They were categorized as pediatric patients. We retrospectively evaluated the clinical data of the patients. The mean age of the patients was 10.6 +/- 3.7 years (5-14 years) in children and 32.2 +/- 14 years (16-75 years) in adults. The rate of intact cyst was 71% in children and 57% in adults (P = .07). The mean diameter of the cyst was 8.5 +/- 3.1 cm (3-15 cm) and 6.6 +/- 3 cm (2-16 cm) in children and adults, respectively (P < .001). The rate of parenchyme-saving procedures was 84.1% in children, whereas 94.9% in adults. Lobectomy was performed in 16% of children, whereas it was performed in 1.5% of adults (P < .001). Morbidity rates were 13.6% in children and 11.6% in adults. No children but 1 adult died. Long-term follow-up revealed the recurrence rates as 4.5% in children and 4.3% in adults. Surgery, the primary method of treatment of hydatid cyst, is safe. Parenchyma-saving procedures such as cystotomy and capitonnage should be performed as much as possible. Nevertheless, hydatid cyst can reach relatively larger dimensions in children than in adults, which causes parenchyme destruction eventually leading to lung resection.
  Journal of Pediatric Surgery 08/2006; 41(7):1230-6. · 1.45 Impact Factor
• Article: A new surgical technique for adenoid cystic carcinoma involving tracheal carina.

  Adnan Sayar, Muzaffer Metin, Okan Solak, Akif Turna, Süha Alzafer, Turan Ece
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  ABSTRACT: Reported is the successful treatment of a 24-year-old male with adenocystic carcinoma involving the tracheal carina, in which the tumor extended along the right main bronchus across the orifice of the right upper lobe. The patient underwent a carinal resection plus right upper lobectomy and reconstruction of the carina, resulting in neither anastomotic complication nor recurrence of disease during 28 months of follow-up.
  Asian cardiovascular & thoracic annals 10/2005; 13(3):280-2.
• Article: Lactate dehydrodgenase levels predict pulmonary morbidity after lung resection for non-small cell lung cancer.

  Akif Turna, Okan Solak, Erdoğan Cetinkaya, Ali Kiliçgün, Muzaffer Metin, Adnan Sayar, Atilla Gürses
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  ABSTRACT: The prevention of pulmonary complication after pulmonary resection for non-small cell lung cancer may minimize postoperative mortality rates and hospitalization period. The purpose of this study was to identify preoperative factors associated with the development of pulmonary complications after lung resections to help predict which patients are at increased risk for morbidity. From January 2000 to June 2003, 108 consecutive pulmonary resections were performed for non-small cell lung cancer in our institution. The following information was recorded: demographic, clinical, functional, and surgical variables. We evaluated all complications, which arose after pulmonary resection during hospitalization. The risk of complication was evaluated using univariate and multiple logistic regression analysis to estimate odds ratio. Sixty-six lobectomies, 31 pneumonectomies, 11 bilobectomies and four wedge resections were done. Forty-nine complications were realized in all patients. A logistic regression analysis on relevant variables showed that only the increased serum lactate dehydrogenase (LDH) levels (>320 U/l) was a significant predictor of a pulmonary complication (P=0.03). Age, side of resection, low FEV(1), stage of the disease, low partial arterial oxygen pressure, low partial arterial carbon dioxide pressure, cigarette smoking and concomitant disease were not significant predictors of morbidity. Patients who have higher serum LDH levels are at increased risk for developing postoperative morbidity. Postoperative physical therapy and medical care might be intensified in those patients at high risk.
  European Journal of Cardio-Thoracic Surgery 09/2004; 26(3):483-7. · 2.55 Impact Factor
• Article: Prognostic significance of surgical-pathologic multiple-station N1 disease in non-small cell carcinoma of the lung.

  Adnan Sayar, Akif Turna, Ali Kiliçgün, Okan Solak, Nur Urer, Atilla Gürses
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  ABSTRACT: The surgical outcome of pathologic N1 disease in resectable non-small cell lung carcinoma (NSCLC) is controversial. The prognosis of the patients with multiple/bulky N2 disease was invariably dismal. However, the prognostic significance of tumor involvement in more than one hilar or intralobar lymph node station has not been fully described. From 1996 to 2002, 181 patients with NSCLC had complete resection. Four levels of N1 nodes and N2 nodes were identified using the new regional lymph node classification for lung cancer staging. There were 67 patients (37%) with no nodal disease (N0), 43 patients (24%) with N1 and 71 patients (39%) with N2 disease. The N1 subgroup cases were reviewed. The prognostic significances of single and multiple N1 diseases were tested. The cumulative postoperative survival at 3 and 5 years was 57 and 29%, respectively. The survival associated with single-station N1 disease was significantly better than that of multiple-station N1 disease (45 vs 32% at 5 years; P=0.03). Five-year survival was similar in patients with multiple N1 disease and patients with single-station N2 involvement (32 vs 31% at 5 years; P=0.84). However, no patient survived when tumor was detected in more than one mediastinal station (i.e. multiple N2 disease). It was suggested that N1 disease is a compound of two subgroups: one involving in one node and the other (multiple N1 disease) in which the postoperative prognosis was not statistically different from that of N2 disease.
  European Journal of Cardio-Thoracic Surgery 04/2004; 25(3):434-8. · 2.55 Impact Factor
• Article: Nonanatomic prognostic factors in resected nonsmall cell lung carcinoma: the importance of perineural invasion as a new prognostic marker.

  Adnan Sayar, Akif Turna, Okan Solak, Ali Kiliçgün, Nur Urer, Atilla Gürses
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  ABSTRACT: A number of prognostic factors have been reported for resected nonsmall cell lung carcinoma. Although none of them reported to have greater prognostic impact than the TNM staging system, which is based on anatomical descriptions of tumors, the prognoses of a significant number of patients are not in agreement with real survival of the patients. Moreover, certain histopathologic properties of the tumor (such as lymphatic and vascular invasion) could help to predict the survival of the patients. A retrospective study was conducted on 82 surgically resected nonsmall cell lung carcinomas, and the following prognostic factors were evaluated in univariate analysis: age, gender, clinical and surgical-pathologic T and N status, histologic type of tumor, grade of differentiation, lymphatic invasion, vascular invasion, and perineural invasion. Lymphatic invasion and perineural invasion of the tumor were found to be significant prognostic factors (p = 0.02 and p = 0004). Blood vessel invasion (venous or arterial involvement) had no prognostic impact (p > 0.05). According to multivariate analyses, three factors were selected as prognostic indicators: (1) clinical N status (p = 0.027), (2) lymphatic invasion (p = 0.027) and (3) perineural invasion (p = 0.0148). By combining these factors we identified a poor prognostic subgroup of patients with stage I disease. Our study showed that lymphatic vessel and perineural invasion of the tumor could be prognostic factors, along with anatomical determinants such as cN and surgical-pathologic stage of the pulmonary carcinoma.
  The Annals of Thoracic Surgery 02/2004; 77(2):421-5. · 3.74 Impact Factor
• Article: Prompt surgery for massive hemoptysis: more acceptable than it was reported.

  Muzaffer Metin, Akif Turna, Adnan Sayar, Atilla Gürses
  European Journal of Cardio-Thoracic Surgery 05/2003; 23(4):647; author reply 648. · 2.55 Impact Factor
• Article: Extended cervical mediastinoscopy in the diagnosis of anterior mediastinal masses.

  Muzaffer Metin, Adnan Sayar, Akif Turna, Atilla Gürses
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  ABSTRACT: Although transthoracic needle biopsy (TNB) has been the preferred method for the diagnosis of anterior mediastinal masses, it has inherent limitations in accuracy. In particular, lymphoma and thymoma are diagnosed less reliably using needle biopsy. Videothoracoscopy has been advocated as an alternative method for diagnosis. Our goal was to assess the usefulness of extended cervical mediastinoscopy (ECM) in the diagnosis of anterior mediastinal masses. The ECM technique was performed in 9 patients in whom TNB and Tru-cut biopsies had been inefficient for histologic diagnosis. All lesions were in the anterior mediastinum. Extended cervical mediastinoscopy was carried out using the same incision as in a standard cervical mediastinoscopy and dissection was performed behind the sternum as previously published. Mean operative time was 50 minutes (range 40 to 70 minutes) and mean hospital stay was 8 hours (range 5 to 36 hours). Diagnosis of lymphoma in 4 cases, thymoma in 3 cases, and thymic hyperplasia in 2 cases were obtained by ECM. In 1 of 2 patients with suspected thymoma who underwent resectional surgical procedures, final histologic diagnosis was non-small cell lung carcinoma. There was no surgical mortality or intraoperative complication. One patient had minimal pneumothorax requiring no intervention. We conclude that ECM in the diagnosis of anterior mediastinal masses is technically feasible and provides an alternative to the conventional approaches in patients with paraaortic or aortopulmonary masses.
  The Annals of Thoracic Surgery 02/2002; 73(1):250-2. · 3.74 Impact Factor