[Show abstract][Hide abstract] ABSTRACT: Esophageal perforation (EP) is a critical and potentially life-threatening condition with considerable rates of morbidity and mortality. Despite many advances in thoracic surgery, the management of patients with EP is still controversial.
We retrospectively reviewed 34 patients treated for EP, 62% male, mean age 53.9 years. Sixty-two percent of the EPs were iatrogenic. Spontaneous and traumatic EP rates were 26% and 6%, respectively. Three patients had EP in the cervical esophagus and 31 in the thoracic esophagus.
Mean time to initial treatment was 34.2 hours. Twenty patients comprised the early group <24 h) and 14 patients the late group (>24 h). Management of the EP included primary closure in 30 patients, non-surgical treatment in two, stent in one and resection in one. Mortality occurred in nine of the 34 patients (26%). Mortality was EP-related in four patients. Three of the nine patients that died were in the early group (p<0.05). Mean hospital stay was 13.4 days.
EP remains a potentially fatal condition and requires early diagnosis and accurate treatment to prevent the morbidity and mortality.
Eurasian Journal of Medicine 02/2015; 47(1):41-7. DOI:10.5152/eajm.2014.55
[Show abstract][Hide abstract] ABSTRACT: Background Function of the thoracic sympathetic chain (TSC) reportedly recovers after surgical clips are removed. Hence, this study was designed to study nerve regeneration after unclipping the TSC. Methods The bilateral TSCs of six goats were studied; the goats were separated into three groups (groups I, II, and III) during excision, clipping, and unclipping. During surgery, the TSCs were excised with a scalpel in group I and clipped in groups II and III. In group III, the clips were removed 1 month postoperatively and observed for possible nerve healing for 1 month. All TSCs were examined histologically following en block resection at 1 month postoperatively in groups I and II and at 2 months postoperatively in group III. Results Inflammation in nerve sections was noted following clip removal. Furthermore, there was significant degeneration and cell infiltration in the nerve fibers of the clipped regions. The Schwann cells around the peripheral nerve endings in the unclipped regions facilitated nerve transmission by reconstitution of myelin. Conclusion Clipping the TSC can cause histologic degeneration; however, histologic nerve regeneration occurs after unclipping.
The Thoracic and Cardiovascular Surgeon 09/2014; DOI:10.1055/s-0034-1390046 · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A universal and consistent stage classification system, which describes the anatomic extent of a cancer, provides a foundation for communication and collaboration. Thymic epithelial malignancies have seen little progress, in part because of the lack of an official system. The International Association for the Study of Lung Cancer and the International Thymic Malignancies Interest Group assembled a large retrospective database, a multispecialty international committee and carried out extensive analysis to develop proposals for the 8th edition of the stage classification manuals. This tumor, node, metastasis (TNM)-based system is applicable to all types of thymic epithelial malignancies. This article summarizes the proposed definitions of the T, N, and M components and describes how these are combined into stage groups. This represents a major step forward for thymic malignancies.
Journal of Thoracic Oncology 09/2014; 9(9):S65-72. · 5.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Despite longstanding recognition of thymic epithelial neoplasms, there is no official American Joint Committee on Cancer/Union for International Cancer Control stage classification. This article summarizes proposals for classification of the T component of stage classification for use in the 8th edition of the tumor, node, metastasis classification for malignant tumors. This represents the output of the International Association for the Study of Lung Cancer and the International Thymic Malignancies Interest Group Staging and Prognostics Factor Committee, which assembled and analyzed a worldwide database of 10,808 patients with thymic malignancies from 105 sites. The committee proposes division of the T component into four categories, representing levels of invasion. T1 includes tumors localized to the thymus and anterior mediastinal fat, regardless of capsular invasion, up to and including infiltration through the mediastinal pleura. Invasion of the pericardium is designated as T2. T3 includes tumors with direct involvement of a group of mediastinal structures either singly or in combination: lung, brachiocephalic vein, superior vena cava, chest wall, and phrenic nerve. Invasion of more central structures constitutes T4: aorta and arch vessels, intrapericardial pulmonary artery, myocardium, trachea, and esophagus. Size did not emerge as a useful descriptor for stage classification. This classification of T categories, combined with a classification of N and M categories, provides a basis for a robust tumor, node, metastasis classification system for the 8th edition of American Joint Committee on Cancer/Union for International Cancer Control stage classification.
Journal of Thoracic Oncology 09/2014; 9(9):S73-80. · 5.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Stage classification is an important underpinning of management of patients with cancer, and rests on a combination of three components: T for tumor extent, N for nodal involvement, and M for more distant metastases. This article details an initiative to develop proposals for the first official stage classification system for thymic malignancies for the 8th edition of the stage classification manuals. Specifically, the results of analysis of a large database and the considerations leading to the proposed N and M components are described. Nodal involvement is divided into an anterior (N1) and a deep (N2) category. Metastases can involve pleural or pericardial nodules (M1a) or intraparenchymal pulmonary nodules or metastases to distant sites (M1b).
Journal of Thoracic Oncology 09/2014; 9(9):S81-7. · 5.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background:
Thymomas and thymic carcinomas are rare malignancies and devising clinically effective molecular targeted therapies is a major clinical challenge. The aim of the study was to analyze BLC2 and vascular endothelial growth factor receptor (VEGFR) expression and KRAS and EGFR mutational status and to correlate them with the clinical characteristics of patients with thymomas and thymic carcinomas.
Materials and methods:
A total of 62 patients (mean age: 50.4 ± 13.2 years) with thymomas and thymic carcinomas were enrolled. The expression of BLC2 and VEGFR in tumor cells and normal tissues was evaluated by RT-PCR. The mutational status of the KRAS and EGFR genes was investigated by PCR with sequence specific primers.
The BLC2 and VEGFR expression levels did not differ significantly between tumor and normal tissues. Moreover, there were no clearly pathogenic mutations in KRAS or EGFR genes in any tumor. None of the molecular markers were significantly related to clinical outcomes.
Changes in levels of expression of BLC2 and VEGFR do not appear to be involved in thymic tumorigenesis. Moreover, our data suggest that KRAS and EGFR mutations do not play a major role in the pathogenesis of thymomas and thymic carcinomas.
Asian Pacific journal of cancer prevention: APJCP 04/2014; 15(8):3457-60. DOI:10.7314/APJCP.2014.15.8.3457 · 2.51 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To update the recommendations for the structural characteristics of general thoracic surgery (GTS) in Europe in order to provide a document that can be used as a guide for harmonizing the general thoracic surgical practice in Europe.
A task force was created to set the structural, procedural and qualification characteristics of a European GTS unit. These criteria were endorsed by the Executive Committee of the European Society of Thoracic Surgeons and by the Thoracic Domain of the European Association for Cardio-Thoracic Surgery and were validated by the European Board of Thoracic Surgery at European Union of Medical Specialists.
Criteria regarding definition and scope of GTS, structure and qualification of GTS unit, training and education and recommendations for subjects of particular interest (lung transplant, oesophageal surgery, minimally invasive thoracic surgery, quality surveillance) were developed.
This document will hopefully represent the first step of a process of revision of the modern thoracic surgeons' curricula, which need to be qualitatively rethought in the setting of the qualification process. The structural criteria highlighted in the present document are meant to help and tackle the challenge of cultural and language barriers as well as of widely varying national training programmes.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2014; 45(5). DOI:10.1093/ejcts/ezu016 · 3.30 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: This study aims to investigate the feasibility of the video-assisted thoracoscopic (VAT) laser ablation technique in the treatment of primary spontaneous pneumothorax (PSP). Methods: Between January 2006 and June 2012, 60 patients with complicated PSP were included. Patients were prospectively randomized into two groups including 30 patients in each. Video-assisted thoracoscopic blebectomy and/or bullectomy with staplers was performed for group 1, whereas VAT laser ablation was performed for group 2. Pleural abrasion using the Marlex mesh was performed in both groups. A single chest tube (28 F) per patient was inserted. The operating time, number of complications, duration of hospital stay, duration of tube thoracostomy, and PSP recurrence rate were compared between the groups. Results: The median stapler use was 1.6 (1-4) in group 1, and the median energy use was 2700 J (1800-3700 J) in group 2. The median operating time was 31 min (17-65 min) in group 1 and 34 min (15-59 min) in group 2. Delayed lung expansion occurred in only two patient (6%) in group 1 and 22 patients (75%) in group 2 (p≤0.05). The mean hospital stay was 2.75 (2-4) days in group 1 and 3.7 (2-10) days in group 2 (p≤0.05). The duration of chest tube use was 2.3 (1-7) days in group 1 and 7.9 (2-14) days in group 2 (p<0.001). There was two PSP recurrence (5%) in group 1 and one lung collapse following chest tube removal in group 2. Conclusion: Although delayed lung expansion due to thermal damage may develop, VAT laser ablation appears to be safe and effective with comparable results to those of VATS bullectomy.
Turkish Journal of Thoracic and Cardiovascular Surgery 01/2014; 22(3):577-582. DOI:10.5606/tgkdc.dergisi.2014.8463 · 0.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background: This study was conducted to investigate the effect of pneumonectomy after neoadjuvant therapy on survival, morbidity, and mortality in patients with non small cell carcinoma (NSCLC). Methods: Files of 130 patients who were performed pneumonectomy in our clinic for NSCLC between November 1995 and August 2012 were retrospectively reviewed. Patients with other malignancies and/or distant metastasis, and who underwent completion pneumonectomy were excluded, and the remaining 116 patients (113 males, 3 females; mean age 57 years; range 31 to 82 years) constituted the study group. Neoadjuvant treatment was administered to 47 patients (group 1) who had advanced stage (T3-4N0-1 or T1-3N2) NSCLC. Pneumonectomy without neoadjuvant treatment was performed in 69 patients with T2-4N0-1 (group 2). Survival, morbidity, and mortality rates were compared between the groups. Results: Sixty-two patients (53%) underwent left pneumonectomy. The median length of hospital stay was 6.4 days (range 1-33 days). Chemotherapy was administered in 29 patients (62%), and chemoradiotherapy in 18 patients (38%) preoperatively. Left pneumonectomy was performed in 29 patients after neoadjuvant treatment. Complications were detected in 31% of patients (group 1: 28%, group 2: 33%). Ninety-day mortality rate was 4.2% in group 1, and 5.8% in group 2. Five-year-survival rate was 41% and 35% for group 1 and group 2, respectively. Median survival time was 41 months and 40 months for group 1 and group 2, respectively. No statistically significant difference was detected between the two groups in terms of morbidity, mortality, and survival. Conclusion: This study showed that pneumonectomy after neoadjuvant treatment may be safely administered in patients with locally advanced NSCLC with acceptable morbidity, mortality, and survival rates.
Turkish Journal of Thoracic and Cardiovascular Surgery 01/2014; 22(4):777-784. DOI:10.5606/tgkdc.dergisi.2014.8755 · 0.14 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: OBJECTIVES We evaluated the results of treatment in patients with thymic tumors treated with postoperative adjuvant radiotherapy. METHODS Eighteen patients were treated median 5400 cGy radiotherapy between 1995-2010. Diagnosis of patients were thymoma (n=10), thymic carcinoma (n=7), thymic neuroendocrin carcinoma (n=1). R0 resection was made on 12 of them. According to prognostic stratification with Masaoka stage and WHO classification, there were 5 good, 7 moderate, and 6 poor risk patients. Survival was calculated from diagnosis. RESULTS A total of 33% patients were recurred median 29.5 months with 34 months follow-up. Local control, median overall and disease-free survival for all patients were 77%, 113 months, and 105 months. Local control for good, moderate, poor risk groups were found 100%, 71%, 50%. There were significant differences survival rates for Masaoka stage, R0 resection, and prognostic groups. CONCLUSION Prognostic risk classification was found to be better predictive in terms of local control and survival.
Turk Onkoloji Dergisi 01/2013; 28(2):59-66. DOI:10.5505/tjoncol.2013.904
[Show abstract][Hide abstract] ABSTRACT: Aim: To describe the clinical features of descending necrotizing mediastinitis (DNM) and to outline the diagnostic and therapeutic measures to be taken in its management. Materials and methods: We retrospectively analyzed the data from 13 patients with DNM treated between 2001 and 2012 in 2 tertiary care centers, together with their demographics, diagnostic methods, therapeutic interventions, and clinical outcomes. Results: The patients consisted of 10 males and 3 females, aged from 16 to 72 years (mean age: 44). Odontogenic and tonsillar infections were the probable sources of infection in the majority of cases. Computerized tomography is a crucial imaging modality in the diagnosis and follow-up of patients with DNM. All patients underwent surgical treatment in addition to intravenous broad-spectrum antibiotics. Tube thoracostomy, mediastinal drainage, cervical drainage, and thoracotomy were the therapeutic measures utilized in these patients. Five patients were lost (38%) and 8 survived. Conclusion: DNM is a life-threatening condition that may originate from oropharyngeal infections. Emergency surgical intervention is mandatory in the management of DNM. The 2 most important survival factors are early surgical intervention and adequate drainage.
Turkish Journal of Medical Sciences 12/2012; 42:1437-1442. DOI:10.3906/sag-1203-103 · 0.50 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To investigate prognostic factors of survival following curative, non-palliative surgical removal of lung metastases secondary to colorectal cancer (CRC).
Between 1999 and 2009, a radical metastasectomy with curative intent was performed on lung metastases in 21 patients with CRC (15 male and 6 female; mean age: 57.4 ± 11.8 years; age range: 29-74 years) who had already undergone primary tumour resection.
The mean number of lung metastases ranged from one to five. The mean overall survival was 71 ± 35 mo (median: 25 mo). After adjusting for potential confounders, multivariable Cox regression analyses predicted only the number of lung metastases (1 vs ≥ 2; hazard ratio: 7.60, 95% confidence interval: 1.18-17.2, P = 0.03) as an independent predictor of poor survival following lung resection for metastatic CRC.
Resection of lung metastases is a safe and effective treatment in selected CRC patients with single lung metastases.
World Journal of Gastroenterology 02/2012; 18(7):662-5. DOI:10.3748/wjg.v18.i7.662 · 2.37 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pericardial cysts are usually asymtomatic, benign, congenital mediastinal lesions but may also be acquired after cardiothoracic surgery. The purpose of the study was to evaluate surgical approach and results of our experience with pericardial cysts.
A total of 12 patients who had undergone surgical treatment for pericardial cyst between February 1999 and August 2010 were retrospectively evaluated. All patients were analyzed according to the symptoms, method for the diagnosis, cyst location, management, and outcomes.
The mean age was 50.4±17 years (range, 23-68 years) with a female-to-male ratio of 8:4. Pericardial cyst were located in the right hemithorax in 8 (67%) patients and left hemithorax in 4 (33%) patients. The cysts were resected by thoracotomy in 4 (33%) patients and by video-assisted thoracic surgery in 8 (67%) patients. There was an excellent long-term follow-up with no morbidity or mortality.
Videothoracoscopic surgical removal of pericardial cysts is an excellent surgical intervention without serious morbidity and mortality.
[Show abstract][Hide abstract] ABSTRACT: One of the most important considerations in the care of thoracic surgery patients is the control of pain, which leads to increased morbidity and relevant mortality.
Between February and May 2009, 60 patients undergoing full muscle-sparing posterior minithoracotomy were prospectively randomized into two groups, according to the thoracotomy closure techniques. In the first group (group A), two holes were drilled into the sixth rib using a hand perforator, and sutures were passed through the holes in the sixth rib and were circled from the upper edge of the fifth rib, thereby compressing the intercostal nerve underneath the fifth rib. In the second group (group B), the intercostal muscle underneath the fifth rib was partially dissected along with the intercostal nerve, corresponding to the holes on the sixth rib. Two 1/0 polyglactin (Vicyrl) sutures were passed through the holes in the sixth rib and above the intercostal nerve.
There were 30 patients in each group. The visual analog score, observer verbal ranking scale (OVRS) scores for pain, and Ramsay sedation scores were used to follow-up on postoperative analgesia and sedation. The von Frey hair test was used to evaluate hyperalgesia of the patients. The patients in group B had lower visual analog scores at rest and during coughing. The patients in group B had lower OVRS scores than group A patients. The groups were not statistically different in terms of the Ramsay sedation scores and von Frey hair tests.
Thoracotomy closure by a technique that avoids intercostal nerve compression significantly decreases post-thoracotomy pain.
European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 04/2011; 39(4):570-4. DOI:10.1016/j.ejcts.2010.08.003 · 3.30 Impact Factor