Adalet Demir

Yedikule Hospital for Chest Disease and Thoracic Surgery, İstanbul, Istanbul, Turkey

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Publications (38)44.15 Total impact

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    ABSTRACT: Since radiation and chemotherapy have limitations as therapies for malignant pleural mesothelioma (MPM). The type of surgery [extrapleural pneumonectomy (EPP), extended pleurectomy (E/P), and pleurectomy/decortication (P/D)] remains controversial. This study involves 76 consecutive patients. 58 of the cases were males (76%) with a median age of 53.17±10.93 years. EPP, E/P, and P/D were performed in 31, 20, and 25 cases, respectively. The median survival time was 20 months in all patients. Overall, five-year survival rate was 14.3%. The survival rate was significantly better in epithelioid mesothelioma (P=0.049). For EPP cases, the median survival rate was 17 months, and the three-to-five year survival rates were 21% and 17%, respectively. For E/P cases, the median survival rate was 27 months and the three-year and four-year survival rates were 34% and 30%, respectively. For P/D cases, the median survival rate was 15 months and the three-to-five year survival rate was 13% and 0%. There were no statistically significant differences between the three surgical techniques (P=0.088). A comparative analysis indicates only a statistically significant difference in the E/P and P/D comparison (P=0.032). Hospital mortality showed a higher trend in EPP group (EPP: 12.9%, E/P: 0% and P/D: 4%, P=0.145). N2 cases, there were no cases of two-year survival. The survival rate in N2 was comparatively much lower, which was statistically significant (P=0.005). In multivariate analysis, only P/D (OR 0.3, 95% CI: 0.1-0.9, P=0.049) and N2 (OR 1.6, 95% CI: 0.9-2.6, P=0.090) were found to be poor prognostic factors. E/P could be encouraged to EPP with lower mortality rate and better survival trend in MPM. N2 diseases were negative prognostic factors in MPM.
    Journal of thoracic disease. 08/2013; 5(4):446-54.
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    ABSTRACT: Background Squamous cell carcinomas confined to the bronchial wall (SCC-CBW) exhibit two distinct patterns of growth: superficially spreading and endobronchial mass lesions. We examined whether differences exist in the histopathological features and prognosis of SCC-CBW exhibiting different growth patterns.Materials and Methods In this study, 37 cases with SCC-CBW were included. Tumors were classified into two groups: superficially spreading squamous cell carcinoma (s-SCC) and nodular squamous cell carcinoma (n-SCC). For each case, the growth pattern, T and N status, lymphovascular and perineural invasions, immunohistochemical expressions of p53 and Ki-67, and survival rates were analyzed.Results Twenty cases were classified as s-SCC, and 17 cases were classified as n-SCC. There was a significant relationship and correlation between the length of s-SCC in the longitudinal axis and the depth of invasion (p = 0.01, R = 0.557). There was a statistically significant positive relationship between the depth of invasion and the nodal status (N1 involvement) (p < 0.0001, R = 0.71).Conclusions SCC-CBW exhibits variable growth patterns. However, despite this variability, there are no biological or histological differences between tumors of different growth patterns, and this variability has very little, if any, effect on survival.
    The Thoracic and Cardiovascular Surgeon 05/2013; · 0.93 Impact Factor
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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. · 0.13 Impact Factor
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    ABSTRACT: Optimal resection type for non-small cell lung cancer (NSCLC) with interlobar lymph node involvement (ILNI) has seldom been reported. To completely resect a NSCLC with ILNI, some surgeons believe that a pneumonectomy is needed. We retrospectively studied 151 patients (147 men, 4 women; mean age 58 ± 8 years, range 34-79) with non-small lung cancer without mediastinal or hilar lymph node metastasis who underwent an anatomic lung resection with systematic lymph node dissection between January 1995 and November 2006. All patients had involvement of the surgical-pathologic interlobar (#11) lymph node: 8 patients had a T1 tumor; 95, T2; 39, T3; and 9, T4. We evaluated the effect of resection type (pneumonectomy in 90 patients versus lobectomy in 61) on their prognosis by univariate and multivariate analyses. The 5-year survival rate of patients was 61% for the lobectomy and 35% for the pneumonectomy (p = 0.04). We did not find statistically significant differences in sex, median age, distributions of tumor site, histology and differentiation, complete resection rate, N1 involvement status, morbidity and mortality. Patients who underwent the pneumonectomy had larger tumors and more T3 tumors. The T status, multiple levels N1 involvement and histology did not affect survival in the univariate analysis. Multivariate analysis revealed resection type as a significant prognostic factor. Pneumonectomy was not necessary in patients with NSCLC and interlobar lymph node involvement that we had discovered intraoperatively.
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 06/2011; 17(3):229-35.
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    ABSTRACT: The presence of synchronous multiple primary non-small-cell lung cancers (SMPLC) is a rare condition and the optimal treatment remains unclear. In this study, the survival of surgically treated SMPLC patients and the factors affecting survival were analyzed. Methods: Between 2001 and 2008, 26 consecutive patients diagnosed with SMPLC, who had all of their tumors resected, were retrospectively evaluated. Patients, who had bronchoalveolar carcinoma or carcinoid tumors and satellite nodules, were excluded. Prognostic factors were analyzed using univariate and multivariate analyses. The tumors were unilateral in 14 and bilateral in 12 patients. In total, 38 procedures were performed. A complete resection was achieved in 35 (92.1%) procedures. The in-hospital mortality rate was 7.6% (two patients). The overall 5-year survival rate was 49.7%, and the median survival time was 40 months. The 5-year survival rate was 40.6% for unilateral and 62.8% for bilateral SMPLC patients (p = 0.47). Histopathologic tumor type, N1 nodal disease, tumor (T) status, and older age did not influence survival. There was no survival disadvantage for patients, upon whom a sublobar resection had been performed. There was a trend toward poorer survival in patients upon whom a pneumonectomy had been performed (p = 0.12). The 3-year survival rate for patients, who received adjuvant chemotherapy and/or radiotherapy (66.7%), was better than other patients (56.3%). In the multivariate analysis, we found a trend toward poor survival in patients, who received a pneumonectomy, and a trend toward better survival in patients, who received adjuvant therapy (p = 0.05 and p = 0.06). The survival of SMPLC patients, who were treated surgically, was satisfactory. Pneumonectomy was a poor prognostic factor, whereas adjuvant therapy was a good prognostic factor.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 02/2011; 39(2):160-6. · 2.40 Impact Factor
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    ABSTRACT: The European Society of Thoracic Surgeons (ESTS) has proposed preoperative lymph-node staging guidelines (LNSGs) for non-small-cell lung cancer (NSCLC) based on the introduction of new staging modalities into clinical practice. The validity of these guidelines was assessed. Among the patients (n=185) with histologically confirmed NSCLC diagnosed between 2007 and 2009, who were suitable for thoracotomy, the 168 who underwent computed tomography (CT) of the chest and CT-integrated positron emission tomography (PET-CT) were included in the study. The preoperative mediastinal stage was confirmed by mediastinoscopy in all patients. A thoracotomy was done for mediastinoscopy-negative patients. The mediastinal staging results were adapted to the ESTS-LNSG (direct thoracotomy for T1-2 N0 tumour according to CT and PET-CT and invasive staging for others) and the validity of the guidelines was tested. In this series, the overall mediastinal lymph-node metastasis (MLNM) prevalence was 29.2%. If the guidelines had been applied, thoracotomy without invasive mediastinal staging would have been done in only 11 (6.5%) patients, and no MLNM would have been detected. Mediastinoscopy would have been performed in 157 patients and MLNM would have been found in 41 (26%). In the 116 mediastinoscopy-negative patients, MLNM would have been detected after thoracotomy in an additional eight patients. Thus, the sensitivity, specificity, and positive and negative predictive values of the guidelines were calculated as 84%, 100%, 100% and 94%, respectively. The preoperative LNSGs for NSCLC proposed by the ESTS are effective.
    European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 12/2010; 40(2):287-90. · 2.40 Impact Factor
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    ABSTRACT: The effects of angiogenesis on survival were assessed by measuring the tumor microvessel density and vascular endothelial growth factor expression in patients with resected stage I non-small cell lung carcinoma. The study population included 141 patients who underwent complete resection for stage pT1 and T2 N0 M0 tumors between 1999 and 2007. Lobectomy and pneumonectomy were performed in 131 and 10 patients, respectively. Tumor specimens were analyzed immunohistochemically for staining with anti-CD105 antibody to determine tumor microvessel density and anti-vascular endothelial growth factor antibody to determine the vascular endothelial growth factor expression level. Univariate and multivariate analyses were performed for factors influencing patients' survival. The overall 5-year survival was calculated as 68%, with rates of 76.9% for patients with T1 disease and 66.2% for patients with T2 disease (P = .4). The vascular endothelial growth factor expression rate was 94.3% for patients with stage I non-small cell lung carcinoma. Vascular endothelial growth factor expression did not influence survival (P = .9). The median microvessel density of the tumors measured based on the level of CD105 expression was 19.8. The effect of microvessel density on survival was significant (P = .02). The 5-year survivals of patients with tumors with 20 or more microvessels and less than 20 microvessels were 76.8% and 56.1%, respectively; this difference was highly significant (P = .004). The microvessel density was determined as an independent factor influencing survival on multivariate analysis (P = .03). The level of vascular endothelial growth factor expression in tumors was not a successful predictor of survival in patients with resected stage I non-small cell lung carcinoma. A high microvessel density based on CD105 is a strong predictor of prognosis in these patients.
    The Journal of thoracic and cardiovascular surgery 11/2010; 140(5):996-1000. · 3.41 Impact Factor
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    ABSTRACT: Intrathoracic hemorrhage following surgical intervention that needs rethoracotomy has a low rate in the daily practice of thoracic surgery. Hemothorax in the contralateral site is definitely unexpected after thoracotomy. We present a case of contralateral hematoma after left posterolateral thoracotomy as a rare and enigmatic complication.
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 10/2009; 15(5):336-8.
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    ABSTRACT: Due to its rarity there is no clear policy on the management of spontaneous pneumomediastinum (SPM). We treated 23 SPM patients between January 1 996 and November 2 006. There were 20 males and 3 females and their mean age was 27. Clinical records of the patients were collected and analyzed. The most frequent symptoms were neck swelling (n = 20) and rhinolalia (n = 15). Onset of the symptoms was acute. A preceding factor was found in 19 (83 %) patients; these included vigorous cough, forced physical activity, vigorous sneezing and enormous efforts during spontaneous vaginal delivery. Chest X-ray was sufficient to show mediastinal free air in 18 patients. Computerized chest tomography showed pneumomediastinum in all patients. Twenty patients were treated expectantly. Subcutaneous air drainage was needed to drain massive subcutaneous emphysema in three patients. Acute onset of typical symptoms, the existence of a preceding factor and the exclusion of other possible causes of pneumomediastinum with the help of CT are sufficient to make a diagnosis of SPM. A surgical intervention is generally not needed for the treatment of this entity.
    The Thoracic and Cardiovascular Surgeon 07/2009; 57(4):229-31. · 0.93 Impact Factor
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    ABSTRACT: Patients with N1 non-small cell lung cancer represent a heterogeneous population with varying long-term survival. To better define the importance of N1 disease and its subgroups in non-small cell lung cancer staging, we analyzed patients with N1 disease using the sixth edition and proposed seventh edition TNM classifications. From January 1995 to November 2006, 540 patients with N1 non-small cell lung cancer who had at least lobectomy with systematic mediastinal lymphadenectomy were analyzed retrospectively. For completely resected patients, the median survival rate and 5-year survival rate were 63 months and 50.3%, respectively. The 5-year survival rates for patients with hilar N1 (station 10), interlobar (station 11), and peripheral N1 (stations 12 to 14) involvement were 39%, 51%, and 53%, respectively. Patients with hilar lymph node metastasis showed a shorter survival period than patients with peripheral lymph node involvement (p = 0.02). Patients with hilar zone N1 (stations 10 and 11) involvement tended to show poorer survival than patients with peripheral zone N1 (12 to 14) metastasis (p = 0.08). Multiple-station lymph node metastasis indicated a poorer prognosis than single-station involvement (5-year survival 39% versus 51%, respectively, p = 0.01). Patients with multiple-zone N1 involvement showed poorer survival than patients with single-zone N1 metastasis (p = 0.04). A significant survival difference was observed between N1 patients with T1a versus T1b tumors (p = 0.02). Multivariate analysis revealed that only multiple-station lymph node metastasis was predictive of poor prognosis (p = 0.05). Multiple-station versus single-station N1 disease and multiple-zone versus single-zone N1 involvement indicate poorer survival rate. Patients with hilar lymph node involvement had lower survival rates than patients with peripheral N1. The impact of T factor seemed to be veiled by the heterogenous nature of N1 disease. Further studies of adjusted postoperative strategies for different N1 subgroups are warranted.
    The Annals of thoracic surgery 05/2009; 87(4):1014-22. · 3.45 Impact Factor
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    ABSTRACT: This study aims to investigate the treatment modalities and factors influencing survival in surgically treated superior sulcus tumors. Sixty-five cases of surgically treated non-small cell carcinoma of the lung occurring as superior sulcus tumors between 1994 and 2007 were retrospectively reviewed. Twenty-five patients underwent induction radiotherapy (RT), 10 had induction chemoradiotherapy (CT/RT). In thirty patients surgery was performed directly. The mortality rate was 6.2 %. Pathological stage was T3 in 55, T4 in 10, N0 in 52, and N1 in 5 and N2 in 8 patients. Overall 5- and 10-year survival rates were 31 % and 28 %, respectively. Complete resection rate was 90 % for patients who received induction CT/RT and 80 % for patients who either received induction RT alone or patients in whom surgery was performed directly. In patients who received neoadjuvant therapy with complete tumor resection, the median survival time was 33 months (28 months for patients who received induction RT alone and 36 months for patients who received induction CT/RT), and the 5-year survival rate was 41 %. Median survival time and 5-year survival rate of patients treated by direct surgery with complete resection was 24 months and 37 %, respectively ( P = 0.87). Five-year survival and 10-year survival rates were significantly higher after complete resection than after incomplete resection (38 % and 34 % vs. 0 %, P = 0.0001). In multivariate analysis, only N2 disease ( P = 0.04) and incomplete resection ( P = 0.03) were found to be poor prognostic factors. The presence of N2 disease and incomplete resection are the two most important factors affecting survival. Induction CT/RT may increase the ability to achieve complete surgical resection.
    The Thoracic and Cardiovascular Surgeon 04/2009; 57(2):96-101. · 0.93 Impact Factor
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    ABSTRACT: Pleural effusion due to congestive heart failure (CHF) typically are transudates. Light's criteria may be insufficient in determining if the pleural effusion is transudative or exudative in patients with CHF. The aim of our study was to assess the diagnostic performance of the amino-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) in pleural fluid and serum for the identification of pleural effusion owing to heart failure. The study prospectively evaluated NT-proBNP in serum and pleural fluid from patients with effusion owing to heart failure (n=51) and other causes (n=64). Measurements were made of levels of NT-proBNP by an electrochemiluminiscence immunoassay. The discriminative properties of NT-proBNP levels in identifying pleural effusion due to heart failure were determined by receiver operating characteristic curve (ROC) analysis and compared to the diagnostic value of finding a transudate by Light's criteria and serum-pleural fluid albumin gradients. Serum and pleural fluid NT-proBNP levels were significantly elevated in patients with pleural effusion owing to heart failure. The area under ROC for the diagnosis of pleural effusion from heart failure was similar for pleural fluid (0.973, 95% CI: 0.914-0.995) and serum (0.968, 95% CI: 0.890-0.989) NT-proBNP. NT-proBNP levels in either pleural fluid or serum have high diagnostic values and they are easily useable parameters in the diagnosis of heart failure-related pleural effusion.
    Internal Medicine 02/2009; 48(5):287-93. · 0.97 Impact Factor
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    ABSTRACT: Introduction: Primitive neuroectodermal tumors (PNETs) are rare, rapidly progressive, small- round cell tumors with a poor prognosis despite multimodal therapy, including surgery and chemoradiotherapy. The treatment of choice was unknown since no clinical series with surgical therapy had been reported. We evaluated the impact of multimodal treatment in patients with PNETs located in the thoracic region. Methods: Between 1998 and 2006, 25 patients with PNETs in the thoracic region were treated in 3 tertiary-care hospitals. The patients consisted of 15 males and 10 females with a mean age of 27.2 years (range, 6-60). The tumor was in the chest wall in 20 (involving the costovertebral junction in 9), the lung in four, and the heart in one patient. Twelve patients received neoadjuvant chemotherapy (54.5%), and 22 of 25 patients underwent surgery. Results: In patients who received neoadjuvant treatment, the mean regression rate was 65.4% (range, 30-100%). Eighteen (82%) patients underwent chest wall resection, while 7 (32%) had vertebral resections, and the remaining 4 (16%) had pulmonary resections. A complete resection was possible in 18 of 22 patients (82%). Patients with incomplete and complete resections had 25% and 56% 5-year survival rates, respectively (p = 0.13). The progression-free 3-year survival rate was 36% and the median survival time was 13 months. The complete resection rate was significantly higher in patients receiving neoadjuvant therapy (p = 0.027). The 5-year survival rate of the patients with or without neoadjuvant therapy was 77% and 37%, respectively (p = 0.22) although it prolonged the disease-free survival (p = 0.01). The 5-year survival rate of patients without costovertebral junction involvement was 66%, whereas patients with PNETs involving the costovertebral junction had a 21% 3-year survival. The difference was statistically significant (p = 0.01). The 5-year progression-free survival rate of patients without costovertebral junction involvement was 58%, whereas patients with PNETs involving the costovertebral junction had a 14% 1-year progression-free survival (p = 0.004). Conclusions: PNET is an aggressive malignancy that often requires multimodal therapy. Induction chemotherapy leads to a greater complete resection rate and better disease-free survival, while involvement of the costovertebral junction indicates a poorer survival.
    Journal of Thoracic Oncology 01/2009; 4(2):185-192. · 4.47 Impact Factor
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    ABSTRACT: Most parathyroid glands in hyperparathyroidism can be resected through a cervical approach. In approximately 2% of cases, the ectopic gland is in the mediastinum in a location that requires a thoracic approach. Advancement in video-assisted thoracoscopic surgical (VATS) techniques has decreased the need for sternotomy to successfully remove these ectopic glands. We describe a case involving a 29-year-old woman with hyperparathyroidism resulting from an ectopic mediastinal parathyroid adenoma that caused neonatal hypocalcemia, which was removed through VATS.
    Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 11/2008; 14(5):325-8.
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    ABSTRACT: The aim this study is to determine the characteristics, survival, and factors affecting the survival of resected T3 non-small cell lung cancer. The records of 97 cases were retrospectively reviewed with T3 non-small cell lung cancer patients that were operated between 1996-2001. Complete resection was achieved in 71 (73.2%) patient. The distribution of N status was 47.4%, 28.9%, and 23.7% for N0, N1 and N2 respectively. The evaluated prognostic factors in univariate and multivariate analyses were, histologic type, type of resection, N status, subgroups of pT3, resection margins and effect of adjuvant therapy. Overall 5-year survival rate was 24.3%. Median survival and 5-year survival of the patients whose tumors resected completely was 33 months and 31.5%, whereas 18 months and 7.3% for the patients resected incompletely (P=0.03). Median survival being not significantly different among the three subgroups: 25, 23, and 32 months (P=0.7) in the bronchial pT3, mediastinal pT3, and peripheral pT3 subgroups, respectively. Histology (P=0.57), type of surgical resection (lobectomy versus pneumonectomy) (P=0.25), and use of adjuvant therapy (P=0.054) did not influence the survival significantly. However N status influenced the survival significantly (P=0.01). According to the multivariate analyses, two factors were selected as prognostic indicators: N2 status (P=0.03) and incomplete resection (P=0.03). Three pT3 subgroups did not show survival differences. Complete resection and N2 status are the two most influencing factors in survival of the patients. Adjuvant therapy effected the survival and the quality of life reversely.
    Minerva chirurgica 05/2008; 63(2):101-8. · 0.39 Impact Factor
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    ABSTRACT: Currently the best prognostic indicator for resected non-small cell lung cancer (NSCLC) is the TNM stage. Moreover, certain histopathological properties of the tumor (such as lymphatic, vascular and perineural invasion) can help to predict the survival of the patients. Between 1997 and 2004, the results of surgical treatment were retrospectively analyzed for 153 patients with T3 non-small cell lung cancer. One hundred and twenty-four of them had had complete (R0) resections, and 29 had had incomplete (R1) resections. The prognostic factors evaluated by univariate and multivariate analysis were: type of resection; N status; subgroup of pT3; effect of adjuvant therapy; tumor size; histological type; tumor differentiation; lymphatic invasion; vascular invasion; and perineural invasion. The overall 5-year survival rate was 32 % in R0 patients, and 8 % in R1 patients ( P = 0.0002). The presence of N2 disease, vascular invasion, and perineural invasion were found to be significant prognostic indicators in univariate analysis ( P = 0.0058, P = 0.033, and P = 0.0058, respectively). Among these indicators, N2 disease and perineural invasion were also found to be significant prognostic factors in multivariate analyses ( P = 0.013, and P = 0.003, respectively). Incomplete resection, N2 disease, vascular and perineural invasion were found to be prognostic indicators for the survival of T3 NSCLC patients. Of these indicators, perineural invasion was found to be the strongest predictor of poor prognosis and independently affected the patients' survival.
    The Thoracic and Cardiovascular Surgeon 04/2008; 56(2):93-8. · 0.93 Impact Factor
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    ABSTRACT: Chronic empyema is not a rare complication of pulmonary tuberculosis. Various treatment modalities ranging from open drainage to pneumonectomy, depending on the status of the disease, have been used to treat this complication. However, the best strategy for this disease remains unknown. This study examined the results of different treatment strategies for chronic tuberculous empyema. Between January 1993 and December 2002, 36 patients (29 male and 7 female) with an average age of 29.3 years (range 13 - 52 years) presented with chronic tuberculous empyema characterized by empyema cavity and persistent pleural infections that were secondary to tuberculosis. The series consisted of patients who had had tube thoracostomy and underwater drainage without complete re-expansion. All patients were treated with open drainage. Of these, 6 patients had Eloesser flap for complete drainage of pleural pus and resolution of pleural infection. Eloesser-flap drainage resulted in a higher morbidity compared to the open-drainage-only method ( P = 0.011). Pneumonectomy, used as a final therapeutic option, resulted in more complications postoperatively ( P = 0.034). Antituberculosis therapy lasting six months or longer reduced the morbidity rate (54 % vs. 33.3 %), but the difference was not significant. Our findings indicate that open drainage leads to better results compared to those of Eloesser flap in patients with chronic tuberculous empyema. Patients who underwent pneumonectomy were expected to have higher complication rates and the procedure must therefore be avoided when possible.
    The Thoracic and Cardiovascular Surgeon 04/2008; 56(2):99-102. · 0.93 Impact Factor
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    ABSTRACT: The aim of this study was to investigate oxidative stress status in different stages and histological types of lung cancer. Forty-nine lung cancer patients, who had not received any therapy, and 20 healthy subjects were chosen for the study. Lung cancer patients were divided into those with early stage or advanced stage disease. The tumour type was adenocarcinoma in 24 patients, squamous cell carcinoma in 21 and large cell carcinoma in four. We measured serum nitrite, nitrate, ascorbic acid, retinol, beta-carotene and ceruloplasmin levels, and whole-blood malondialdehyde, reduced glutathione levels and catalase activity in patients with non-small cell lung carcinoma and healthy subjects. Statistically significant differences between the patient group and the control group were detected for all biochemical parameters. Mean malondialdehyde, nitrite, nitrate and ceruloplasmin levels and catalase activity were significantly higher in the group with advanced stage disease than in the control group. Mean beta-carotene, ascorbic acid and reduced glutathione levels were significantly lower in the group with advanced stage disease than in the control group. Mean malondialdehyde and nitrite levels were significantly higher in the patients with squamous cell carcinoma than in those with adenocarcinoma, and mean malondialdehyde level was also significantly higher in patients with squamous cell carcinoma than in those with large cell carcinoma. These results suggest that with advancing stage of lung cancer, the levels of oxidative stress increase, while levels of antioxidant molecules decrease. Patients with squamous cell carcinoma have higher oxidative stress as reflected by higher levels of malondialdehyde and nitrite.
    Respirology 02/2008; 13(1):112-6. · 2.78 Impact Factor
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    ABSTRACT: Our study aimed to determine the frequency of sick euthyroid syndrome (SES) among patients diagnosed as non-small cell lung cancer (NSCLC) and its association with the stage of the disease, Karnofsky index (KI), and nutritional parameters. We enrolled 80 consecutive patients with newly diagnosed NSCLC. Cases with NSCLC were staged by using the TNM system. The cases were examined for thyroid function tests, KI and nutritional evaluation before treatment. Moreover, cases were investigated for their overall survival ratio. Out of 80 patients, SES was identified in 28 (35%). SES was more frequent among stage III (26%) and stage IV (62%) cases. The body mass index (BMI), KI and serum albumin level were found to be significantly low in cases with SES when compared to cases without SES. SES was found to be negatively correlated with BMI, KI and serum albumin level, and it was positively correlated with disease stage and weight loss. Additionally, the presence of SES was found as a prognostic factor at survival analysis (p=0.0002). SES was frequently seen in cases with NSCLC. SES can be used as a predictor of poor prognosis in NSCLC patients.
    Internal Medicine 02/2008; 47(4):211-6. · 0.97 Impact Factor
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    ABSTRACT: Mediastinal lymph node metastasis (MLNM) is the most important prognostic factor and guide to the treatment in non-small cell lung cancer (NSCLC) patients with no distant metastasis. As a non invasive method, using of positron emission tomography (PET) to evaluate NSCLC is increasing. We aimed to compare results of PET and mediastinoscopy to reveal effectiveness of PET in the mediastinal staging of NSCLC patients. PET was performed to 100 operable NSCLC patients between 2004 and 2006. Later, standard cervical mediastinoscopy was performed to all of the patients. Twenty-six patients who detected MLNM at mediastinoscopy were referred to oncology clinic for neoadjuvant or definitive chemo-radiotherapy. Other 74 patients underwent thoracotomy and performed lung resection and mediastinal lymphatic dissection. Sensitivity and specificity rates for detecting mediastinal lymphatic metastasis of PET and mediastinoscopy were compared. There were 89 male and 11 female with mean age of 59 years. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates were calculated as 74%, 76%, 59%, 86% and 76% respectively for PET and 83%, 100%, 100%, 93% and 95% respectively for mediastinoscopy. Accuracy rate of PET is not sufficient and mediastinoscopy is still the gold standard to evaluate mediastinal staging of NSCLC, at present.
    Tuberkuloz ve toraks 02/2008; 56(1):56-63.