Ahmet Üçvet

Background: Prolonged air leak (PAL) remains one of the most common complications following lobectomy for non-small-cell lung cancer (NSCLC), leading to prolonged hospitalization, increased healthcare costs, and delayed recovery. We aimed to develop and internally validate a practical model for predicting PAL after lobectomy. Methods: This retrospective single-center cohort study included 905 consecutive patients who underwent lobectomy for NSCLC between 2017 and 2024. Patients were randomly allocated to derivation (n = 680) and internal validation (n = 225) cohorts (3:1). Candidate clinical, operative, and pathological variables were evaluated to identify predictors of PAL, and multivariable logistic regression was used to develop the Suat Seren Prolonged Air Leak (SSPAL) model. Model performance was assessed by discrimination (AUC) and calibration. Results: The overall incidence of PAL was 20.8%. Multivariable logistic regression identified lower body mass index (OR, 0.915; 95% CI, 0.871–0.961; p < 0.001), current smoking (OR, 4.096; 95% CI, 1.359–12.350; p = 0.01), and left-sided lobectomy (OR, 0.637; 95% CI, 0.424–0.956; p = 0.03) as independent predictors of PAL. Sex (p = 0.07) and upper lobectomy (p = 0.08) were retained in the final model. The SSPAL model demonstrated acceptable discrimination in the derivation cohort (AUC, 0.723; 95% CI, 0.675–0.771) and the internal validation cohort (AUC, 0.728; 95% CI, 0.649–0.807). Conclusions: The SSPAL model is a simple candidate risk-prediction model for estimating PAL risk after lobectomy for NSCLC. Prospective multicenter external validation is required before its clinical utility and potential role in decision-making can be established.

Aim: This study aims to evaluate factors affecting long-term prognosis in geriatric patients undergoing anatomical resection for non-small cell lung cancer (NSCLC).Materials and Methods: A total of 795 patients aged 65 years and above who underwent surgical resection for NSCLC between 2011 and 2020 were evaluated retrospectively. The study population was stratified into two age-based cohorts: patients aged between 65 and 75 years (Group 1) and those older than 75 years (Group 2). Comparisons between groups were made regarding gender, pathological TNM stage, pathological subtype, and Charlson Comorbidity Index (CCI).Results: Kaplan-Meier analysis demonstrated an average survival time of 61 months for male patients and 74 months for female patients (p=0.056). Survival time was 69 months for right-sided resections and 57 months for left-sided resections (p=0.011). The median survival was 65 months for patients in Group 1 and 51 months for those in Group 2 (p=0.045). According to the Charlson Comorbidity Index, patients scoring 1-3 had an average survival of 78 months, those scoring 4-5 had 63 months, and those with scores above 5 had 45 months (p< 0.001). Average survival was 68 months in patients undergoing lobectomy, compared to 43 months in those undergoing pneumonectomy (p< 0.001).Conclusions: This study reveals that gender, surgical technique, and comorbidities significantly affect survival outcomes in elderly patients receiving surgical treatment for NSCLC. These findings are critical for determining optimal surgical strategies and optimizing therapeutic approaches in elderly patient populations.

Background: This study aims to evaluate the outcomes of surgical treatment of post-intubation tracheal stenosis cases and to identify factors associated with recurrence and treatment success. Methods: Between January 2010 and December 2024, a total of 56 patients (38 males, 18 females; mean age: 49.1±14.8 years; range, 24 to 61 years) who were treated for postintubation tracheal stenosis were retrospectively analyzed. Data were collected using a standardized data extraction form. Demographic data, clinical characteristics, comorbidities, surgical procedures, and postoperative outcomes of the patients were recorded. Results: Comorbidities, particularly diabetes, were common in the majority of patients. Recurrence occurred in 14 (25%) of the cohort. Early mortality was observed in one (1.7%) patient. Middle tracheal stenosis as the site of stenosis and the use of 3/0 Vicryl separating sutures had higher recurrence rates. The mean length of the removed segment was 3.7±0.7 cm in patients without recurrence, while it was 3.2±0.5 cm in patients with recurrence (p=0.361). While the recurrence rate was 71.4% among patients with comorbidities such as diabetes, hypertension, epilepsy, and Crohn's disease, this rate was 28.6% in those without comorbidities (pConclusion: Surgical treatment of post-intubation tracheal stenosis presents challenges due to the high recurrence rate, particularly in patients with comorbidities. Individualized treatment approaches, meticulous surgical techniques, and comprehensive postoperative care are essential to improve patient outcomes.

Background: This study aimed to review the management and treatment approaches for patients who underwent surgery for bilateral pulmonary hydatid cysts in our clinic. Methods: A total of 175 patients who underwent surgery for pulmonary hydatid cysts between January 2008 and February 2023 were retrospectively analyzed. Bilateral pulmonary hydatid cysts were detected in 16 patients (9.14%), and 12 patients who underwent bilateral surgical treatment were included in the study. Results: The average age of the patients was 36.7 ± 18.0 years (ranging from 15 to 65 years), with an equal number of males and females. One patient underwent simultaneous bilateral thoracotomy, while the others received sequential thoracotomy for surgical treatment. A total of 36 pulmonary hydatid cysts were removed across 23 surgical sessions involving 12 patients. The cysts had an average diameter of 4.7±1.42 cm and were predominantly located in the lower lobes (56%). The contralateral side was operated on an average of 3.81 months after the intervention on one hemithorax. After the second operation, albendazole treatment at a dosage of 10 mg/kg/day was initiated. No operative mortality was recorded, and the average follow-up duration was 26.6 months. Conclusion: This study emphasizes the importance of reviewing the necessary criteria for successful surgical planning in cases of hydatid cysts in bilateral lungs. According to the data obtained, prioritizing numerous, larger, and intact cysts can help minimize the risk of potential operative complications.

This study aims to compare postoperative outcomes of video-assisted thoracoscopic surgery (VATS) and thoracotomy in elderly patients undergoing segmentectomy or lobectomy for primary non-small cell lung cancer (NSCLC). A retrospective analysis was conducted on 129 patients aged 70 years or older who underwent anatomical lung resection (segmentectomy or lobectomy) for NSCLC between January 2016 and June 2021. Patients were divided into two groups based on surgical approach: VATS and thoracotomy. Demographics, tumor characteristics, postoperative complications, chest drainage duration, hospital stay, and short- and mid-term mortality rates were analyzed and compared. The mean age of patients was 73.5 ± 3.2 years, with 55% undergoing surgery via VATS. The VATS group had significantly shorter chest drainage duration (median 4 vs. 6 days, p < 0.001) and hospital stay (median 6 vs. 7 days, p < 0.001). Minor complications were more common in the thoracotomy group (p = 0.022), while no significant differences were found in major complications (p = 0.888). Thirty-day, ninety-day, one-year, and in-hospital mortality rates showed no statistically significant differences between groups. Both VATS and thoracotomy are viable surgical options for elderly NSCLC patients, with similar mortality and major morbidity rates. However, VATS provides advantages in terms of reduced chest drainage duration and shorter hospitalization. Surgical approach should be individualized, taking into account patient characteristics and surgical risk.

Background: This study aims to examine the factors influencing prognosis and long-term survival outcomes in pathological single-station N2 (pN2a) patients undergoing surgical treatment for non-small cell lung cancer. Methods: Between January 2012 and June 2021, a total of 144 patients (125 males, 19 females; mean age: 60.5±8.4 years; range, 48 to 78 years) who underwent anatomical resection for non-small cell lung cancer and were identified with pN2a disease were retrospectively analyzed. Factors influencing prognosis were analyzed. Survival analysis was performed. Results: Forty-nine (34%) patients received neoadjuvant therapy and 87 (60.4%) patients underwent lobectomy. In terms of staging, 95 (66%) patients were classified as Stage 3A, while 49 (34%) patients were categorized as Stage 3B. Analysis of N2 subtypes revealed that 77 (53.5%) patients were classified as known N2, whereas 67 (46.5%) patients were identified as incidental. Histopathological evaluation revealed that 58 (40.3%) patients had adenocarcinoma, while 86 (59.7%) patients had non-adenocarcinoma histology. N2 disease was categorized as skip metastasis (pN0N2a) in 61 (42.4%) patients and non-skip metastasis (pN1N2a) in 83 (57.6%) patients. Adjuvant therapy was administered to 126 (87.5%) patients, with treatment modalities determined by the oncology clinics and patient characteristics. Among these, 46 (31.9%) patients received chemotherapy, 15 (10.4%) patients underwent radiotherapy, and 65 (45.1%) patients were treated with chemoradiotherapy. The five-year overall survival rate was 33.9% with a median duration of 37.1±5.0 months. The disease-free survival rate was 24.9% with a median duration of 18.2±2.3 months. Adenocarcinoma histology, non-skip N2 disease, lack of adjuvant therapy, and advanced age (>65 years) were found to be significant factors affecting the prognosis of pN2a disease. Conclusion: The findings of this study indicate that adenocarcinoma histology, advanced age, absence of adjuvant therapy, and the presence of pN1N2a are significant prognostic factors in pN2a patients undergoing curative resection for non-small cell lung cancer.

This study aims to evaluate the long-term results of patients with non-small cell lung cancer who underwent pulmonary artery resection and reconstruction. Between January 2010 and January 2023, a total of 50 patients (47 males, 3 females; mean age: 60.5±8 years; range, 43 to 83 years) who underwent lobectomy and pulmonary artery resection and reconstruction due to invasion of the pulmonary artery were retrospectively analyzed. Partial resection was performed in 45 patients. Circular pulmonary artery resection was performed in the remaining five patients. Demographic data of the patients, histopathology, lymph node metastasis, tumor size, T status, stage, comorbidity, neoadjuvant treatment and adjuvant treatment were recorded. Survival analysis was performed. All patients were operated via thoracotomy. Except for those who underwent tangential resection with a stapler, the proximal and distal parts of the artery were resected by placing a Satinsky clamp. In 35 (70%) patients, pulmonary artery invasion originated from the tumor itself, while in 15 (30%) patients, it originated from the lymph node. The five-year survival rate was 46%, with an operative mortality rate of 6% and a morbidity rate of 24%. Cox regression analysis identified neoadjuvant treatment and N2 disease as statistically significant factors influencing survival. The median disease-free survival time for all patients was 27.9 (range, 4.5 to 51.2) months. Operated side, neoadjuvant treatment, N status, reason for pulmonary artery resection, sleeve resection and type of pulmonary artery resection showed statistically significant differences in the Kaplan-Meier analysis. Our study results suggest that pulmonary artery resections and reconstructions are feasible with acceptable morbidity and mortality rates. Neoadjuvant treatment, N2 disease, and the reason and type of pulmonary artery resection are potential factors influencing long-term survival. Pulmonary artery reconstruction is safe in experienced clinics with promising long-term survival outcomes.

Objectives Lobectomy is the most frequently performed surgical treatment for lung cancer; isolated middle lobectomy (IML) is the least frequently performed lobectomy. Until recently, IML performed for Non-Small Cell Lung Cancer (NSCLC) located in the middle lobe of the lung was considered insufficient in oncologic surgery, and upper bilobectomy (Upper lobe + Middle lobe) or lower bilobectomy (Lower lobe + Middle lobe) was performed for isolated middle lobe tumors. Since postoperative morbidity and mortality rates are worse in bilobectomy compared to lobectomy, IMLs have become frequently performed. In this study, patients who underwent IML for NSCLC were compared with upper or lower lobectomies (ULL), and the oncologic results of patients who underwent IML were evaluated. Materials and methods In this study, 45 patients who underwent IML at our institution between 2012 and 2022 and 45 patients, who underwent right upper or lower lobectomy and were similar in terms of gender and age, were retrospectively analyzed. Oncological outcomes between these two groups were evaluated. Results The mean age of 45 patients, 34 (75.6%) male and 11 (24.5%) female, who underwent IML was found to be 62.5 ± 8.4 years. According to the type of surgery, 27 (60%) patients underwent thoracotomy and 18 (40%) patients underwent Video-Assisted Thoracoscopic Surgery (VATS). When tumor histopathologies were examined in all lobectomy patients, it was seen that squamous cell carcinoma was statistically significantly more dominant in IML patients than in the other two lobectomy groups (p = 0.014). In addition, it was seen that the tumor size was smaller in IML patients than in the other groups (p = 0.005). When the survival characteristics between these two groups were evaluated, the overall survival time (OS) of patients who underwent IML was 118.0 (59.0–124.0) months, while the overall survival time of patients who underwent ULL was 71.0 (66.0–74.0) months, and no statistically significant difference was found between the groups. No statistically significant difference was observed between the groups in terms of 30-day and 90-day mortality rates and 5-year survival rates. Conclusion There was no significant difference in survival between patients who underwent IML for NSCLC and those who underwent same-sided ULL. Based on these results, IML can be considered as an oncologically appropriate treatment option for masses confined to the middle lobe without the need for bilobectomy. Graphical Abstract

Background: This study aims to evaluate the long-term results of patients with non-small cell lung cancer who underwent pulmonary artery resection and reconstruction. Methods: Between January 2010 and January 2023, a total of 50 patients (47 males, 3 females; mean age: 60.5±8 years; range, 43 to 83 years) who underwent lobectomy and pulmonary artery resection and reconstruction due to invasion of the pulmonary artery were retrospectively analyzed. Partial resection was performed in 45 patients. Circular pulmonary artery resection was performed in the remaining five patients. Demographic data of the patients, histopathology, lymph node metastasis, tumor size, T status, stage, comorbidity, neoadjuvant treatment and adjuvant treatment were recorded. Survival analysis was performed. Results: All patients were operated via thoracotomy. Except for those who underwent tangential resection with a stapler, the proximal and distal parts of the artery were resected by placing a Satinsky clamp. In 35 (70%) patients, pulmonary artery invasion originated from the tumor itself, while in 15 (30%) patients, it originated from the lymph node. The five-year survival rate was 46%, with an operative mortality rate of 6% and a morbidity rate of 24%. Cox regression analysis identified neoadjuvant treatment and N2 disease as statistically significant factors influencing survival. The median disease-free survival time for all patients was 27.9 (range, 4.5 to 51.2) months. Operated side, neoadjuvant treatment, N status, reason for pulmonary artery resection, sleeve resection and type of pulmonary artery resection showed statistically significant differences in the Kaplan-Meier analysis. Conclusion: Our study results suggest that pulmonary artery resections and reconstructions are feasible with acceptable morbidity and mortality rates. Neoadjuvant treatment, N2 disease, and the reason and type of pulmonary artery resection are potential factors influencing long-term survival. Pulmonary artery reconstruction is safe in experienced clinics with promising long-term survival outcomes.