Yunus Türk

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.

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.

There are risk-based screening programs for lung cancer screening in the world. There is no screening program for lung cancer in Turkiye. The aim of our study was to investigate the incidence of pulmonary nodules and lung cancer detected incidentally with computed tomography scans performed due to the COVID-19 pandemic. Thoracic Computed Tomography (CT) scans performed with suspicion of COVID-19 between 11.03.2020 and 31.03.2022 were analyzed as a single-center and retrospective cohort. Patients with a history of previously diagnosed malignancy or in the follow-up with solitary pulmonary nodules were excluded. A total of 2381 patients were examined, and the mean age was 50.42± 17.03 years. While 267 (11.2%) patients had solitary pulmonary nodules on CT scans, 66 (2.7%) patients were diagnosed with lung cancer. Patients were categorized according to age. The risk of pulmonary nodules increased 1.92-fold between the ages of 51-60, 2.26-fold between the ages of 61-70, and 2.05-fold above the age of 70 compared to age 50 (p< 0.001 for all). Compared to age 50, the risk of developing lung cancer increased 10.3-fold between the ages of 51-60, 33.5-fold between the ages of 61-70, and 34.5-fold above the age of 70 (p< 0.001 for all). In our study, we observed that the risk of incidental detection of pulmonary nodules and lung cancer increased with the age above 50. With this cohort study, we aimed to provide an overview of lung cancer risk prediction models and applications for lung cancer screening. Keywords: Solitary Pulmonary Nodule, COVID-19, Lung Cancer, Screening

Malignant pleural effusion (MPE) is a complication of malignancy. Treatment of MPE is based on predicted outcome. The aim of this study was to compare the performance characteristics of LENT, PROMISE, RECLS, AL and pNLR scores for prediction of mortality in lung cancer patients who have MPE. Patients who were diagnosed with MPE that was associated with underlying lung cancer between January 2010 and December 2019 were included and analyzed retrospectively in a single center. Outcomes considered were 30-day, 6 months, and 1-year mortality. A total of 180 patients were examined. For 30-day mortality, the areas under the ROC curves (AUC) (95% CI) were: LENT 0.83 (0.76–0.87), RECLS 0.71 (0.63–0.77), and PROMISE 0.70 (0.17–0.38). For 6-month and 1-year mortality the order of these AUCs was similar. Cox regression showed that none of the scores were significantly associated with 30-day mortality, but LENT and RECLS were significantly associated with 6-month and 1-year mortality. Comparison of – 2log likelihood ratios showed that LENT score was more, strongly associated with 6-month mortality than PROMISE (p = 0.001) or RECLS (p = 0.02). LENT score was also more strongly associated with 1-year mortality than PROMISE (p = 0.001) but there was no difference between LENT and RECLS score (p = 0.64). We observed that the LENT score was more predictive than the other scores in mortality in patients who have lung cancer and MPE. The LENT and RECLS scores have similar performance characteristics for prediction of 1-year mortality in these patients.