Potential Survival Benefit of Upfront Surgery for Lung Tumors Unconfirmed but Highly Suspicious for Stage I Lung Cancer.

Background: Patients with early-stage lung tumors that are highly suspicious for malignancy typically undergo a preoperative diagnostic workup, primarily through bronchoscopy or transthoracic biopsy. Those without a preoperative diagnosis may alternatively be treated with upfront surgery, contingent upon the potential for intraoperative diagnosis. Previous studies have yielded conflicting results regarding the impact of upfront surgery on the survival of these patients. Our study aimed to elucidate the effect of upfront surgery on the survival outcomes of patients undergoing surgery for early-stage lung cancer without a preoperative diagnosis. Methods: We analyzed the survival rate of 158 consecutive patients who underwent pulmonary resection for stage I lung cancer, either with or without a preoperative diagnosis. Results: A total of 86 patients (54%) underwent upfront surgery. This approach positively impacted both disease-free survival (p=0.031) and overall survival (p=0.017). However, no significant differences were observed across subgroups based on sex, smoking status, forced expiratory volume in 1 second, histologic tumor size, or histologic subtype. Univariate analysis identified upfront surgery (p=0.020), age (p=0.002), maximum standardized uptake value (SUVmax) exceeding 7 (p=0.001), and histological tumor size greater than 20 mm (p=0.009) as independent predictors. However, multivariate analysis indicated that only SUVmax greater than 7 (p=0.011) was a significant predictor of unfavorable survival. Conclusion: Upfront surgery does not appear to confer a survival advantage in patients with stage I lung cancer undergoing surgical intervention.

Video-Assisted Thoracoscopic Surgery Is a Safe and Feasible Technique for Mediastinal Parathyroid Lesions.

Introduction: Hyperfunctional ectopic parathyroid glands in the mediastinum pose a challenge to diagnosis and require optimal surgical management. Video-assisted thoracoscopic surgery (VATS) has emerged as a promising minimally invasive approach, offering potential benefits in terms of both patient comfort and oncological principles. This study aimed to evaluate the effectiveness and safety of VATS for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum. Methods: Among the 538 patients with mediastinal tumors who underwent thoracoscopic surgery at Istanbul University (2008-2021), 11 exhibited hyperfunctional ectopic parathyroid glands. The localization of the glands was performed using various diagnostic techniques, including neck ultrasound, sestamibi scan, CT (computerized tomography), and SPECT (Single-photon emission computed tomography). VATS (Video-assisted thoracoscopic surgery) was used to remove ectopic parathyroid glands in all 11 patients, with no need for conversion to open surgery. Results: The pathological results showed that VATS successfully removed the ectopic glands in all 11 patients. Serum parathyroid hormone (PTH) levels were monitored intraoperatively, and frozen sections were used to confirm the presence of parathyroid adenomas in all cases. Postoperative analysis showed that PTH levels dropped by at least 50% within 10-15 minutes after adenoma removal. Conclusion: VATS is a safe and effective method for the treatment of hyperfunctional ectopic parathyroid glands in the mediastinum with a low risk of complications.

The Role of [18F]FDG PET/CT in the Characterization of Thymic Epithelial Tumors at Initial Stage.

Purpose: The aim of this study was to evaluate the potential role of [18F]FDG positron emission tomography/computed tomography (PET/CT) in the characterization of thymic epithelial tumors (TETs). Materials and Methods: A total of 73 patients who underwent preoperative [18F]FDG PET/CT were included in this study. Visual total score (VTS), maximum standard uptake values (SUVmax), metabolic tumor volume (MTV), total lesion glycolysis (TLG), and heterogeneity index (HI) parameters were analyzed to investigate the prediction of histopathologic grade and advanced stage. Results: The cohort included 26 patients with low-grade thymoma (LGT), 36 patients with high-grade thymoma (HGT), and 11 patients with thymic carcinoma (TC). Ninety-one percent of TC had VTS >2, whereas 31% of LGT and 75% of HGT had VTS >2. SUVmax, MTV, and TLG were statistically significantly higher in the TC group than in both thymoma and HGT. Using the cutoff value of 7.25 for SUVmax, TC was differentiated from thymomas with 91% sensitivity and 74% specificity. TC had significantly lower HI values than thymomas. HI parameters showed good diagnostic ability to differentiate TC from thymoma and TC from HGT. SUVmax, MTV, and TLG were significantly higher in advanced-stage disease than in early-stage disease. Conclusions: Visual and quantitative parameters can reliably predict both advanced disease and the grade of primary tumor in TETs. Therefore, as a promising metabolic imaging method, [18F]FDG PET/CT makes important contributions to preoperative evaluation in routine clinical practice.

Thymoma patients with or without myasthenia gravis have increased Th17 cells, IL-17 production and ICOS expression.

Thymoma associated myasthenia gravis (TAMG) is a small disease subgroup with autoantibodies against the acetylcholine receptor. The aim of this study was to assess the role of T helper (Th) cells in TAMG compared to thymoma patients without MG (TOMA) and healthy controls (HC). Peripheral blood cells were used for intracellular cytokine measurements and phenotyping of CD4+ Th cells. IL-21 and IL-4 productions and peripheral Th cells were higher in TAMG compared to TOMA patients and HC. Increases of ICOS and Th17 population were detected both in TAMG and TOMA groups. Higher IL-10 and Th1 population have been observed related to thymectomy. ICOS expression and Th17 induced by thymoma may contribute to the development of TAMG.

Does Fissureless Videothoracoscopic Lobectomy Help for Postoperative Air Leak?

BACKGROUND: Postoperative air leak is a common problem in patients undergoing pulmonary resections. A conventional fissure dissection technique during videothoracoscopic lobectomy, particularly in patients with fused fissures is very likely to result in parenchymal damage and prolonged air leak (PAL). In contrast, fissureless video-assisted thoracoscopic surgery (VATS) lobectomy may have advantages regarding PAL and hospital stay. METHODS: We conducted a retrospective study consisting of 103 consecutive patients who underwent a VATS lobectomy either with a conventional or fissureless technique and statistically analyzed the results particularly with respect to PAL, chest tube duration (CTD), and length of hospital stay (LOS). RESULTS: We had 21 (20.4%) cases with PAL. Gender (p = 0.009), histological size of tumor (p = 0.003), and surgical technique (p = 0.009) showed statistically significant differences for PAL in contingency tables. Significant predictors for PAL in univariate analysis were male sex (p = 0.017), histological size of tumor more than 24 mm (p = 0.005), and conventional technique (p = 0.017). Similarly, multivariate analysis revealed male sex (p = 0.036), histological size of tumor more than 24 mm (p = 0.043), and conventional technique (p = 0.029) as significant predictors for PAL. In addition, both the medians of CTD (p = 0.015) and LOS (p = 0.005) were comparably lesser as 3 days, in patients who underwent fissureless videothoracoscopic lobectomy. CONCLUSION: The fissureless technique helps for PAL in patients undergoing videothoracoscopic lobectomy.

Double sleeve resections.

Double sleeve lung resections are complex surgical procedures that require specialized surgical expertise and careful patient selection. These procedures allow for the preservation of lung tissue while still achieving complete tumor resection for central tumors. Although initially considered high-risk operations, double sleeve lung resections have become a viable option for central tumors. Recent studies have shown that double sleeve lung resections are associated with lower morbidity and mortality rates than pneumonectomy. Furthermore, double sleeve lung resections may be associated with similar or even better long-term oncological outcomes compared to pneumonectomy, with the added benefit of preserving lung parenchyma and reducing the incidence of postoperative complications.

Predictors of malignancy in patients with solitary pulmonary nodules undergoing pulmonary resection.

BACKGROUND: The management of a solitary pulmonary nodule is a challenging issue in pulmonary disease. Although many factors have been defined as predictors for malignancy in solitary pulmonary nodules, the accurate diagnosis can only be established with the permanent histological diagnosis. OBJECTIVE: We tried to clarify the possible predictors of malignancy in solitary pulmonary nodules in patients who had definitive histological diagnosis. METHODS: We made a retrospective study to collect the data of patients with solitary pulmonary nodules who had histological diagnosis either before or after surgery. We made a statistical analysis of both the clinic and radiological features of these nodules with respect to malignancy both in contingency tables and with logistic regression analysis. RESULTS: We had a total of 223 patients with a radiological diagnosis of solitary pulmonary nodule. Age, smoking status and pack years of smoking, maximum standardized uptake value (SUVmax), and radiological features such as solid component, spiculation, pleural tag, lobulation, calcification, and higher density were significant predictors of malignancy in contingency tables. Age, smoking status and smoking (pack/year), SUVmax, and radiological features including spiculation, pleural tag, lobulation, calcification, and higher density were the significant predictors in univariate analysis. However, multivariate analysis revealed only SUVmax greater than 2.5 (p < 0.0001), spiculation (p = 0.009), and age older than 61 years (p = 0.015) as the significant predictors for malignancy. CONCLUSION: Age, SUVmax, and spiculation are the independent predictors of malignancy in patients with solitary pulmonary nodules.

Prognostic factors in patients undergoing pulmonary resection for sarcomatoid carcinomas of the lung.

BACKGROUND: Pulmonary sarcomatoid carcinomas are very rare lung neoplasms, and no consensus exists regarding their optimal treatment. The prognosis of sarcomatoid carcinomas has been reported to be unfavorable compared with non-small-cell lung cancers; however, prognostic factors in patients undergoing surgery for sarcomatoid carcinomas remain unclear. AIMS: To analyze clinicopathologic prognostic factors and survival outcomes in patients who underwent surgery for pulmonary sarcomatoid carcinoma. STUDY DESIGN: Retrospective cross-sectional study. METHODS: We designed a retrospective cross-sectional study in patients who underwent surgery for pulmonary sarcomatoid carcinomas and statistically analyzed the prognostic factors regarding clinicopathologic features with respect to survival outcomes. RESULTS: We had a total of 44 patients with sarcomatoid carcinoma who had pulmonary resection. Sex distribution was 34 (77%) males and 10 (22.7%) females, which was determined by declaration. The mean age of patients was 57.3 ± 16 years with a median of 60 years. The 5-year progression-free survival and overall survival rates were 59% and 58%, respectively. The 5-year survival rates were significantly different for tumors > 5 cm (P = 0.044), tumorstatus (T) (P=0.016), lymph node status (N) (P=0.005), and pathologic tumor-node-metastasis (TNM) stage (P = 0.0001 ). However, histologic subtype (P = 0.628) and adjuvant treatment (P = 0.804) did not have any significant effect on survival. Similarly, the significant prognostic factors in univariate analysis were tumor size (P = 0.085), T status (P = 0.005), N status (P = 0.028), and pathologic TNM stage (P = 0.0001). Multivariate analysis showed only T status (P = 0.058), N status (P = 0.018), and pathologic TNM stage (P = 0.019) as independent prognostic factors, with statistical power of 87%, 43.1% and 21.2%. CONCLUSION: Surgery appears to be an optimal treatment with favorable outcomes for patients with pulmonary sarcomatoid carcinoma. Patients with small tumors at earlier stages are very likely to benefit from surgery, regardless of histologic subtype.

Effectiveness of Video-Assisted Thoracoscopic Surgery in Undiagnosed Exudative Pleural Effusions.

OBJECTIVES: Undiagnosed pleural effusions mostly require histologic studies for a definite diagnosis. In addition, malignant pleural effusions responsible for a significant part of exudative pleurisy need palliative therapy The purpose of our study is to research the effectiveness of video-assisted thoracoscopic surgery in definitive diagnosis and palliative treatment of unexplained non-parapneumonic exudative pleural effusions. MATERIALS AND METHODS: The study included 263 patients with non-parapneumonic exudative pleurisy, which could not be diagnosed by an initial clinical, radiological, biochemical, microbiological, and cytological investigation in three centers. All patients underwent video-assisted thoracoscopic surgery for definitive diagnosis between January 2002 and January 2018. Patients' data were retrospectively analyzed in terms of age, gender, symptoms, previously diagnosed cancers, computerized tomography of chest findings, histopathological diagnosis, cytological diagnosis, morbidity, mortality, and success rates of the procedure. Patient groups from the three centers were divided into three groups according to the center of the patient. The groups were compared statistically in terms of cytologic diagnosis rates. RESULTS: The most common complaint was dysnea (66.5%). Of the 263 cases, 83 were previously diagnosed with cancer. The simple pleural effusion (66.5%) was the most frequent radiological finding. The success rate for definitive diagnosis was detected as 97%. Of all the cases, the rate of specific cytological diagnosis was detected to be 34%. The cytologic diagnosis rate was meaningfully lower in Group 1than in Groups2 and 3. The postoperative morbidity rate was detected as 9%. CONCLUSION: Video-assisted thoracic surgery is not only a rapid and effective diagnostic method, but also a palliative therapeutic method. We think that it should be used immediately after initial diagnostic thoracentesis in undiagnosed exudative PEin the less experienced centers.