Factors influencing postoperative recurrence of early-stage non-small cell lung cancer.

PURPOSE: This study aims to explain the factors that may influence recurrence after surgical resection for early non-small cell lung cancer (NSCLC). METHODS: A retrospective analysis was made of 302 patients who underwent lung resection for stage I-IIA NSCLC in our clinic between January 2014 and August 2021. RESULTS: The recurrence rate was higher in patients with squamous cell carcinoma (SCC) than in those with adenocarcinoma (AC) (p = 0.004). Disease-free survival (DFS) was shorter in SCC (p = 0.004). According to histopathological subtypes, the presence of lymphovascular invasion (LVI), vascular invasion (VI), visceral pleural invasion (VPI) and tumor spread through air spaces (STAS) caused an increased risk of recurrence ((p = 0.004), (p = 0.001), (p = 0.047), (p = < 0.001)) and shorter DFS ((p = 0.002), (p = < 0.001), (p = 0.038), (p = < 0.001)). LVI and VI was more common in patients with distant recurrence (p = 0.020, p = 0.002), while the STAS was more common with locoregional recurrence (p = 0.003). CONCLUSION: The presence of LVI, VI, VPI, and STAS are negative risk factors for recurrence and DFS in all patients and in patients with AC. In patients with SCC, the diagnosis of SCC itself and the presence of STAS were risk factors for recurrence and DFS. Moreover, the risk of distant recurrence is higher in the presence of LVI or VI, and the risk of locoregional recurrence in the presence of STAS is higher.

Diagnostic efficacy of intraoperative histopathological examination of lesions with unknown diagnosis suspicious for malignancy.

Objective: In this study, the efficiency of intraoperative histopathological examination (frozen section examination; FS) in patients operated per suspected lung malignancy was evaluated. Methods: The data of 136 patients who underwent surgery in our clinic due to suspected lung malignancy between January 2020 and June 2021 was evaluated prospectively. Results: The FS was inconclusive in 7.3 % of the 136 patients. In contrast, the accuracy of differentiating between benign and malignant lesions was 99.2 %, while the rate of false negative was 0.8 % in 126 patients with a prediagnosis. FS examination led to an accurate diagnosis in 91.9 % of the 98 patients without a history of extrapulmonary malignancy (EPM), with a false negativity rate of 1 %, whereas a paraffin-embedded examination was recommended in 7.1 %. The accuracy of the FS was 98.9 % in 91 patients prediagnosed based on an FS, with a false negativity rate of 1.1 %. In the same group of patients, the FS examination was successful in establishing the subtype in 32.9 % of the patients with primary lung cancer (PLC), whereas the efficacy of the FS examination in determining the subtype was better in benign diseases (63.6 % vs 32.9 %, p = 0.009). The FS examination was unable to differentiate between benign and malignant lesions in 92.1 % of patients with EPM but differentiated between primary and metastatic lesions in 48.3 % of patients who had malignancy. Furthermore, FS examination successfully guided surgery in 89 patients with no history of EPM (90.8 %) and 20 patients (52.6 %) with a history of EPM. Conclusion: Although FS is insufficient in subtyping lung cancers and distinguishing PLC and metastasis, it is an important and effective diagnostic approach with its overall ability to distinguish benign and malignant lesions and guiding surgical procedures.

Survival of pleurectomy-decortication and hyperthermic chemotherapy in mesothelioma.

Background: This study aims to evaluate overall survival, diseasefree survival, and prognostic factors in patients undergoing pleurectomy-decortication and hyperthermic intrathoracic chemotherapy with the diagnosis of malignant pleural mesothelioma. Methods: Between January 2020 and November 2021, a total of 53 patients (27 males, 26 females; mean age: 58.1±1.3 years; range, 39 to 81 years) who underwent pleurectomy-decortication and hyperthermic intrathoracic chemotherapy with the diagnosis of malignant pleural mesothelioma were retrospectively analyzed. Data including characteristics, comorbidities, postoperative complications, recurrence and mortality status of the patients were recorded. Overall survival and disease-free survival and prognostic factors were evaluated. Results: The median disease-free survival was 11.67 months and the median overall survival was 24.60 months. The median disease-free survival was 8.80 months in men and 13.17 months in women, indicating a statistically significant difference as it showed that recurrence was detected earlier in male patients (p=0.037). The median disease-free survival and overall survival was 6.13 months and 11.70 in cases diagnosed with biphasic mesothelioma, respectively, while it was 11.67 months and 25.46 months in cases with epithelial mesothelioma, respectively. Pathological subtype was found to be an effective prognostic factor for both survival (p=0.049 and p<0.001, respectively). Conclusion: Hyperthermic intrathoracic chemotherapy following cytoreductive surgery is a preferable and tolerable method in the treatment of malignant pleural mesothelioma. While evaluating surgical indications, it should be kept in mind that cases with epithelial mesothelioma may benefit more from surgical treatment.

The significance of immunonutrition nutritional support in patients undergoing postoperative adjuvant chemotherapy for lung cancer: case-control study.

BACKGROUND: In this study, the effect of postoperative early nutritional supplementation on the course of the disease was investigated in patients who were operated for non-small cell lung cancer and received adjuvant chemotherapy. METHODS: The study examined the data of patients who anatomical pulmonary resection for non-small cell lung cancer and who were treated with adjuvant chemotherapy at our clinic between January 2014 and January 2020. Patients who received early postoperative nutritional supplements and those who continued with a normal diet were compared in terms of complications, mortality, recurrence, and survival. RESULTS: The study sample consisted of 68 (84%) male and 13 (16%) female patients, and the mean duration of postoperative follow-up was 31.6 ± 17.9 (4-75) months. Metastasis was identified in eight (17.4%) patients in GrupNS (Nutritional Supplements) compared to 10 (28.6%) patients in GroupC (Control) (p = 0.231). Of the total, 11 (23.9%) patients died in GroupNS compared to 13 (37.1%) in GroupC (p = 0.196). Mean survival was 58.9 ± 3.8 (95% CI: 4.0-75.0) months in GroupNS compared to 43.5 ± 4.6 (95% CI: 6.0-66.0) months in GroupC (p = 0.045). CONCLUSION: Early nutritional supplements should be considered as having a positive effect especially on survival in this specific patient group involving factors with high catabolic effects, such as neoplasia, operation, and chemotherapy together.

The Importance of tumor markers in patients undergoing resection for lung metastasis of colorectal carcinoma.

OBJECTIVES: In patients with suitable conditions, complete resection is a potential curative treatment for lung metastases of colorectal cancers (CRC). Various prognostic factors affecting survival have been reported in these patients. In our study, the prognostic significance of CEA and CA19-9 tumor markers in patients who underwent lung resection for CRC metastasis was researched. METHODS: Fifty-three patients who underwent lung resection for CRC metastasis between January 2015 and July 2021 were included in the study. The relationship between preoperative and postoperative CEA and CA19-9 values, survival times, tumor size, and preoperative CEA and CA19-9 levels were investigated. RESULTS: Patients with high preoperative and postoperative CEA had shorter survival (OS) compared with patients with lower values (p ≤ 0.001 and p = 0.009, respectively). Disease-free survival (DFS) was also shorter in patients with higher preoperative CEA values (p = 0.008). For patients with higher preoperative and postoperative CA 19-9 values, OS and DFS were shorter (p = 0.013 and p ≤ 0.001) and (p = 0.042 and p ≤ 0.001), respectively. There was a weak positive correlation between preoperative CEA value and tumor size (p = 0.008, Pearson correlation coefficient = 0.360). However, a strong positive correlation between preoperative CA19-9 value and tumor size was discovered (p ≤ 0.001, Pearson correlation coefficient = 0.603). CONCLUSION: In our study, it was shown that preoperative-postoperative CEA and CA19-9 levels in patients with metastatic colon carcinoma are associated with overall survival.

Relationship between survival and erythrocyte sedimentation rate in patients operated for lung cancer.

Background: This study aims to investigate the relationship between preoperative erythrocyte sedimentation rate and survival in patients undergoing pulmonary resection due to lung cancer. Methods: Between January 2011 and July 2017, a total of 575 patients (433 males, 142 females; mean age: 61.2±9.9 years; range, 29 to 82 years) who were operated due to primary lung cancer in our clinic were retrospectively analyzed. The patients were grouped according to erythrocyte sedimentation rate to analyze the relationship between erythrocyte sedimentation rate and survival. Results: The mean overall survival time was 61.8±1.7 months in 393 patients with an erythrocyte sedimentation rate of ≤24 mm/h and 48.9±2.9 months in 182 patients with an erythrocyte sedimentation rate of ≥25 mm/h (p<0.001). Among the patients with Stage 1-2 disease, the mean survival time was 66.2±1.9 in patients with an erythrocyte sedimentation rate of ≤24 mm/h and 53.8±3.2 in patients with an erythrocyte sedimentation rate of ≥25 mm/h (p=0.008). The mean survival time in patients with adenocarcinoma was 62.4±2.4 months in patients with ≤24 mm/h erythrocyte sedimentation rate and 46.1±4.6 months in patients with ≥25 mm/h erythrocyte sedimentation rate (p=0.003). Conclusion: The relationship between elevated erythrocyte sedimentation rate and poor prognosis in patients with the same stage of the disease is promising for the use of erythrocyte sedimentation rate as a prognostic marker.

Evaluation of the relationship between the eighth edition of TNM staging, the mMasoaka, and World Health Organization histopathological classification for thymoma.

Aim of Study: The aim of this study was to describe the correlation between the eighth tumor, node, and metastasis (TNM), mMasaoka staging, and the World Health Organization (WHO) histopathologic classification and to identify prognostic values in predicting survival and recurrence of thymoma. Materials and Methods: Medical files of 90 patients with thymoma diagnosed between 1992 and 2018 were evaluated for this trial. Results: The distributions of patients were similar between mMasaoka and eighth TNM staging according to early (I, II) and advanced stages (IIIA, IIIB, IV). Interestingly, 55 of 63 stage I patients with TNM staging showed difference as 31 of them up-staged to stage IIA and 24 of them up-staged to stage IIB in mMasoaka staging. Both staging systems closely correlated with WHO classification (p < 0.001); stages I and II were associated with low-risk groups (type A, AB, B1), and stages III and IV were associated with high-risk groups (type B2, B3). WHO classification was not a prognostic factor for overall survival (OS) (P = 0.13) and progression-free survival (PFS) (p = 0.08), but it was a prognostic factor for 10-year cancer-specific survival (CSS) (p = 0.04). Myasthenia gravis was associated to early stages (stage I, II) (p = 0.007) and related with better prognosis. Conclusions: Our study showed a correlation between both staging system and WHO classification. A certain difference was found between eighth TNM staging and the mMasoaka staging in terms of stage I disease. Both staging systems effectively prognosticated OS, CSS, and PFS. To clarify the prognostic relevance and clinical usefulness of the WHO classification may be beneficial in clinical practice for the treatment decision.

Long-Term Outcomes and Course of Compensatory Sweating after Endoscopic Sympathicotomy.

BACKGROUND: Endoscopic thoracic sympathicotomy is an effective approach to the treatment of idiopathic localized hyperhidrosis, and compensatory sweating is the main reason for patient dissatisfaction. Our study discusses both the long-term outcomes of sympathicotomy and the course of compensatory sweating. METHODS: Patients with palmar and/or axillary hyperhidrosis who were operated by the same surgical team between January 2008 and December 2014 were included in the study. After at least 5 years (60 months) from operation, patients were questioned about their treatment outcomes by using an original survey form. RESULTS: Of the 137 patients included in the study, 88 (64.2%) were female and 49 (35.8%) were male. The mean time from the operation to the survey interview was 80.9 ± 14.1 (64-136) months. After operation, complaints disappeared in 95.1% of the patients, and decreased in 4.9% with palmar hyperhidrosis. Complaints completely disappeared in 12.9% and decreased in 81.7% of the patients with axillary hyperhidrosis. Ninety-seven (70.8%) of the patients described increased sweating in some parts of their body after operation but only 47 reached an uncomfortable intensity. The number of patients who regretted the operation due to the compensatory sweating was 13 (9.5%). The patients' overall scoring of the operation and procedure was calculated as 8.0 ± 2.1 (0-10 points) out of 10. CONCLUSION: Endoscopic thoracic sympathicotomy's long-term outcomes are also satisfactory in the treatment of palmar and axillary hyperhidrosis. Compensatory sweating may decrease over time, only a minority of patients will express regret at undergoing the treatment.

Association of Daily Step Count with the Prolonged Air Leak in Thoracic Surgery Patients.

BACKGROUND: In thoracic surgery clinics, patients are encouraged to walk; however, to our knowledge, there is no data regarding the minimum step count necessary to protect them from complications. In our study, we aim to ascertain the relationship between walking and prolonged air leak (PAL), which is one of the most common complications following thoracic surgery. METHODS: Patients, who were being followed-up at our clinic between December 2016 and July 2017, were separated into three groups and were investigated prospectively. The groups were established as follows: Group I, included patients with spontaneous pneumothorax; Group II, comprised patients who were applied sublobar lung resection; and Group III, comprised (pneumonectomy excluded) patients who were applied anatomic lung resection. All the patients were supplied with a standard pedometer. The step counts of the patients were recorded prospectively, beginning from the first postoperative day, and an attempt was made to establish the relationship between the patients' daily and mean step counts and the development of PAL. RESULTS: PAL developed in 11 (39.29%) of the 28 patients in Group I; in 1 (2.04%) of the 49 patients in Group II and in 22 (36.07%) of the 61 patients in Group III. When receiver operating characteristic (ROC) analysis was applied to the data of Group I, and when the cut-off value for the first-day step count was confirmed to be 2,513 steps, it was revealed that the development of PAL could be determined with a sensitivity of 100% and a specificity of 100%. The analysis of the patients in Group III revealed significant correlations between the first-day and second-day step counts, and the development of PAL (p = 0.017 and 0.007, respectively). The development of PAL decreased as walking was maximized. CONCLUSION: Early and sufficient mobilization decreases the likelihood of postoperative complications. Our study defines concepts, such as post-operative daily step count, target step count, and step count protecting from PAL, and in this regard, we consider it to be a primary study in the literature.

Assessment of Cardiac Complications in Patients Undergoing Pulmonary Resection.

BACKGROUND: Patients who underwent lung resection in our clinic were retrospectively investigated in terms of development of postoperative cardiac complications. METHODS: The file records of 207 patients who underwent lung resection between the years 2010 and 2014 were reviewed. One hundred and eighteeen (118) (57%) of the patients were evaluated by the preoperative cardiologist and the risk level of the patients was determined according to the Lee index. Postoperative cardiac complication relation was compared with each parameter. RESULTS: The difference between the mean age of the patients with and without complication was statistically significant (p=0.024). When the patients were grouped as over and under 65 years old, the risk of developing postoperative complications was higher and statistically significant (p=0.015) in patients over 65 years of age. When the patients were evaluated in line with the presence of additional disease, smoking and electrocardiogram (ECG) findings, patients with hypertension developed more complications than those without hypertension (p=0.002). When the logistic regression was adjusted according to age and sex, the development of cardiac complications in patients with hypertension was 3.25 times greater. CONCLUSIONS: It should be kept in mind that the presence of hypertension in patients who will undergo lung resection and advanced age increases the risk of cardiac complications and that preoperative cardiology care may be appropriate for these patients.

Quantitative measurement of air leak in patients with chest drains.

BACKGROUND: This study aims to evaluate a new method that detects peak air leak speed and peak air leak flow, investigate the correlation between the amount of air leak and development of prolonged air leak, and identify patients who are at risk of developing prolonged air leak after lung resection. METHODS: In this prospective trial, the amount of air leak was measured with the assistance of an anemometer connected to the top of a standard underwater drainage system, and a mobile phone with android operating system. Patients who underwent tube thoracostomy for spontaneous pneumothorax were assigned to group 1 (18 males, 1 female; mean age 31.6±10.9 years; range, 18 to 70 years), whereas patients who underwent lung resection for benign or malignant lung diseases were assigned to group 2 (37 males; 16 females; mean age 56.9±15.6 years; range, 18 to 80 years). The receiver operating characteristics analysis was performed for the statistical analysis of the data. RESULTS: Prolonged air leak was observed in five patients (26.3%) in group 1 and in six patients (11.3%) in group 2. In group 1, first measurement on postoperative day zero could detect prolonged air leak development with 100% sensitivity and 92.9% specificity. Similarly, in group 2, measurements on day zero could detect prolonged air leak development with 100% sensitivity and 87.2% specificity. CONCLUSION: Compared to similar products, this newly developed measuring device may be widely used in clinics with its low cost and ease of use. Measured peak air leak flow values can predict patients who may develop prolonged air leak. Patent work for the device is ongoing.

A pathology not be overlooked in blunt chest trauma: Analysis of 181 patients with bilateral pneumothorax.

BACKGROUND: Bilateral pneumothorax (BPTx) can become tension PTx and a cause of mortality, especially in severe multi-trauma patients. The purpose of this study was to analyze the incidence, morbidity, mortality, and associated factors of BPTx in multi-trauma patients in order to highlight the importance of the management of these cases, as well as complications, morbidity, and mortality. METHODS: The data of 181 patients with BPTx, from a total of 3782 trauma patients, were reviewed retrospectively. The details recorded were age, gender, mechanism of trauma, radiological findings, co-existing thoracic and extra-thoracic injuries, incidence of intubation, mortality, and injury severity score (ISS). The association between laterality of rib fracture, hemothorax, subcutaneous emphysema, and BPTx, and the effect of age and gender on these injuries, mortality, and ISS were analyzed. RESULTS: The patient group included 144 males, and the mean age was 36.07±15.77 years. The primary cause of trauma was a motor vehicle accident, seen in 67 (37.0%) patients. Bilateral rib fractures were detected in 75 (41.4%) patients. Hemothorax accompanied PTx in 41 (22.6%) patients bilaterally. The laterality of the rib fracture and hemothorax demonstrated a significant difference in the patient group over 60 years of age (p=0.017, p=0.005). Co-existing bilateral thoracic injuries were detected more often in this group. Twelve (17.6%) patients with only blunt chest trauma and 56 (82.4%) patients with multi-trauma were intubated. The difference between the 2 groups was not significant (p=0.532). The overall mortality rate was 18.2%. A comparison of ISS and mortality between the groups revealed no significant difference (p=0.22). CONCLUSION: The incidence of BPTx after multi-trauma is approximately 5%, so it must be taken into consideration, especially in severe multi-trauma patients, to reduce mortality. Older age and the number of rib fractures were determined to be risk factors for morbidity and mortality in trauma with BPTx.

Diagnostic value of 18F-FDG-PET/CT in benign lung diseases.

INTRODUCTION: There are many diseases which, despite not being malignant, show high metabolic activity and cause false-positive results. AIM: To evaluate the results of positron emission tomography (PET) in patients who underwent resection after preliminary diagnosis of malignancy based on fluorodeoxyglucose (FDG) uptake value, in whom the lesions were later classified as pathologically benign. MATERIAL AND METHODS: The analysis included the records of 106 (12.3%) patients out of 862 patients who underwent surgery between January 2012 and December 2015 after being initially diagnosed with malignant lung lesions based on PETCT results, in whom the lesions were later classified as pathologically benign. Diagnoses, PET findings, types of surgery, and demographic data of the patients were recorded. RESULTS: The mean age of the patients was 55.5 (26-79) years. The mean diameter and SUVmax of the lesions were 2 ±2.14 (0.5-13) and 3.55 ±4.35 (0-22.2) cm, respectively. The pathology results were analyzed in five different groups. The SUVmax in the hamartoma group was significantly lower than in the other groups (p < 0.001), while the SUVmax in the granulomatous disease group was significantly higher than in the other groups (p < 0.001). CONCLUSIONS: The possibility of false positive PET results must be kept in mind when diagnosing and treating lung cancer. In particular, in the case of suspected granulomatous disease, all available pre- and intraoperative diagnostic procedures must be used.

A rare tumor metastasis of bilateral lung: Epithelioid trophoblastic tumor.

A 44-year-old female patient with a history of a gestational trophoblastic tumor surgery was referred to our clinic upon detection of cystic-cavitary lesion showing slow progression in both lungs. It was decided to perform bilateral surgery in the patient for diagnosis and treatment purposes; first, left upper lobectomy and one month later, right lower lobectomy were applied. Histopathological examination results of the specimens obtained during both operations reported an "epithelioid trophoblastic tumor" metastasis. Aspergilloma was also noted in the tumor in left upper lobe at the same time. Epithelioid trophoblastic tumors, a very rare member of gestational trophoblastic tumors, can achieve distant organ metastasis. Surgical treatment remains important in these cases, which are mostly resistant to chemotherapy.

Is the Risk of Postoperative Atrial Fibrillation Predictable in Patients Undergoing Surgery Due to Primary Lung Cancer?

BACKGROUND: Atrial fibrillation (AF) is a type of cardiac arrhythmia which is commonly seen following lung resection. There is currently no algorithm which can predict which patients will develop postoperative AF (PAF). The present study aims to identify the risk factors for the development of PAF and high-risk patients with PAF along with multiple risk factors. MATERIALS AND METHODS: A total of 887 patients, who underwent lung resection due to primary lung malignancy at our clinic between January 2000 and December 2016, were retrospectively analysed. Group 1 (n=44) consisted of the patients who developed PAF and Group 2 (n=843) consisted of the patients without PAF. Age and sex of the patients, comorbidities, previous diagnosis of malignancy, and surgery-related variables were evaluated using statistical methods for their effects on the development of AF. A score was assigned to each identified risk factor and scores of the patients were calculated. The risk of developing PAF was evaluated based on this scoring system. RESULTS: We found that ≥60 years of age and the diagnosis of chronic obstructive pulmonary disease (COPD) were significant risk factors for the development of PAF (p<0.05). The risk of developing PAF was not associated with male sex, previous history of malignancy, presence of comorbidities, and the type of surgery applied. There was an increased risk of AF with increasing scores in the risk calculation system. CONCLUSION: Advanced age and the presence of COPD were found to be associated with an increased risk of developing PAF. In addition we found a significant increase in the risk of developing PAF in the presence of multiple factors, although they did not reach statistical significance alone.

Analysis of the patients with simultaneous bilateral spontaneous pneumothorax.

BACKGROUND: Simultaneous bilateral spontaneous pneumothorax (SBSP) is an uncommon condition with limited data on its incidence in the literature. In this study, we aimed to describe the bilaterality in both primary and secondary spontaneous pneumothorax cases, and the clinical approach in simultaneous disease and prognosis of these patients. METHODS: A total of 16 patients who were followed with the diagnosis of bilateral spontaneous pneumothorax between January 2005 and January 2017 were retrospectively analyzed. The patients were divided into two groups: secondary spontaneous pneumothorax (SSP; Group 1, n = 11) and primary spontaneous pneumothorax (PSP; Group 2, n = 5). Demographic data, underlying lung pathologies, treatments applied, clinical findings and survival data were recorded. RESULTS: Of the patients in Group 1, four (36.3%) had chronic obstructive pulmonary disease (COPD), three (27.3%) had granulomatous lung disease, two (18.2%) had idiopathic pulmonary fibrosis, one (9.1%) had bronchiectasis and one (9.1%) had hypersensitivity reaction. Of these patients, four had bilateral tube thoracostomy, four had unilateral tube thoracostomy and the remaining three received medical treatment under follow-up. Of the Group 1 patients, six (54.6%) died during the 72-month follow-up period, while only one of these patients had COPD. All patients in Group 2 were treated using bilateral video-assisted thoracoscopic surgery either in the first or the second episode. CONCLUSIONS: These results suggest that simultaneous and bilateral occurrence of SPP is an indicator of an advanced lung pathology with a poor prognosis.

Psychiatric assessments in patients operated on due to lung cancer.

Background This study was undertaken to determine the relationship between preoperative and postoperative psychiatric status and postoperative complications in patients operated on due to lung cancer. Methods We prospectively enrolled 25 patients undergoing surgery with a diagnosis of lung cancer. There were 17 (68%) males, 8 (32%) females, and the mean age was 61 ± 8.9 years (range 38-81 years). Their psychiatric status was assessed using the Experiences in Close Relationships Scale II, European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30, Perceived Family Support Scale, the combined Stress Thermometer and Hospital Anxiety Depression Scale, in the preoperative period, and the Perceived Family Support, Stress Thermometer, and European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 at 1 month postoperatively. Results We found that 44% of patients had depression and 28% had anxiety. There was no difference between sexes in terms of anxiety ( p = 0.088), but more women had depression ( p = 0.03). Postoperative complications occurred in 5 of 18 patients with negligible anxiety scores (27.8%) and 3 (42.9%) of 7 patients with high scores, as well as 3 (21.4%) patients with negligible depression scores and 5 (45.5%) of 11 patients with high scores. Conclusions Patients selected for lung cancer surgery should be assessed preoperatively using the Hospital Anxiety-Depression Scale and Stress Thermometer. Psychosocial support is recommended to improve their quality of life and reduce postoperative complications.