Factors associated with pulmonary recurrence after pulmonary metastasectomy for sarcomatous disease.

PURPOSE: To analyze the factors associated with survival and pulmonary recurrence after complete metastasectomy for patients with sarcomatous disease. METHODS: Among the 51 patients who underwent complete pulmonary metastasectomy at our hospital between January 2002 and November 2010, 30 (58.8 %) suffered pulmonary recurrence in an ipsilateral hemithorax. We analyzed the factors affecting survival and recurrence after complete metastasectomy. RESULTS: The 51 patients who underwent pulmonary metastasectomy comprised 33 male and 18 female patients, with a median age of 22 years (range 11-61 years). The median survival was 24 months. Multivariate analysis revealed recurrence (p = 0.016) and the type of tumor (p = 0.024) as independent predictors of survival. Recurrence developed in 30 (58.8 %) patients. The risk of recurrence was higher in patients with a DFI <12 months and >1 metastasis resected during the initial metastasectomy. CONCLUSIONS: Based on the findings of our analysis, patients with a DFI <12 months and >1 metastases resected during initial surgery have a higher risk of recurrence. We recommend postoperative follow-up at frequent intervals and reconsideration of oncological treatment after complete resection.

Utilizing the lymphocyte-monocyte ratio in predicting the recurrence of spontaneous pneumothorax.

OBJECTIVE: Lymphocyte-to-monocyte ratio (LMR) has been introduced as a predictor and a prognostic factor for multiple diseases. This study aimed to determine the efficiency of LMR in predicting the recurrence of spontaneous pneumothorax. MATERIALS AND METHODS: A total of 374 patients who had received chest tubes at the first episode of primary spontaneous pneumothorax were examined in terms of age, gender, side of the pneumothorax, status of recurrence, LMRs at the time of admittance and recurrence, and the interval until the recurrence. RESULTS: Recurrence was diagnosed in 106 (28.3%) patients, whereas the mean time until the recurrence was 15.32 ± 5.57 months. Significantly, the recurrence rate was higher, while the time until the relapse was shorter for patients with elevated levels of LMR. Moreover, LMR counting over 1.25 demonstrated a 70.8% sensitivity and a 94.4% specificity in predicting a potential recurrence. CONCLUSIONS: Calculation of LMR at the first episode of spontaneous pneumothorax contributes to predict a potential recurrence when combined with traditional risk factors.

OBJETIVOS: La proporción de linfocitos a monocitos (PLM) se ha introducido como un predictor y un factor pronóstico para múltiples enfermedades. Este estudio tuvo como objetivo determinar la eficiencia de LMR en la predicción de la recurrencia del neumotórax espontáneo. MATERIALES Y MÉTODOS: Un total de 374 pacientes que habían recibido tubos de tórax en el primer episodio de neumotórax espontáneo primario fueron examinados en términos de edad, género, lado del neumotórax, estado de recurrencia, PLM al momento del ingreso y recurrencia, y el intervalo hasta la recurrencia. RESULTADOS: Se diagnosticó recidiva en 106 (28.3%) pacientes, siendo el tiempo medio hasta la recidiva de 15.32 ± 5.57 meses. Significativamente, la tasa de recurrencia fue mayor, mientras que el tiempo hasta la recaída fue más corto para los pacientes con niveles elevados de PLM. Además, el recuento de PLM superior a 1.25 demostró una sensibilidad del 70.8 % y una especificidad del 94.4 % para predecir una posible recurrencia. CONCLUSIÓN: Calcular la PLM en el primer episodio de neumotórax espontáneo predice una posible recurrencia cuando se combina con los factores de riesgo tradicionales.

Efficacy of preoperative white blood cell count and lymphocyte/monocyte ratio in predicting post-lobectomy pneumonia.

BACKGROUND: This study aims to examine preoperative white blood cell count and lymphocyte/monocyte ratio and to investigate foreknown risk factors for pneumonia following lobectomy. METHODS: Between January 2005 and May 2018, a total of 152 patients (135 males, 17 females; mean age: 61.9±7.5 years; range, 45 to 73 years) who underwent right lower lobectomy for non-small cell lung cancer were retrospectively analyzed. Data including age, sex, preoperative white blood cell count and lymphocyte/monocyte ratio, smoking, preexisting chronic diseases, body mass index, stage of lung cancer, the use of neoadjuvant chemotherapy, type of surgery, operation duration, blood transfusion, and postoperative intensive care unit admission were recorded. RESULTS: Twenty-five (16.4%) patients developed postoperative pneumonia. Older patients presenting with elevated levels of preoperative white blood cell count and lymphocyte/monocyte ratio, excessive tobacco consumption, prolonged operation duration, history of a chronic disease, a body mass index over 30 kg/m2, advanced lung cancer, neoadjuvant chemotherapy, and intensive care unit admission after surgery were at high risk for postoperative pneumonia. There was no significant difference in sex, type of surgery (thoracotomy versus thoracoscopy), and the use of blood products. In predicting the development of postoperative pneumonia, lymphocyte/monocyte ratio had 85.% sensitivity and 87.5% specificity, while white blood cell count had 72.5% sensitivity and 77.5% specificity. CONCLUSION: Preoperative white blood cell count and lymphocyte/ monocyte ratio provide supporting evidence in predicting pneumonia following lobectomy contributing to the existing risk identification criteria.

Factors Affecting Long-Term Survival Following Pulmonary Metastasectomy of Renal Cell Carcinoma.

PURPOSE: Role of pulmonary metastasectomy of renal cell carcinoma (RCC) is significant considering its contribution to survival rates. The aim of this study is to present the prognostic factors affecting the surgical outcomes and long-term survival. MATERIALS AND METHODS: Forty-eight patients who had undergone pulmonary metastasectomy of RCC between 2000 and 2018 were analyzed in terms of gender, age, subtypes and pathological T stages of RCC, side and size of pulmonary metastases, disease-free interval (DFI) and type of lung resections in order to reveal the prognostic factors from the stand point of selecting suitable patients for lung metastasectomy. RESULTS: Overall survival was 56.2 ±21.7 months. Survival time was less than 3 years for 7 (14.6%) , between 3 and 5 years for 11 (22.9%) and more than 5 years for 30 (62.5%) patients.  Young age, female gender, unilateral pulmonary lesions,  longer DFI, lung metastases limited in number and volume were statistically significant for better survival rates (P <.05) whereas subtypes and pathological stage of the primary tumor or the type of pulmonary metastasectomy did not act on the outcomes (P >.05). CONCLUSION: The most distinctive factor affecting the surgical outcomes is the complete resection of lung metastases rather than the extent of the surgery. This study clearly states that patients aged under 50 years with unilateral lung metastases counting less than 3 and measuring smaller than 4 cm3  and also DFI lasting longer than 32 months  benefit from pulmonary metastasectomy of RCC.

Efficiency of Lymphocyte-to-Monocyte Ratio in Differential Diagnosis of Parapneumonic Effusion and Thoracic Empyema.

Background: Parapneumonic effusion (PPE) and thoracic empyema (TE) necessitate prompt differential diagnosis regarding their unequal rates of mortality and disparate methods of treatment. Patients and Methods: A total of 80 patients with equally divided between the PPE and TE groups were evaluated in terms of age, gender, side of the affected hemithorax, and peripheral blood counts including white blood cell (WBC) count, C-reactive protein (CRP), lymphocyte, monocyte, and lymphocyte-to-monocyte ratio (LMR). Results: The difference between the two groups in terms of age, gender, side of the disease, and monocyte count was not statistically significant (p > 0.05) whereas WBC count, lymphocyte, and LMR was significantly higher in the TE group (p < 0.05). Lymphocyte-to-monocyte ratio over 2.45 was a differential diagnostic test of PPE and TE at 85% sensitivity and 87.5% specificity. Conclusions: Lymphocyte-to-monocyte ratio is an effective indicator to finalize the differential diagnosis of PPE and TE when combined with high levels of serum WBC, CRP, and lymphocytes in addition to clinical and radiologic findings.

Successful treatment of a combined bronchial and aortic trauma.

Tracheobronchial injury is an uncommon but severe complication of blunt thoracic trauma. In this study, we present a patient who developed complete avulsion of the left main bronchus with a vertical rupture toward the carina accompanying a contained rupture of the descending aorta after being run over by a van. We performed a left upper lobectomy and reimplantation of the lower lobe to the left main bronchus. Subsequently, an endovascular stent was placed to cover the pseudoaneurysm. The patient was discharged on day nine after an uneventful postoperative course. Tracheobronchial trauma complicated with concomitant major injuries apparently requires a rapid and challenging multidisciplinary approach in a well-developed and experienced trauma centre for a successful treatment.

F-18 fluorodeoxyglucose positron emission computed tomography in the diagnosis of pleural metastases from breast carcinoma

Background: This study aimed to investigate the feasibility of F-18 fluorodeoxyglucose (FDG) positron emission computed tomography (PET/CT) in identifying the pleural invasion of metastatic breast cancers.Methods: A retrospective study was conducted to include 75 patients with untreated breast cancer who had undergone thoracoscopy to drain pleural effusions and to perform pleural biopsies. Whole group of patients were evaluated in terms of age, type of primary breast cancer, macroscopic appearance of pleura during thoracoscopy, maximum standardized FDG uptake value (SUV) reported by PET/CT scan in addition to presence of malignancy detected in pleura and/or pleural effusion.Results: All of 75 patients were female and mean age was 56.12±11.70. Metastatic disease was diagnosed in the pleura of 40 (53.3%) and in the pleural effusion of 43 (57.3%) patients. The sensitivity and specificity of PET/CT in detecting pleural metastases of breast carcinoma was calculated as 88.2% and 96.2% whereas PET/CT demonstrated sensitivity of 91.9% and specificity of 91.3% in identifying malignant pleural effusion. Cut-off values of FDG uptake were 4.25 for pleural metastases and 3.85 for malignant pleural effusions. PET/CT also indicated a false negative rate of 12.5%, a false positive rate of 16.28% and an overall accuracy rate of 85.33% in the diagnosis of pleural metastasis of breast carcinoma.Conclusions: PET/CT reporting an FDG uptake over 4 in the pleura or pleural effusion is beneficial in managing the patients with the suspicion of pleural metastases from breast cancer.

Efficacy of homologous fibrin sealant in the surgery for pneumothorax

Background: Prolonged air leakage following pneumothorax surgery is a significant issue causing increased hospital stay and morbidity. This study aimed to investigate the cost and efficacy of homologous fibrin sealant in preventing the air leakages.Methods: Among the patients who had undergone bullectomy and subtotal parietal pleurectomy for recurrent primary spontaneous pneumothorax via transaxillary mini thoracotomy between 2010 and 2018, two groups each including 35 cases were conducted as to whether fibrin sealent had been applied. These two patient groups were compared in terms of age, gender, duration of air leakage and cost.Results: Mean age of whole group of patients including 59 males and 11 females was 21.5 years. Mean values of air leakage duration and cost of hospital stay was calculated as 1.94 days and 2777 TL for sealant applied group and 2.97 days and 1200 TL for sealent unapplied group, respectively. The patient groups did not indicate a statistically difference in terms of age and gender whereas duration of air leakage was shorter but cost was higher in the group for whom fibrin sealant had been administered (p<0.001). None of the patients developed mortality but recurrence was present in 4 (5.7%) patients.Conclusions: Although homologous fibrin sealant applied in pneumothorax surgery results in cost increase, it contributes to surgical outcomes by preventing possible additional complications in consideration of shortened duration of air leakage.

Is the recurrence of primary spontaneous pneumothorax predictable?

Background: Recurrence of Primary Spontaneous Pneumothorax (PSP) constitutes a serious challenge for both physicians and patients.Methods: A retrospective study was conducted in 115 patients who had chest tubes at their first onset of PSP. Considering the development of recurrence, two groups were composed and comparatively examined in terms of age, body mass index, smoking status, side and size of initial pneumothorax, presence of bulla and duration of chest tube drainage at the first episode.Results: Among 115 patients with PSP, 24 cases developed recurrence. Male gender was prominently relevant to develop recurrent PSP (p=0.034) whereas remaining inspected parameters revealed no significant relationship with a relapse. Interval between first onset and recurrence of PSP was calculated as 9.2 months. Interestingly, most of the patients developed recurrence in low-temperature months.Conclusions: Recurrence of PSP is substantially unpredictable. Therefore, close follow-up of cases in the following year of their first episode and also informing the patients about probability of a relapse and measures to consider under this circumstance is of great importance.