Semih Halezeroglu

Streptokinase for malignant pleural effusions: a randomized controlled study.

Effective palliative treatment in malignant pleural effusion can only be carried out when the lung is fully expanded after drainage of effusion. We investigated the efficacy of intrapleural fibrinolytics for lysing fibrin deposits and improving lung reexpansion in patients with malignant pleural effusion. We randomly allocated 47 patients with malignant pleural effusion into 2 groups: a fibrinolytic group of 24 were given 3 cycles of 250,000 U intrapleural streptokinase; the control group of 23 received pleural drainage only. Pleurodesis with 5 mg of talc slurry was performed in all patients who had lung reexpansion after drainage. Patient characteristics, pleural drainage, lung expansion assessed by chest radiography, and pleurodesis outcomes were compared between the 2 groups. Patient characteristics were similar in both groups. Lung reexpansion was adequate for performing talc pleurodesis in 96% of patients in the fibrinolytic group and 74% in the control group. In the fibrinolytic group, the mean volume of daily pleural drainage before streptokinase administration was 425 mL, and it increased significantly to 737 mL after streptokinase infusion. Intrapleural administration of streptokinase is advisable for patients with malignant pleural effusion.

Prophylactic intraoperative pneumoperitoneum decreases pleural space problems after lower lobectomy or bilobectomy of the lung.

BACKGROUND Following lower lung lobe resection, prolonged air leaks and residual pleural space are common. We investigated whether an artificially induced prophylactic intraoperative pneumoperitoneum would prevent these complications. METHOD Sixty patients who underwent lower lobectomy or bilobectomy were prospectively randomized into 2 groups according to the use of intraoperative pneumoperitoneum. Air was delivered via a catheter placed under the diaphragm in the pneumoperitoneum group. Parameters related to pleural drainage, complications, and hospital stay were compared. RESULTS No difference between the preoperative characteristics of both groups was present. The mean duration of chest tube drainage was shorter (3.47 +/- 1.04 days vs. 4.87 +/- 1.43 days, P < 0.001) and the mean amount of chest drainage was lower (305.0 +/- 76.9 ml vs. 488.3 +/- 215.2 ml, P < 0.001) in the pneumoperitoneum group. Residual pleural space was observed in 1 pneumoperitoneum patient (3.3 %) and in 8 controls (26.7 %). Pneumoperitoneum patients were discharged 1.1 days earlier on average than the controls. CONCLUSION Artificial prophylactic intraoperative pneumoperitoneum is a simple and safe procedure that decreases the postoperative amount of fluid drainage, residual pleural space, duration of chest tube drainage, and hospital stay.

Surgical Management for Hydatid Disease

Hydatid disease is caused by the parasite Echinococcus granulosus. The liver and the lungs are common sites. When a cystic lesion is seen on CT scan, diagnosis is made based on the patient having lived in an endemic area. Serologic tests are used for differential diagnosis. Medical treatment is centered on albendazole. Surgery is recommended either by open or endoscopic technique depending on the characteristics of the cysts and the patient. Complications of surgery are rare except for prolonged air leaks. Mortality occurs when the cyst is located in the central nervous system or occludes major vessels.

Management of recurrence after initial surgery for malignant pleural mesothelioma: a mini-review

Recurrence after surgery in the multimodality therapy for malignant pleural mesothelioma is a common problem. As the majority of patients experience not only local but also distant metastases, a systemic treatment strategy in addition to local control measures remains necessary. Nevertheless, none of the chemotherapy regimens have achieved clinical success. Local management modalities such as stereotaxic treatments, cryoablation and redo surgery on the other hand have promising results, but provide palliative outcomes.

Superiority of video-assisted to standard mediastinoscopy in non-small-cell lung cancer staging.

BACKGROUND We compared the efficiency of videomediastinoscopy (VM) and standard mediastinoscopy (SM) in detecting mediastinal lymph node (MLN) metastasis in non-small-cell lung cancer (NSCLC) patients. METHODS By SM method a surgeon sampled bilateral paratracheal and subcarinal lymph node stations and then by VM method, another surgeon resampled all lymph node stations once more through the same incision in the same operative setting. Results of the pathologic examinations of two methods were compared. RESULTS Twenty-seven consecutive mediastinoscopies were included. The numbers of nodal stations biopsied in SM and VM were 97 and 103, respectively. Lymph node metastasis was found in six patients with SM and nine patients with VM. Lymph node dissection by thoracotomy revealed metastases, which were not found by mediastinoscopy, in two patients. Our study showed an accuracy of 92.3% for VM versus 80.7% for SM and corresponding negative predictive values of 88.2% and 75%, respectively (p = 0.002; Fig. 1). CONCLUSION This study showed that VM is superior to SM in detecting MLN metastasis in patients with NSCLC.

Lingual inferior segmentectomy for a 7-cm pulmonary arteriovenous malformation.

Pulmonary arteriovenous malformation (PAVM) is a relatively rare abnormal pulmonary vascular connection that is mostly congenital. We report on a patient who was treated by lingual inferior segmentectomy for a 7-cm PAVM. This particular case emphasized the feasibility of resection of the PAVM by pulmonary segmentectomy regardless of the size of the lesion.

Surgery for “advanced” lung and esophageal cancer: new horizons or false dawn?

Worldwide every 30 seconds somebody dies from lung cancer, and only one out 10 patients survive more than 5 years after diagnosis. Although there have been many scientific advancements in the last 100 years [1], lung cancer remains the primary cause of death in the world, and each year claims more victims than breast and prostate cancer combined. Long term survival in patients with lung cancer is disappointing, and this is not only due to the delayed diagnosis but also to the dismal survival of the 70%–75% inoperable patients. Although advanced lung cancer is considered an inoperable disease, approximately 35% of patients with non-small cell lung cancer (NSCLC) present with “locally” advanced nonmetastatic disease. The same reality is true for advanced esophageal cancer. Does hope for long term survival exist for patients with advanced lung and esophageal cancer? The IV Mediterranean Symposium in Thoracic Oncologic (Figure 1) contributed to clarify at least in part the role of surgery and ancillary therapies for ‘advanced lung’ and esophageal cancer. In this short introduction to the supplement, we have summarized some important issues discussed during the symposium.

Single incision video-assisted thoracic surgery pneumonectomy for centrally located lung cancer

Increasing experience in single-incision video-assisted thoracoscopic (SIVATS) lung resections for lung cancer has made some sophisticated lung resections such as bronchial or vascular sleeve resections, chest wall resections and pneumonectomy possible. There are some case series published in medical literature about the feasibility and safety of multiportal video-assisted thoracic surgery pneumonectomy. However, in this prepubertal period of its evolution the literature data are still immature, and limited only to rare case reports or video presentations for SIVATS pneumonectomy for lung cancer. This article aims to discuss the technique, feasibility and place of SIVATS pneumonectomy in the management of non-small-cell lung cancer.