Bronchopleural Fistula: Causes, Diagnoses and Management

Bronchopleural fistula (BPF) is a pathological communication between the bronchial tree and pleural space. This clinical condition, which has high mortality and morbidity, is one of the major therapeutic challenges for clinicians even today. BPF may result from a lung neoplasm, necrotizing pneumonia, empyema, blunt and penetrating lung injuries, and a complication of surgical procedures. Lung resection is the most common cause of BPF, and this chapter will focus more on this topic. Frequency ranges from 4.5 to 20% after pneumonectomy and from 0.5 to 1% after lobectomy. Several risk factors have been defined in the development of postoperative BPF; preoperative radiotherapy, pulmonary infection, diabetes, right pneumonectomy, a long bronchial stump, residual cancer at the stump (R1 and R2 resection), and the need for postoperative ventilation (especially with high PEEP). BPFs are divided, based on the time elapsed since surgery, into early or late fistula. This grouping is important in management of patient treatment. In early BPF, surgical treatment is generally the preferred treatment modality, whereas in late BPF, conservative approach is preferred. The management of BPF is still one of the most complex challenges encountered by the thoracic surgeons; so prevention is the best way to manage postoperative BPF

The Role of Minimally Invasive Surgery in the Treatment of Lung Cancer

Lobectomy plus regional lymph node dissection remains the gold standard treatment method in early-stage lung cancer. However, with the demonstration of the safety and efficacy of minimally invasive approaches, the expression of surgery in this statement, replaced by thoracoscopic anatomical lung resection. Clinical studies have demonstrated the superiority of VATS in terms of postoperative pain, drainage time, length of hospital stay, and complications, moreover, long-term oncologic results are similar or better than thoracotomy. Therefore, VATS lobectomy is the preferred surgical method in early-stage lung cancer. Different surgical techniques are available in VATS and can be modified according to the surgeon’s personal experience. Uniport can be applied as well as two or three port incisions. In this book section, I plan to focus on VATS lobectomy, technique-related tricks, complication management, and long-term oncologic results in early and locally advanced lung cancer

Minimally Invasive Approaches in the Thoracic Surgery

Minimally invasive techniques in thoracic surgery have made great progress over the past 20 years and are still evolving. Many surgical procedures performed with large thoracotomy incisions in the past can now be performed with much smaller incisions. With many studies, the advantages of minimally invasive surgery have been clearly seen, and thus its use has become widespread worldwide. Today, minimally invasive surgical methods have become the first choice in the diagnosis and treatment of lung, pleural and mediastinal pathologies. Minimally invasive approaches in thoracic surgery include many different techniques and applications. In this chapter, current minimally invasive techniques in thoracic surgery are discussed and important points are emphasized in the light of the current literature

Does age have an impact on lung cancer survival?

OBJECTIVE: Lung cancer is the most diagnosed and the most frequent cause of cancer-related deaths in the world. Nonsmall cell lung cancer (NSCLC) prognosis in younger patients is controversial. In this study, surgical survival of young age group with NSCLC was analyzed retrospectively. MATERIALS AND METHODS: A total of 1043 patients who underwent anatomical lung resection and mediastinal lymph node dissection were analyzed between January 2005 and December 2013. Patients were divided into two groups in terms of age being below 45 years and younger (Group 1) and over 45 years (Group 2). RESULTS: There were 68 patients in Group 1 and 975 patients in Group 2. Male/female rate was 2.4 and 14, respectively (P < 0.001). Adenocarcinoma was more diagnosed in Group 1 (47.1%), and squamous cell carcinoma was more seen in Group 2 (54.7%). The pathological diagnosis was statistically significant (P < 0.001). All groups' median survival time was 51 months, and 5-year survival rate was 47.1%. Group 1 and 2 survival rates were 64 and 48 months, respectively, with Group 1 having significantly better results than Group 2 (P < 0.001). The 5-year survival rate of female patients included in Group 1 was 73%, whereas it was 44.7% in Group 2 (P < 0.001). Age is determined to have remarkable impact on the survival with Cox-regression test (P < 0.001, 95% confidence interval). CONCLUSION: The survival which is significantly better in younger patients may encourage aggressive approaches for these patients. The effect of age on prognosis and survival should be evaluated with multicenter studies

When conservative treatment in trachea laserations?

Introduction: The tracheobronchial injuries are usually fatal and some of the lucky people can reach emergency services without dying in the place of trauma. They can cause severe symptoms which can be lifetreathing. This type of injuries must been taken carefully and need to decide fast what treatment you going to give. Case report: We present a 53 years old patient who has been stabbed during a fight and got his trachea ruptured. His complaints shortness of breath and neck swelling. He can be treated conservatively with bronchoscopic and clinical evaluation. Discussion: Tracheobronchial injuries are life-threatening and the airway must be secured first. They can be treated conservatively in some cases. CT can be useful but fiberoptic bronchoscopy is the key in diagnosis. Conclusion: Although early treatment of tracheal lacerations is urgent surgery, it is reported that these injuries can be treated with conservative methods under appropriate conditions

Surgical and survival outcomes of sleeve lobectomy after neoadjuvant theraphy in lung cancer: With group of 265 patients

[Abstract Not Available

Tuberculosis cases presenting with spontaneous hemopneumothorax and hypotension

Sir, Tuberculosis (TB) is the second most common fatal infectious disease, following human immunodeficiency virus/ acquired immunodeficiency syndrome (HIV/AIDS), in the adult population. Socio-economic deprivation, immigration, wars, omission of tuberculosis control programs, and HIV/AIDS epidemics have led to an increase in the incidence of tuberculosis. The World Health Organization (WHO) publishes a global tuberculosis report annually. The 2013 report stated that, in 2012, 8.6 million people developed TB, and 1.3 million people died from the disease, including 320,000 deaths among HIV-positive individuals

Soliter fibrous tumor of diaphragm in a patient with larynx cancer: Case report

Introduction: Solitary fibrous tumor is a neoplasm of mesenchymal origin with benign and malignant forms. We aimed to present a case of solitary fibrous tumor which developed in a patient operated for laryngeal cancer and originated from diaphragm in the light of the literature. Case report: A 61-year-old male patient with tracheostomy with an undiagnosed lesion that appears to be almost 10 cm was referred to our clinic. Since it was a large volume mass, we chose to perform a thoracotomy over thorachoscopic approach. Discussion: Although solitary fibrous tumors most commonly occur in the pleura but may also originated from diaphragm, and our case is valuable that originates from diaphragmatic since there are less than 5 reported cases in literature for past two decades. Conclusion: Even in the case of recurrence, the main treatment remains as total surgical excision. Solitary fibrous tumors are usually detected because of compression symptoms. That is the main reason why we chose thoracotomy