Turk Gogus Kalp Damar Cerrahisi Dergisi-Turkish Journal of Thoracic and Cardiovascular Surgery最新文献

Background: Adenocarcinoma is the most common subtype of lung cancer. Histopathologically, lung adenocarcinoma is classified into five distinct patterns: lepidic, acinar, papillary, solid, and micropapillary. In 80-90% of cases, heterogeneous histopathological patterns are observed. This study aimed to evaluate the impact of predominant histological patterns on survival in surgically treated patients, as well as to identify other clinical, demographic, and histopathological factors affecting prognosis.

Methods: In this retrospective cohort study, 499 patients who underwent surgery for primary lung adenocarcinoma were evaluated. Survival data were obtained from electronic medical records. Demographic, clinical, and histopathological parameters were analyzed for both surviving and deceased patient groups. Univariate and multivariate Cox regression analyses were conducted to determine independent predictors of mortality.

Results: A total of 499 patients who underwent anatomical resection for primary lung adenocarcinoma and had complete medical data were retrospectively analyzed. The mean age was 61±8.1 years, and 77.6% of patients were male. The median tumor size was 3.5 cm (range: 2.30-5.20 cm), and the median Charlson comorbidity index was 3 (range: 2-4). The 5-year overall survival (OS) rate was found to be 64.5%. The 5-year OS was 59.8% in males and 77.7% in females (p=0.001). Regarding the side of surgery, the 5-year OS was 57.8% for left-sided resections and 67.9% for right-sided resections (p=0.024). The presence of a micropapillary pattern and acinar predominance were both identified as negative prognostic factors for survival (p=0.017, p=0.024, respectively). Additionally, lymphatic invasion and postoperative complications were found to be independent prognostic factors adversely affecting survival in multivariate analysis (p=0.014, p=0.011).

Conclusion: This study demonstrates that predominant histological patterns significantly influence survival in lung adenocarcinoma. The presence of a micropapillary component and acinar predominance were identified as negative predictive factors in multivariate analysis. We believe that relying solely on the TNM staging system may be insufficient for survival prediction; factors such as predominant histological pattern, lymphatic invasion, gender, Charlson comorbidity index, and postoperative complications should also be taken into account. These criteria may also be considered in planning oncological treatment strategies.

Pulmonary valve dysfunction following transannular patch repair of Tetralogy of Fallot can result in right ventricular (RV) dilation, potentially leading to lifelong complications. This study describes three surgical RV remodeling techniques aimed at addressing RV dilation during pulmonary valve replacement (PVR). Early postoperative evaluations demonstrated significant reductions in RV outflow tract diameters and improvement in QRS duration. These findings indicate that incorporating RV remodeling techniques during PVR may help mitigate the progression of RV dysfunction. Long-term follow-up is necessary to confirm these preliminary results.

Background: Corrosive esophagitis caused by ingestion of acidic or alkaline substances remains a serious public health issue, especially in developing countries. Despite numerous studies, there is currently no universally accepted treatment algorithm for corrosive esophagitis. This study aims to present a diagnostic and treatment algorithm developed from 26 years of clinical experience and to evaluate current management approaches.

Methods: In this retrospective study, patients diagnosed with corrosive esophagitis and admitted to a tertiary thoracic surgery clinic between January 1998 and December 2024 were analyzed. Demographic data, ingested substance type and intent (accidental or suicidal), clinical presentation, diagnostic methods, treatment strategies, and outcomes were evaluated. Endoscopic injury severity was classified using the Zargar system. As this was a descriptive study, no statistical testing was performed.

Results: A total of 501 patients were included. Commonly ingested substances were bleach, limescale removers, and detergents. Rigid esophagoscopy was performed in 248 patients (49.5%) and classified using Zargar grades. Oral intake was initiated based on symptoms and injury severity, with a mean of 4.5±5.23 days. All patients received intravenous proton pump inhibitors and antibiotics; corticosteroids were selectively used. Surgery was required in 3 patients due to complications such as perforation and fibrosis, and 8 underwent dilatation for strictures. Four patients (0.8%) died due to airway injury, suicide, or cardiopulmonary arrest.

Conclusion: Corrosive esophagitis remains a diagnostic and therapeutic challenge. A symptom- and imaging-based triage approach may guide safe management. Routine corticosteroid use appears unnecessary. The proposed algorithm, based on 26 years of clinical experience, may serve as a practical tool to streamline management and improve patient outcomes.

Background: This study aimed to evaluate the prognostic value of the Naples prognostic score (NPS) in patients undergoing isolated coronary artery bypass grafting (CABG).

Methods: Patients undergoing isolated CABG were retrospectively analyzed. Patients were stratified into three groups based on preoperative NPS values. Thirty-day and one-year mortality, postoperative atrial fibrillation (AF), intensive care unit (ICU) and ward length of stay were recorded. Logistic regression analysis was used to assess the independent predictive value of NPS. Its contribution to the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) model was evaluated using ROC curves and Nagelkerke R².

Results: A total of 1.195 patients were included. Higher NPS was significantly associated with 30-day (odds ratio [OR] =1.838) and 1-year mortality (OR=1.620) (p<0.001). Postoperative AF was significantly more common in higher NPS groups (p=0.010). NPS was significantly associated with both ICU length of stay (p<0.001) and ward length of stay (p=0.029). The addition of NPS to EuroSCORE improved the predictive performance for both 30-day and 1-year mortality. Patients with higher NPS had significantly lower survival during follow-up.

Conclusion: The NPS is an independent and significant predictor of short- and long-term mortality in patients undergoing isolated CABG. As a simple, objective score reflecting both inflammatory and nutritional status, NPS enhances the predictive capacity of established risk models when integrated preoperatively.

Background: This study aimed to evaluate the prognostic value of the Naples prognostic score (NPS) in patients undergoing isolated coronary artery bypass grafting (CABG).

Methods: Patients undergoing isolated CABG were retrospectively analyzed. Patients were stratified into three groups based on preoperative NPS values. Thirty-day and one-year mortality, postoperative atrial fibrillation (AF), intensive care unit (ICU) and ward length of stay were recorded. Logistic regression analysis was used to assess the independent predictive value of NPS. Its contribution to the European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) model was evaluated using ROC curves and Nagelkerke R².

Results: A total of 1.195 patients were included. Higher NPS was significantly associated with 30-day (odds ratio [OR] =1.838) and 1-year mortality (OR=1.620) (p<0.001). Postoperative AF was significantly more common in higher NPS groups (p=0.010). NPS was significantly associated with both ICU length of stay (p<0.001) and ward length of stay (p=0.029). The addition of NPS to EuroSCORE improved the predictive performance for both 30-day and 1-year mortality. Patients with higher NPS had significantly lower survival during follow-up.

Conclusion: The NPS is an independent and significant predictor of short- and long-term mortality in patients undergoing isolated CABG. As a simple, objective score reflecting both inflammatory and nutritional status, NPS enhances the predictive capacity of established risk models when integrated preoperatively.

Background: This study aims to evaluate the diagnosis, surgical outcomes, and prognosis of patients with traumatic diaphragmatic rupture and discuss recent advancements in diagnostic technologies.

Methods: Between January 2014 and January 2024, a total of 35 patients (27 males, 8 females; mean age: 45.3±14.2 years; range, 13 to 68 years) who underwent diaphragmatic repair for traumatic diaphragmatic rupture in three centers were retrospectively analyzed. Data including demographic characteristics of the patients, medical history, type of trauma, clinical findings, diagnostic methods used preoperatively, preoperative interventions, the establishment of an intraoperative diagnosis, associated organ injuries, side of the diaphragmatic rupture, type of surgical procedure, postoperative complications, and length of hospital stay were recorded.

Results: Among the cases, penetrating trauma was the most common mechanism (62.9%). Among the 25 patients who underwent computed tomography, a preoperative diagnosis of diaphragmatic rupture was established in 14 (56%). The median defect size in the diaphragm was 5.7 cm in blunt trauma cases and 4.04 cm in penetrating trauma cases. The morbidity rate was 40%, and the mortality rate was 5.7%. The length of hospital stays for the surgically treated patients ranged from 4 to 16 days. Comparing the laparotomy and thoracotomy groups, the laparotomy group had a longer hospital stay (p=0.017) and had statistically significant data in terms of participation in multidisciplinary surgery (p=0.001).

Conclusion: Diaphragmatic rupture should be considered in cases involving high-energy blunt trauma, particularly when multiple lower rib fractures, liver lacerations, or splenic lacerations are present, or in patients with a history of penetrating trauma to the thoracoabdominal region. As delays in diagnosis and treatment may increase morbidity and mortality, early recognition and prompt management are essential. The choice of surgical procedure should be guided by the presence or absence of concomitant injuries.

Thoracic aortic transection is a high mortality event which usually occurs after motor vehicle accidents and is caused by separation of the aortic layers. In this article, we present a 33-year-old, 8 weeks and 5 days pregnant by in vitro fertilization, multi-trauma patient with thoracic aortic transection after a motor vehicle accident. The patient with a complete transection distal to the subclavian artery was successfully treated with thoracic endovascular aortic repair method under general anesthesia, taking all necessary precautions. The patient had a healthy delivery with no problems in follow-up visits. Not one, but two lives were saved with thoracic endovascular aortic repair. In conclusion, this report emphasizes that thoracic endovascular aortic repair is a fast and safe critical treatment method in the treatment of life-threatening aortic transections.

Background: This study aims to assess differences in cardiorespiratory fitness improvement after phase II cardiac rehabilitation in coronary artery bypass grafting patients with various risk factor profiles and to investigate their correlation.

Methods: Between October 2023 and March 2024, a total of 45 patients (35 males, 10 females; mean age: 59.5±8.5 years; range, 55 to 64 years) who underwent phase II cardiac rehabilitation following coronary artery bypass grafting were retrospectively analyzed. Obesity, hypertension, diabetes mellitus, and dyslipidemia were assessed. The patients were classified according to the specific risk factors and risk factor count. Cardiorespiratory fitness parameters including 6-minute walk distance, maximal oxygen consumption, and metabolic equivalents before and after cardiac rehabilitation were recorded.

Results: The average risk factor count was 2.3 per patient, with dyslipidemia most prevalent (73.3%). The highest improvement in cardiorespiratory fitness was shown in patients with four risk factors and those who had obesity. A significant improvement in the cardiorespiratory fitness was observed in all patients, groups with one to four risk factors, and all specific risk factor groups (p<0.05). Patients with obesity showed significantly greater cardiorespiratory fitness improvement, compared to non-obese patients (p=0.009). There was no significant correlation between risk factor count and cardiorespiratory fitness improvement (p>0.05).

Conclusion: Cardiac rehabilitation significantly improved cardiorespiratory fitness in all post-coronary artery bypass grafting patients, regardless of risk factor profiles, with notably greater improvements observed in patients with obesity. Clinically, these findings underscore the importance of universally recommending phase II cardiac rehabilitation in this patient group, particularly emphasizing tailored interventions in individuals with obesity to maximize rehabilitation outcomes and potentially reduce cardiovascular morbidity and mortality.

Background: This study aims to evaluate the outcomes of surgical treatment of post-intubation tracheal stenosis cases and to identify factors associated with recurrence and treatment success.

Methods: Between January 2010 and December 2024, a total of 56 patients (38 males, 18 females; mean age: 49.1±14.8 years; range, 24 to 61 years) who were treated for postintubation tracheal stenosis were retrospectively analyzed. Data were collected using a standardized data extraction form. Demographic data, clinical characteristics, comorbidities, surgical procedures, and postoperative outcomes of the patients were recorded.

Results: Comorbidities, particularly diabetes, were common in the majority of patients. Recurrence occurred in 14 (25%) of the cohort. Early mortality was observed in one (1.7%) patient. Middle tracheal stenosis as the site of stenosis and the use of 3/0 Vicryl separating sutures had higher recurrence rates. The mean length of the removed segment was 3.7±0.7 cm in patients without recurrence, while it was 3.2±0.5 cm in patients with recurrence (p=0.361). While the recurrence rate was 71.4% among patients with comorbidities such as diabetes, hypertension, epilepsy, and Crohn's disease, this rate was 28.6% in those without comorbidities (p<0.001), and the presence of comorbidities significantly increased the likelihood of recurrence (odds ratio [OR]=9.167, 95% confidence interval [CI]: 3.482-24.134, p<0.001).

Conclusion: Surgical treatment of post-intubation tracheal stenosis presents challenges due to the high recurrence rate, particularly in patients with comorbidities. Individualized treatment approaches, meticulous surgical techniques, and comprehensive postoperative care are essential to improve patient outcomes.