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Melek H, Özkan B, Volkan Kara H, Evrim Sevinç T, Kaba E, Turna A, Toker A, Gebitekin C. Minimally invasive approaches for en-bloc anatomical lung and chest wall resection. Turk Gogus Kalp Damar Cerrahisi Derg 2023; 31:374-380. [PMID: 37664764 PMCID: PMC10472457 DOI: 10.5606/tgkdc.dergisi.2023.23850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 11/17/2022] [Indexed: 09/05/2023]
Abstract
Background The aim of this study was to evaluate the feasibility of en-bloc anatomical lung and chest wall resection via minimally invasive surgery. Methods Between January 2013 and December 2021, a total of 22 patients (18 males, 4 females; mean age: 63±6.9 years; range, 48 to 78 years) who underwent anatomical lung and chest wall resection using minimally invasive surgery for non-small cell lung cancer were retrospectively analyzed. Demographic, clinical, intra- and postoperative data of the patients, recurrence, metastasis, mortality, and overall survival rates were recorded. Results The surgical technique was robot-assisted thoracic surgery in two, multiport video-assisted thoracoscopic surgery in 18, and uniport video-assisted thoracoscopic surgery in two patients. Upper lobectomy was performed in 17 (77.3%) patients, lower lobectomy in three (13.6%) patients, and upper lobe segmentectomy in two (9.1%) patients. Five different techniques were used for chest wall resection. Nine (40.9%) patients had one, eight (36.4%) patients had two, four (18.2%) patients had three, and one (4.5%) patient had four rib resections. Chest wall reconstruction was necessary for only one of the patients. The mean operation time was 114±36.8 min. Complete resection was achieved in all patients. Complications were observed in seven (31.8%) patients without mortality. The mean follow-up was 24.4±17.9 months. The five-year overall survival rate was 55.3%. Conclusion Segmentectomy/lobectomy and chest wall resection with minimally invasive surgery are safe and feasible in patients with nonsmall cell lung cancer. In addition, the localization of the area where chest wall resection would be performed should be considered the most crucial criterion in selecting the ideal technique.
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Affiliation(s)
- Hüseyin Melek
- Department of Thoracic Surgery, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Berker Özkan
- Department of Thoracic Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Hasan Volkan Kara
- Department of Thoracic Surgery, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - Tolga Evrim Sevinç
- Department of Thoracic Surgery, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
| | - Erkan Kaba
- Department of Thoracic Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Akif Turna
- Department of Thoracic Surgery, Istanbul University-Cerrahpaşa Faculty of Medicine, Istanbul, Türkiye
| | - Alper Toker
- Department of Thoracic Surgery, Istanbul University Istanbul Faculty of Medicine, Istanbul, Türkiye
| | - Cengiz Gebitekin
- Department of Thoracic Surgery, Bursa Uludağ University Faculty of Medicine, Bursa, Türkiye
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Yentürk E, Bayram AS, Sevinç TE, Melek H, Özer E, Gebitekin C. An Alternative to VATS where VATS is not Available. Indian J Surg 2023. [DOI: 10.1007/s12262-023-03665-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Gebitekin C, Melek H, Cetinkaya G, Ozer E, Yenturk E, Sevinç TE, Bayram AS. Intercostal Nerve Reconstruction for Severe Compensatory Hyperhidrosis: The Gebitekin Technique. Ann Thorac Surg 2021; 111:e443-e446. [PMID: 33529603 DOI: 10.1016/j.athoracsur.2020.11.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 11/03/2020] [Accepted: 11/09/2020] [Indexed: 10/22/2022]
Abstract
Compensatory sweating (CS) is the most common and disabling complication of endoscopic thoracic sympathectomy and represents an unmet clinical challenge. Our surgical hypothesis is to generate a parallel pathway to the damaged part of the sympathetic nerve, similar to the Kuntz nerve, by reconstructing the 2 healthy intercostal nerves, thus treating CS. Here, we present a novel videothoracoscopic technique involving bilateral intercostal nerve reconstruction in patients with severe CS after endoscopic thoracic sympathectomy.
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Affiliation(s)
- Cengiz Gebitekin
- Department of Thoracic Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Huseyin Melek
- Department of Thoracic Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey.
| | - Gamze Cetinkaya
- Department of Thoracic Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Erhan Ozer
- Department of Thoracic Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Eylem Yenturk
- Department of Thoracic Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Tolga Evrim Sevinç
- Department of Thoracic Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ahmet Sami Bayram
- Department of Thoracic Surgery, Faculty of Medicine, Uludag University, Bursa, Turkey
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Melek H, Çetinkaya G, Özer E, Yentürk E, Sevinç TE, Bayram AS, Gebitekin C. Pathological complete response after neoadjuvant/induction treatment: where is its place in the lung cancer staging system?†. Eur J Cardiothorac Surg 2019; 56:604-611. [DOI: 10.1093/ejcts/ezz044] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/23/2019] [Accepted: 01/30/2019] [Indexed: 12/25/2022] Open
Abstract
Abstract
OBJECTIVES
Prognosis for patients with non-small-cell lung cancer (NSCLC) who, after neoadjuvant/induction and surgery, have a pathological complete response (pCR) is expected to be improved. However, the place of the pCR patients in the context of the tumour, lymph node and metastasis (TNM) staging system is still not defined. The aim of this study is to investigate the long-term survival of NSCLC patients with pCR and to find their appropriate staging category within the TNM staging system.
METHODS
We retrospectively reviewed the prospectively recorded data of 1076 patients undergoing surgery (segmentectomy or more) for NSCLC between 1996 and 2016. Patients were divided into 2 groups. Group 1: clinical early-stage patients who underwent direct surgical resection (n = 660); group 2: patients who received neoadjuvant/induction treatment before surgical resection for locally advanced NSCLC (n = 416). Morbidity, mortality, survival rates and prognostic factors were analysed and compared.
RESULTS
Postoperative histopathological evaluation revealed pCR in 72 (17%) patients in group 2. Overall 5-year survival was 58.7% (group 1 = 62.3%, group 2 = 52.8%, P = 0.001). Of note, 5-year survival was 72.2% for pCRs. In addition, 5-year survival for stage 1a disease was 82.6% in group 1 and 63.2% in group 2 (P = 0.008); 70.3% in group 1 and 60.5% in group 2 for stage 1b (P = 0.08). Patients with stage II had a 5-year survival of 53.9% in group 1 and 51.1% in group 2 (P = 0.36).
CONCLUSIONS
This study shows that patients with locally advanced NSCLC developing a pCR after neoadjuvant/induction treatment have the best long-term survival and survival similar that of to stage Ib patients.
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Affiliation(s)
- Hüseyin Melek
- Department of Thoracic Surgery, Uludağ University, School of Medicine, Bursa, Turkey
| | - Gamze Çetinkaya
- Department of Thoracic Surgery, Uludağ University, School of Medicine, Bursa, Turkey
| | - Erhan Özer
- Department of Thoracic Surgery, Uludağ University, School of Medicine, Bursa, Turkey
| | - Eylem Yentürk
- Department of Thoracic Surgery, Uludağ University, School of Medicine, Bursa, Turkey
| | - Tolga Evrim Sevinç
- Department of Thoracic Surgery, Uludağ University, School of Medicine, Bursa, Turkey
| | - Ahmet Sami Bayram
- Department of Thoracic Surgery, Uludağ University, School of Medicine, Bursa, Turkey
| | - Cengiz Gebitekin
- Department of Thoracic Surgery, Uludağ University, School of Medicine, Bursa, Turkey
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Tanju S, Erus S, Selçukbiricik F, İliaz S, Kapdağlı M, Bulutay P, Sevinç TE, Mandel NM, Dilege Ş. Level of pleural invasion effects on prognosis in lung cancer. Tumori 2018; 105:155-160. [DOI: 10.1177/0300891618792463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To analyze the extent of visceral pleural invasion (VPI) and its effect on survival along with its place in determining the T descriptor in TNM staging in our patients. Methods: A total of 233 patients underwent lung resection. The data were retrospectively analyzed in terms of sex, age, histopathologic type, stage of the tumor, extent of VPI, and survival. Patients who had neoadjuvant chemotherapy or chemoradiotherapy, distant metastasis, parietal pleural invasion, and operative mortality were excluded. Results: The median follow-up was 59 months (range 4–126). The extent of VPI was PL0 in 119 (65.7%) patients, PL1 in 47 (26%) patients, and PL2 in 15 (8%) patients. The median survival rates were 65 (range 43–96) months for PL0, 54 (range 37–72) months for PL1, and 39 (range 12–69) months for PL2. The 5-year overall survival rates were 74.7% for PL0, 77.8% for PL1, and 53.3% for PL2. There were statistically significant differences in overall survival among PL0, PL1, and PL2 ( p = 0.03). In subgroup analysis, the difference was insignificant in PL0 vs PL1 ( p = 0.81), but significant in PL0 vs PL2 ( p = 0.02) and PL1 vs PL2 ( p = 0.04) groups. Conclusions: This study emphasizes that the presence of VPI is related with poor prognosis independent of lymph node positivity, histologic subtypes, and tumor size. As the study shows, PL0 and PL1 have similar survival rates and these two groups may be considered as VPI (−) patients whereas PL2 disease affects survival outcomes.
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Affiliation(s)
- Serhan Tanju
- Department of General Thoracic Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Suat Erus
- Department of General Thoracic Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Fatih Selçukbiricik
- Department of Medical Oncology, Koç University School of Medicine, Istanbul, Turkey
| | - Sinem İliaz
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul, Turkey
| | - Murat Kapdağlı
- Department of General Thoracic Surgery, VKF American Hospital, Istanbul, Turkey
| | - Pınar Bulutay
- Department of Pathology, Koç University School of Medicine, Istanbul, Turkey
| | - Tolga Evrim Sevinç
- Department of General Thoracic Surgery, Koç University School of Medicine, Istanbul, Turkey
| | - Nil Molinas Mandel
- Department of Pulmonary Medicine, Koç University School of Medicine, Istanbul, Turkey
| | - Şükrü Dilege
- Department of General Thoracic Surgery, Koç University School of Medicine, Istanbul, Turkey
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