Oligometastatic disease in lung cancer is not a rare condition as previously thought. Among 812 non-small cell lung cancer patients treated surgically with lung resection between October 2011 and October 2018 at the Department of Thoracic Surgery, Florence Nightingale Hospitals, Turkey, 28 patients (3.4%) had synchronous cranial metastases. We analyzed synchronous isolated cranial metastases patients treated by locally ablative treatments (surgery, radiotherapy, or both). Metastases existing at the diagnosis of primary cancer were considered as synchronous, and their treatment was performed before (at least 1 month) or after (for maximum 1 month) surgery of the primary lung lesion. Prognostic factors affecting survival are evaluated retrospectively to identify clinical factors predicting survival in an effort to better select patients for surgery. Patients having T1-T2 primary lung tumors, no mediastinal lymph node metastasis, receiving minor anatomical lung resection, receiving neoadjuvant chemotherapy, having single cranial metastasis, and receiving surgical cranial metastasectomy were found to have better survival. According to tumor histology, having adenocarcinoma, and not having lymphovascular or visceral pleura invasion correlated with better survival. Average survival time was 52.1 months and median survival was 32 months. The last mortality during the follow-up was at 24 months; cumulative survival was 48.3% at that time. Our study was designed to define the criteria for patients with oligometastatic disease who may benefit from lung resection.

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females with a median age of 67 years (42-81years). The medical records were retrospectively reviewed, and the overall survival was analyzed. Disease-free interval (DFI) was defined as the time between operations for the primary cancer and the metastatic lesion.Results: The median DFI was 51 months (4-145 months), and 11 patients had solitary pulmonary lesion, 5 had double lesions, and 6 had three or more. Operative procedures of metastasectomy consisted of 15 wedge resections, 2 segmentectomies, and 4 lobectomies. Although no surgical complications and operative mortalities occurred, 9 patients died of primary diseases after pulmonary resection. The estimated MST after pulmonary resection was 35 months, and 3 and 5-years survival was 32% and 16%, respectively. Overall 3-year survival of patients with longer DFI (DFI> 36months) was marginally significantly better than that of those with shorter DFI (DFI 36months) (49% vs. 19%, p¼0.17). The longest survivor was still alive more than 5 years without recurrence after lung resection. Conclusion:Pulmonary resection for metastatic pancreaticobiliary cancer could be performed safely and might offer better survival. Although the optimal operative indication is still unclear, our results suggest that pulmonary resection could be a treatment of choice in selected patients with those diseases. Longer DFI before pulmonary metastasis might be helpful to select proper patients for the metastasectomy.

ÖZPrimer tümörün mediastinal organları invaze ettiği T 4 küçük hücreli dışı akciğer kanserli seçilmiş hastalarda genişletilmiş akciğer rezeksiyonu uzun dönem sağkalıma katkı sağlayabilir. Eğer komplet rezeksiyon ve gerekli rekonstrüksiyon sağlanabilecek ise uygun hastalara cerrahi şansı tanınmalıdır. Bu yazıda, sol atriyumu invaze eden T 4 küçük hücreli dışı akciğer kanserli 63 yaşında bir erkek hasta sunuldu. Hastaya kardiyopulmoner baypas eşliğinde sol atriyum duvarının (4¥2.5 cm) en blok parsiyel rezeke edildiği ve defektin perikardiyal yama ile tamir edildiği genişletilmiş sol pnömonektomi uygulandı. Ameliyat sonrası ciddi bir komplikasyon gelişmedi. Adjuvan kemoterapi verilen hasta 10 yıldan fazla süredir hastalıksız yaşamaktadır.Anah tar söz cük ler: Kardiyopulmoner baypas; lokal ileri akciğer kanseri; sol atriyum rezeksiyonu. ABSTRACTIn selective patients with T 4 non-small cell lung cancer with the primary tumor invading the mediastinal organs, extended lung resection may contribute to long-term survival. Adequate patients should be given a chance for surgery if complete resection and required reconstruction can be achieved. In this article, we report a 63-year-old male patient with T 4 non-small cell lung cancer invading the left atrium. In the patient, we performed an extended left pneumonectomy with en bloc partial resection of the left atrium wall (4¥2.5 cm) where the defect was repaired with pericardial patch via cardiopulmonary bypass. No severe complication developed postoperatively. The patient who was given adjuvant chemotherapy has been living for more than 10 years without disease.

females with a median age of 67 years (42-81years). The medical records were retrospectively reviewed, and the overall survival was analyzed. Disease-free interval (DFI) was defined as the time between operations for the primary cancer and the metastatic lesion.

Central venous punctures are performed frequently in pediatric intensive care units, but life threatening complications are rare due to these. A pseudoaneurysm was observed after 1 month following right subclavian puncture, in a 1-year old case, who has been followed at intensive care units since birth. Surgery was performed by modified 'trapdoor' incision as a combination of right supraclavicular and median sternotomy incisions to the case; suffering from right brachial plexus compression symptoms, diminished right arm arterial flow, and vena cava superior syndrome symptoms.