OBJECTIVES We aimed to develop a malignancy risk score model for solitary pulmonary nodules (SPNs) using the demographic, radiological and clinical characteristics of patients in our centre. The model was then internally validated for malignancy risk estimation. METHODS A total of 270 consecutive patients who underwent surgery for SPN between June 2017 and May 2019 were retrospectively analysed. Using the receiver operating characteristic curve analysis, cut-off values were determined for radiological tumour diameter, maximum standardized uptake value and the Brock University probability of malignancy (BU-PM) model. The Yedikule-SPN malignancy risk model was developed using these cut-off values and demographic, radiological and clinical criteria in the first 180 patients (study cohort) and internally validated with the next 90 patients (validation cohort). The Yedikule-SPN model was then compared with the BU-PM model in terms of malignancy prediction. RESULTS Malignancy was reported in 171 patients (63.3%). Maximum standardized uptake value and BU-PM scores were sufficient to predict malignancy (P < 0.001 for both), while the effectiveness of nodule size determined on thoracic computed tomography did not reach statistical significance (P = 0.09). When the Yedikule-SPN model developed with the study cohort was applied to the validation cohort, it significantly predicted malignancy (area under the receiver operating characteristic curve: 0.883, 95% confidence interval: 0.827–0.957, P < 0.001). Comparison of patients in the validation group with Yedikule-SPN scores above (n = 53) and below (n = 37) the cut-off value of 65.75 showed that the malignancy rate was significantly higher among patients with Yedikule-SPN score over 65.75 (86.8% vs 21.6%, P < 0.001, odds ratio = 23.821, 95% confidence interval: 7.805–72.701). When compared with the BU-PM model in all patients, the Yedikule-SPN model tended to be a better predictor of malignancy (P = 0.06). CONCLUSIONS The internally validated Yedikule-SPN model is also a good predictor of the malignancy of SPN(s). Prospective and multicentre external validation studies with large patients’ cohorts are needed.

ÖZETAkciğer enfeksiyonlarına sekonder olarak plevral boşlukta biriken sıvı parapnömonik efüzyon olarak adlandırılır. Parapnömonik efüzyonlara sıklıkla bakteriyel ve viral pnömoniler neden olurlar ve bu efüzyonların komplike olması ile plevral boşlukta pü birikerek ampiyem ortaya çıkar. GİRİŞParapnömonik efüzyon, akciğer enfeksiyonlarına sekonder olarak plevral boşlukta sıvı birikmesidir. Pnömoni (bakteriyel veya viral), bronşektazi veya akciğer apsesine sekonder olarak ortaya çıkar. Komplike parapnömonik sıvılar ise, antibiyotiklerle rezorbe olmayan ve drenajın gerekli olduğu sıvılardır. Bakteriyel pnömonili hastaların %57'sinde plevral efüzyon vardır ve bunlarında %10 kadarı komplike olarak ampiyeme neden olur (1). Plevral kavitede pü toplanması olarak tanımlanan ampiyem, plevral kaviteyi yaygın olarak tutabileceği gibi, septalarla bölü-nerek lokalize de olabilir. Ampiyem gelişen pnömoni olguların-da hastanede yatış süresi uzamakta, mortalite artmaktadır (2). Bu yüzden parapnömonik sıvılar, erken dönemde tespit edilmeli, uygun antibiyotikler verilmeli ve gerekirse drene edilerek, ampiyeme dönüşmesi engellenmelidir.Ampiyem tarihçesi çok eskilere dayanır. Hipokrat ampiyemi ilk kez 2400 yıl önce tanımlamış ve interkostal insizyon ile drenaj sağlanarak ampiyemin tedavi edilebileceğini bildirmiştir (apse=d-renaj). Hewitt 1876 yılında, lastik dren ve su altı drenajının tedavideki yerini göstermiştir. Eastlander ve Shede ilk torakoplastiyi, Fowler ise ilk dekortikasyon ameliyatını tanımlamışlardır (3-5).Solunum t Volkan Erdoğu ve ark. 69

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M any centers worldwide perform lobectomy by video-assisted thoracoscopic surgery (VATS) as an alternative to open thoracotomy in suitable cases, especially in early stage non-small cell lung cancer (NSCLC) cases. [1] According to many studies, the advantages of VATS lobectomy compared to conventional open thoracotomy include shorter length of hospitalization, less postoperative complications, shorter duration of the chest tube, a more cosmetic incision, less postoperative pain, therefore better postoperative life quality and importantly similar overall survival rates compared to open thoracotomy. [2-4] VATS resections have become increasingly popular worldwide following the improvements in training programmes, drawing young surgeons' interest in VATS lobectomy, leading to increased experience. [5] In our Thoracic Surgery Clinic, VATS lobectomy is being performed since the beginning of the 2010s. VATS experience of Objectives: This study aims to compare the outcomes of video-assisted thoracoscopic surgery (VATS) lobectomy with open thoracotomy lobectomy in patients with non-small cell lung cancer (NSCLC). Methods: There were 269 cases with NSCLC who underwent lobectomy between 2017-2019; these cases were retrospectively studied. VATS lobectomy (VATS Group) and open thoracotomy lobectomy (Thoracotomy Group) patients' results were compared according to the length of hospitalizations, early postoperative complications and tumor size and stages. Results: VATS lobectomy was performed in 89 (33%) of these patients, whereas 180 (67%) patients underwent lobectomy using open thoracotomy for NSCLC. The findings showed that the average length of hospitalization was shorter in the VATS Group compared to the Thoracotomy Group (4 vs. 5.5 days) (p<0.05). It was found that the mean size of the tumour was smaller in the VATS Group when compared to the Thoracotomy Group (2.66 cm vs 3.97 cm) (p<0.001). Early postoperative complications were lower in the VATS Group (n=15, 16.8% vs n=58, 32.2%; p<0.021). Conclusion: In VATS lobectomy cases, postoperative complications are less, and the length of hospitalization is shorter. VATS lobectomy is mostly preferred smaller than 3 cm tumor size.

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Objectives: Hamartomas are common benign tumors of the lung. Rarely, lung cancer coincidence may occur at the time of diagnosis or in the follow-up period. Methods: Between 2016 and 2019, 38 patients who underwent a surgical procedure and diagnosed with lung hamartoma were retrospectively evaluated regarding clinicopathological features. Cases were analyzed according to age, sex, radiological findings, localization of nodules, surgical methods, and the coincidence of lung cancer. Results: The mean age was 50.2±11.1 (range 28–76 years). There were 23 male (60.5%) and 15 female (39.5%) patients. Mean size was 2.7±1.8 (range 0.8–10 cm). In 28 patients, hamartoma was <3 cm in diameter (73.6%). Eighteen hamartomas were localized in the upper lobe (47.4%). Only 6 cases (15.8%) were localized at the central part of the lung. Multiple nodules were reported in 10 cases (26.3%). In 4 cases (10.5%), lung carcinoma and hamartoma were seen together at the time of diagnosis. Video-assisted thoracoscopic surgery (VATS) has been performed in 29 cases (76.3%). As a surgical method, enucleation was performed in 4 cases (10.5%), wedge resection in 28 cases (73.7%), and lobectomy in 6 cases (15.8%). No post-operative mortality appeared in the early follow-up. Conclusion: Pulmonary hamartomas are usually present as solitary pulmonary nodules with benign radiological findings. VATS wedge resection is a method that can be used safely in diagnosis and treatment. Hamartomas may be associated with lung cancer at the time of diagnosis or follow-up, so it should be kept in mind that a different nodule seen in patients diagnosed with hamartoma may be associated with lung cancer.

Video-assisted thoracoscopic and laparoscopic esophagectomy combined with a cervical single-port assist is a safe and minimally invasive technique for whole esophagus and mediastinal lymph node dissection. This technique allows for the clear visualization of the mediastinum, reducing the risk of surgery-related trauma.