Esophageal leiomyoma one of the most common esophageal tumors and frequently cause dysphagia, requiring surgical removal for symptom control. Aberrant right subclavian artery may also cause similar symptoms but its incidence is lower. We report a case who had dual pathologies as possible causes of dysphagia. A straightforward bi-portal video-assisted thoracoscopic removal of an esophageal leiomyoma was performed in a patient with an aberant right subclavian artery coursing posterosuperior to the leiomyoma.

Background: Endoscopic treatment (ET) methods for achalasia such as balloon dilatation and botulinum toxin injection has good success for short and medium term management of achalasia. However some patients either need repeat attempts or referred to surgery. In this study we analyzed and compared the perioperative and disease specific quality of life outcomes of achalasia patients who either underwent surgery as a first line treatment and the ones who underwent ET method prior to surgery. Materials and Methods: The patients who underwent standard of care diagnostic workup and surgery for achalasia by the same surgical team between 2007 and 2014 were recorded in a prospective database. The patients who underwent surgery as a first line treatment (Group 1, n = 55) and the patients who underwent prior ET (Group 2, n = 33) were identified. Demographic data, peroperative complications, length of hospital stay, pre- and postoperative Eckardt scores were recorded and analyzed. Results: A total of 88 patients out of 105 were available for follow up with average follow up time of 61.9 ± 35.8 months. The mean age was 43.3 ± 15.6. Mean hospital stay was 2.3 ± 0.8 days and there was no mortality. Average duration of the effectivity of ET before myotomy was 5.7 ± 7.7 months. Peroperative complications not significantly accumulated in either group. Both groups showed comparable drop in Eckardt scores. Conclusions: Heller myotomy and Dor fundoplication is a safe and durable option for treatment of achalasia for both treatment naive patients and patients with previous repeated ET modalities.

Background: Cyst hydatid is an important health problem in childhood and adult age group. We aimed to present the management of childhood cyst hydatid cases treated with surgery. Materials and Methods: The records of 33 patients that were operated on for lung cyst hydatid disease at our clinic between 1999 and 2016 were evaluated retrospectively in terms of demographic data, clinical findings, location of cysts, treatment methods and follow-up. Results: Among 33 patients included in this clinical analysis study, 20 were male (60.6%) and the mean age was 11.5 (4-15 years). The most common complaint was cough that was observed in 16 patients (48.4%). 78.8% of the patients had only one cyst, whereas 21.2% of the patients had multiple cysts. Cystotomy was performed in 12 patients (36.4%), cystotomy + capitonage in 14 patients (42.4%), and decortication in addition to cystotomy + capitonage in 7 patients (21.2%). There were no postoperative complications and no recurrences were observed during the follow-up. Conclusions: Surgical treatment is the primary treatment that can be performed successfully and safely in childhood lung cysts hydatids.

Background: Non-small cell lung cancer (NSCLC) comprises about 85% of all lung cancers. Although many attempts for early detection and treatment, prognosis of NSCLC is still poor. In recent years the pathways and the genes that play role in lung cancer development were researched widely. PI3K/AKT/MTOR which is thought to be efficacious in the development of many cancer which controls the expression of many genes playing an important role in cell proliferation, metastasis, resistance to apoptosis and angiogenesis. Also the increase in CCND1 expression was shown in several cancer types. The aim of this study is to search the mRNA expression profile of AKT, MTOR and CCND1 genes which has been thought to play role in NSCLC development, and their expression in different pathological stages and histological types of the disease. Materials and Methods: Forty-four NSCLC patients who didn’t get neoadjuvant therapy were included in this study. The samples from tumor and matched normal lung tissue were obtained from resection specimens (lobectomy or pneumonectomy). Total cellular RNA was isolated from the samples. The mRNA expression levels of AKT1, mTOR and CCND1 genes were measured by quantitative real-time polymerase chain reaction (qPCR). Results: Our findings revealed a statistically significant increase of mTOR expression on mRNA levels (P < 0.05). Although AKT and CCND1 expression slightly increased in malign tissues, these changes in the expression were not significant (P > 0.05). The mRNA expression of mTOR was also upregulated and it was statistically significant for early stage disease and adenocarcinoma subtype (P < 0.05). Conclusions: Inhibition of mTOR gene expression at mRNA level might be potential target for future treatment strategies of NSCLC.

Background: Solitary fibrous tumors (SFT) are rare seen tumors assessed to be originated from pleura. Even though they are benign, after their complete resections malignant recurrences might be seen in follow up period. In this study, based on our case series undergone complete surgical resection due to SFT, we looked for an answer whether if it is convenient to accept these tumors as benign or not. Materials and Methods: Patients undergone surgery between January 2000 and January 2011 were included in this study. Follow up data, patients and tumor histopathological characteristics were analysed. Results: Our series consisted of 14 cases (eight male, six female) with a mean age of 49.5 ± 15.3 (15-70 years). All patients’ undergone thoracotomy, and complete resection was performed. The mean followup was 50.3 ± 30.6 months (between 9 -101 months). Two recurrences were detected and both patients died due to recurrent disease. Conclusions: Though they are considered to be benign lesions, SFT have a potential to come along with malignant recurrences. Recurrences were observed in giant tumors and this makes us think if it is possible to overlook a malignant focus in histopathological observation in such kind of big tumors. In this sense, patients should be informed in this regard and a complete and wide resection should be performed as much as possible with a long time follow up period as malignant diseases.

Primary mediastinal ectopic goiter (PMG) is defined as the presence of thyroid tissue in the mediastinum without having a continuity between the cervical thyroid and the mediastinal goiter. A fifty-seven year old man admitted to our clinic suffering from dyspnea, chest pain, shortness of breath, and dysphagia for almost two months. Thorax computed tomography revealed a mass of 12 cm in the posterior mediastinum, compressing the trachea and esophagus. The mass is resected completely via a right thoracotomy.

Pulmonary metastases of papillary thyroid carcinoma (PTC) is rare and generally present as a micronodular or a miliary pattern. Herein we present a single giant chest wall metastasis of PTC that caused mediastinal shift which was not reported in the literature. A 67 year old female patient admitted to the hospital due to shortness of breath. A right sided mass on the chest wall and thyroid nodules were detected. PTC was diagnosed and the patient underwent a total thyroidectomy. pT3N0 were evaluated postoperatively. PETCT demonstrated the mass at right hemithorax (12 cm lesion, SUV max=7.2) plus needle biopsy showed a metastasis of PTC. A chest wall resection plus right upper lobectomy and lymph node dissection was performed as the first choice for PTC metastasis

Emphysema is a frequent phenotypic manifestation of chronic obstructive pulmonary diseases which does not respond to pharmacotherapy. Interventional methods can provide relief for severely ill and highly symptomatic emphysema patients. A quite well studied endoscopic method is the minimally invasive, non-surgical procedure with coils. Coils are small, shape-memory Nitinol implants designed to gather and compress lung tissue, re-tension the diseased airway network and increase the elastic recoil in the emphysematous lung. To date, the positive benefit-risk ratio of coils is documented by several well-designed randomized clinical trials.

Chronic obstructive airway disease (COPD) is a progressive, irreversible and debilitating disease causing lung hyperinflation. Apart from smoking cessation and conventional medical treatment, lung volume reduction surgery (LVRS) has been used for several years but it involves a major thoracic surgery with high incidence of postoperative complications. In the past decade, different approaches of minimally invasive endoscopic lung volume reduction (ELVR) have been developed which differ in indication, mechanism of action, reversibility and are divided into two groups: blocking and non-blocking devices. The endobronchial valves belong to the group of blocking devices available and have the largest series of treated patients. These one way valves are used to occlude the most emphysematous and hence destroyed lobe of the lung. Two different types of valves are available on the market: endobronchial valves (EBV, Zephyr valves) and intrabronchial valves (IBV, Spiration valves). They differ in shape but have a similar mechanism of action. In order to improve the outcome of the ELVR using valves, dedicated screening involving pulmonary function and exercise capacity testing as well as qualitative and quantitative CT analysis and perfusion scan are necessary. Numerous studies in the past years have shown the efficacy and complications following valve therapy. It has been demonstrated that patients with complete fissures show a more pronounced benefit and a significant target lobe volume reduction. Furthermore, unilateral implantation aiming at obtaining complete lobar occlusion has been more effective than the bilateral incomplete treatment. Regarding possible complications, apart from pneumothorax, COPD exacerbations, hemoptysis and valve migrations have been reported. Summarizing, in comparison to LVRS, ELVR using valves is a less invasive alternative with the opportunity to improve shortness of breath, exercise capacity, and quality of life in the patients, who have reached the end of their conventional treatment options.

Pectus excavatum and pectus carinatum are the most common congenital chest wall deformities among others. The current surgical treatment involves insertion of a pectus bar to correct the deformity. It is a minimal invasive technique with minimal incisions but a scar tissue might be seen similar to all surgical interventions. This is an unintended result after surgery. In minimal invasive repairment of pectus deformities, we recommend scar revision after the removal of bar to achieving a good aesthetic outcome.

Extramedullary plasmacytoma (EMP) is a plasma cell neoplasm of soft tissue without bone marrow involvement or other systemic characteristics of multiple myeloma. A 68 year-old male presented with haemoptysis of 3 months. Computed thorax tomography (CT) revealed a 3x5 cm pleural mass adjacent to right lower lobe. The mass was diagnosed as pleural plasmacytoma.

Background: Spontaneous pneumomediastinum is a rare and usually benign finding in young male patient without a history. When subcutaneous emphysema occurs, the patient and medical physicians feel uneasy about the view of face and neck. We review our clinical experience with spontaneous pneumomediastinum in this study. Materials and Methods: We performed a retrospective analysis of demographic features, complaints, precipitating factors and length of hospital stay of patients with spontaneous pneumomediastinum. Results: Fourteen patients with spontaneous mediastinum were identified, included 10 males. Mean age was 25.4 ± 8.9. Chest pain was the most common complaint. All patients underwent chest-x ray and thoracic computed tomography. Only one esophagogram was done. The patients were discharged uneventfully between 3 and 6 days (mean 3.5 ± 1.25). A 12-month follow-up revealed no recurrence of pneumomediastinum in any of the patients. Conclusions: Spontaneous pneumomediastinum is a benign entity and generally treated with conservative management. Chest-x ray and thoracic computed tomography are useful tools for diagnosis of the pneumomediastinum. Additional investigation procedures should be performed selectively.

Background: Primary chest wall tumors (PCWT) constitute 5% of all thoracic tumors. The purpose of this study is to determine the frequency, diagnosis and treatment methods of PCWT in a single-center. Materials and Methods: All patients operated between January 2013 and July 2015 in a single center were retrospectively analyzed and patients having chest wall tumors were included in this study. Results: Among 1073 operations performed during the same period of time, twenty-five patients with primary chest wall tumors were included in this study; 17 were women (68%) and the mean age was 47.6 ± 16.1. The most common symptom was pain (68%). Twenty-four of the lesions were totally excised and reconstructive interventions were added if necessary. Definitive diagnosis was as follows; elastofibroma dorsi in 10 patients (40%), fibrous dysplasia in 3 (12%), and some other rare tumors in the remaining. Twenty-two (88%) of the lesions were benign. Conclusions: It is observed that the frequency of chest wall tumors is not so high, and most of the lesions are benign which can be resected completely.

Background: Hydatid cyst disease, which is mostly caused by Echinococcus granulosus, may result in high morbidity rates particularly in endemic regions, and mortality depending on its size and on the organs where it is located. While the disease can be diagnosed radiologically because of typical symptoms, it becomes more difficult to distinguish it from lung malignancies as the cysts get complicated. Materials and Methods: 15 cases of pulmonary hydatid cyst that underwent clinical and radiological examinations and surgery after being diagnosed as lung abscess and lung cancer between 2008 and 2014 were retrospectively reviewed. Results: Radiological features of the 80% of the cases in thoracic CT were mimicking tumour in the form of thick walled cavitary lesion, hilar mass, cystic necrotic solid mass or solid mass; and 20% of them had radiological features mimicking abscess in the form of thin walled cavitary lesion. Lobectomy was performed for one case, wedge resection was performed for two cases and cystotomy-capitonnage was performed for 12 cases. Conclusions: It should be kept in mind that pulmonary hydatid cyst clinically and radiologically may mimic lung cancer and lung abscess.

Background: Chylothorax is defined as the accumulation of chyle in the pleural space. In this report, we discuss the demographic features of patients with post-operative chylothorax, and the treatment approaches used to emphasize the importance of this complication for thoracic surgery. Materials and Methods: Medical records of 13 patients operated between January 2001 and July 2017, and who were diagnosed with chylothorax in the post-operative period, were retrospectively evaluated. Patients" demographic features, type of surgeries, results of histopathological examination, day of chylothorax diagnosis, and treatment results were recorded. Results: Eight male patients (61.5%) and 5 female patients (38.5%) were included in the study. Chylothorax developed after lobectomy in 9 patients (62.23%), total pleurectomy in 2 patients (15.38%), bilobectomy in 1 patient (7.69%), and pneumonectomy in 1 patient (7.69%). Oral nutrition was discontinued immediately after chylothorax diagnosis, and patients were followed-up with parenteral nutrition. A conservative approach was used in 11 patients (84.61%). Two patients (15.39%) did not respond to medical treatment, and underwent surgery. All patients were successfully treated chylothorax. Conclusions: Chylothorax is a rare but serious post-operative complication after thoracic surgeries. While appropriate conservative treatment leads to recovery in majority of the cases, surgery remains an important option for patients with prolonged drainage and persistent disease.

Postpneumonectomy syndrome is a rare condition caused by rotational displacement of mediastinum over time after pneumonectomy. Usually, dynamic airway obstruction is the predominant symptom. We report the case of a 40-year-old lady who underwent left pneumonectomy due to mucoepidermoid carcinoma 3 years ago and presented to our department with recalcitrant gastroesophageal reflux symptoms such as heartburn and odynophagia. She also had objective reflux findings in pH monitorization. Laparoscopic Toupet fundoplication was performed and resulted in symptomatic relief.

Management of large airway defects is challenging for clinicians due to lack of effective treatment modalities and eventually interest has turned to the field of airway tissue engineering. Considerable progress has been made within the field of airway tissue engineering in recent years and herein we review these recent advances within this field as applied to regeneration and/or replacement of the trachea. Although there are many encouraging researches, we are still far from any routine clinical application of tissue engineered tracheal grafts and it is essential to perform further experimental and clinical researches in order to improve current results and to broaden the clinical application of airway tissue engineering.

Thymic cysts are rarely seen pathologies among mediastinum. They are benign lesions and constitute 1-2% of all tumors in mediastinum. Seventy nine-year-old patient admits to neurology specialist with nausea and dizziness. In left anterior of mediastinum of the patient, smooth margin, cystic lesion with homogenous liquid density in dimensions of 160x130x83 mm is seen in thorax CT. Video assisted thoracoscopic surgery is applied to the patient with diagnosis of intrathoracic, extrapulmonary cystic lesion and lesion is totally excised. Patient is discharged on third day postoperatively with full recovery. Histopathologic examination of the excised lesion reports that it was thymic cyst. Thymic cysts, rarely seen lesions in mediastinum, can be in large sizes and be asymptomatic. They can be treated surgically using video assisted thoracoscopic surgery.

Thoracic splenosis may occur after blunt or penetrating trauma of the thoracoabdominal region. It is diagnosed in 65% of cases of splenic rupture. Trauma-related splenosis is more frequent in the peritoneum, omentum, and mesenterium. The incidence of intrathoracic splenosis is 18%, and the most common location is the pleural space of the left hemithorax. Thoracic splenosis should be considered as a differential diagnosis in patients with multiple lesions in the left hemithorax and a history of splenic trauma involving thoracoabdominal injury.

Currently, thoracentesis is used to drain accumulated fluids in chest cavity such as; pleural effusion, hemothorax and chylothorax and also for diagnosis and treatment of diseases. It is a simple and reliable treatment method which can be used for air drainage in partial pneumothorax cases. After thoracentesis, some complications can occur such as pneumothorax, hemothorax, reexpansion pulmonary edema and organ laceration. Among these complications, pneumothorax is the most frequently seen. In this case report we presented a patient with lung cancer where bilateral pneumothorax developed after thoracentesis.

Background: The aim of this study is to evaluate the effects of fibrin sealant spraying on postoperative air leak in patients undergoing pulmonary resection for non-small cell lung cancer Materials and Methods: Data of twenty-two patients who had undergone pulmonary resection (fibrin sealant group) were compared with a matched control cohort of nineteen patients (control group) retrospectively. Results: Prolonged air leak was seen in fewer patients (n = 2; 10.5%) in fibrin sealant group compared to the control group (n = 4; 18.2%; p = 0.668). Apical chest tube removal time was also lower in fibrin sealant group (3 vs. 4 days; p= 0.01). Postoperative basal drain removal time, total chest tube drainage amount and intensive care unit stay time were similar between the groups (p = 0.945, p = 0.895 and p = 0.452, respectively). Conclusions: Fibrin sealant application cannot replace an exact and precise surgical technique. However, they may be helpful particularly in small air leakages when the air leakage cannot be assured by routine surgical methods.

Background: The aim of this study is to examine the recurrence rates and their causes after axillary thoracotomy and VATS for the treatment of primary spontaneous pneumothorax (PSP). Materials and Methods: Patients who were operated due to PSP in our department between January 2011 and December 2016 were analysed retrospectively. Differences in age, sex, operation side, number of chest tubes inserted during operation, duration of postoperative drainage, need for Heimlich valve system, smoking habit and recurrence were examined between two groups of patients, who underwent axillary thoracotomy and VATS. Results: Among 180 patients operated during this period, 98 (54.4%) patients underwent VATS, and 82 (45.6%) patients underwent axillary thoracotomy. The recurrence rate was 6.1% (n=6) in VATS patients, while it was 8.5% (n=7) after axillary thoracotomy, and the difference was not statistically significant (p=0.533). Eight of 13 patients with recurrences were found to be active smokers in the postoperative period. It was found that active smoking increased the incidence of recurrences from 3.6% to 19%, and the difference was statistically significant (p=0.001). Conclusions: We conclude that patients diagnosed with PSP can be operated by videothoracoscopy since there was no significant difference in the recurrence rates after VATS and axillary thoracotomy, and VATS is a more minimally invasive surgical intervention and causes less incision scar compared to axillary thoracotomy. Because of the significant increase in the postoperative recurrence rates, smoking cessation should be recommended to the patients with PSP and necessary precautions should be taken for this purpose.

Pulmonary venous thrombosis is a rare condition, often seen after lung transplantation, malignancies, fungal infections and sclerosing mediastinitis. It is a life threatening complication which may develop after a thoracic surgery operation. Here we present a patient who underwent a right lower bilobectomy for bronchiectasis, and developed postoperative thrombosis of the right upper pulmonary vein which resulted in a lober gangrene. The patient was discharged uneventfully three weeks after a completion pneumonectomy. This case report aims to discuss the possible cause of this condition, which was not related to a surgical complication, and also to emphasize the importance of rapid a diagnosis and management.

Pulmonary sequestration is a congenital anomaly which receives its blood supply from systemic circulation It has no connection with normal tracheobronchial system, and located in a pulmonary lobe. These lesions should be treated promptly by surgery. Minimally invasive techniques may be preferred for resection. In the 32-year-old female patient, a lobulated, well-circumscribed mass lesion with a diameter of approximately 4 cm was detected on the posterior basilar segment of the left lower lobe. Besides, an aberrant artery which originated from the thoracic aorta and feeding the lesion was found. It was preoperatively observed that the arterial supply of the lesion was approximately 2 cm in diameter, originating from thoracic descending aorta. Venous drainage was through the pulmonary vein. Since intraoperative findings proved intrapulmonary sequestration to be necessary, left lower lobectomy was performed by VATS. The final pathology result was also reported as intralobar sequestration. This case is presented due to its rare occurrence and the use of minimally invasive techniques.

Thoracotomy is one of the most painful surgical procedures known. Chronic pain in the postoperative period after thoracotomy is a common complication. Post-thoracotomy pain syndrome (PTPS) is a chronic pain with neuropathic and non-neuropathic components, continuing after 2 months of thoracotomy, causing disability by affecting the daily activities and functions of patients. Patients generally describe neuropathic symptoms such as hyperalgesia, allodynia, hypoesthesia at the site of the incision or related dermatomes. Etiology includes preoperative, intraoperative and postoperative factors. Although the mechanism of PTPS formation is not clear yet, the most common cause is the intercostal nerve injury. PTPS treatment is complex because of the neuropathic component of the pain. The risk of PTPS formation can be reduced by controlling early pain before the onset of the disease. When pain occurs, medical treatments are implemented and also minimally invasive interventional procedures could be performed if necessary.