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Öğe Akciğer rezeksiyonu uygulanan erken evre akciğer kanserinde sağkalım ve sağkalımı etkileyen prognostik faktörler(İnönü Üniversitesi, 2024) Kalkan, Muhammed; Girgin,? OğuzGiriş ve Amaç: Dünyada ve ülkemizde en öldürücü kanser olan akciğer kanserinin enetkin tedavisi geride tümörün bırakılmadığı komplet eksizyondur. Tanı anında hastaların yalnızca %25'i cerrahi tedaviye uygun olsa da özellikle ileri evrede küratif operabilite oranı ve sağkalım daha düşük olduğundan hastalığın erken evrede teşhisi daha da önem kazanmaktadır. Çalışmamızda erken evre hastalarda tedavi yönetimini daha optimal hala getirmek amacıyla preoperatif, intraoperatif ve postoperatif değişikliklerin hastalık prognozu üzerine olan etkisini ortaya koymayı amaçladık. Gereç ve yöntemler: Bu çalışmada; İnönü Üniversitesi Tıp Fakültesi Göğüs CerrahisiAnabilim Dalında 2012-2021 yılları arasında komplet eksizyon ile opere edilen histopatolojikolarak erken evre(Evre 1A-B) akciğer kanseri tanısı alan olguların verileri retrospektif incelenerek değişik faktörlere bağlı sağkalım analizleri yapıldı. Bulgular: Hastaların ortalama sağkalım süresi 110,39 ay ve genel sağkalımı ,3 olarak saptandı. Preoperatif nefes darlığı varlığı (p=0,003), erkek cinsiyet (p=0,044), hastaların 65 yaş üstü olması (p=0,002), cerrahi prosedür olarak torakotomi tercihi (p=0,043), fissürün komplet olması (p=0,016), intraoperatif komplikasyon varlığı (p<0,001) histopatolojik tanısı skuamöz hücreli karsinom(SHK) olması (p=0,021), lenfovasküler invazyon varlığı (p=0,019), Evre 1B(T2A) olması(p=0,031), postoperatif dönemde kemoterapi alması (p=0,008), postoperatif dönem takiplerinde kemik metastazı izlenmesi (p<0,001) sağkalım üzerinde istatistiksel olarak anlamlı bulundu. Bu faktörlerle yapılan regresyon analizinde; nefes darlığı varlığı, yaş, torakotomi tercihi, intraoperatif komplikasyon, SHK tanısı, lenfovasküler invazyon varlığı sağkalım üzerinde bağımsız birer negatif prognostik faktör olarak saptandı. Sonuçlar: Erken evre akciğer kanserinde en etkin tedavi lenf nodu diseksiyonu ile beraber yapılmış komplet anatomik rezeksiyonlardır. İleri yaş, artan komorbiditeler ve düşük hasta performansı gibi nedenlerden dolayı sublober rezeksiyonlar opsiyonel olarak düşünülse de yaygın tercih lobektomi prosedürüdür. Giderek yaygınlaşan minimal invaziv cerrahi yöntemlerle torakotomiye göre çalışmamızda hastaların sağkalımında istatiksel olarak anlamlı farklılıklar izlendi. Anahtar kelimeler; akciğer kanseri, evre 1A-1B, erken evre, rezeksiyon, sağkalım.Öğe The esophageal rapunzel syndrome: a case of a trichobezoar in the esophagus(Pagepress Publ, 2023) Agar, Mehmet; Celik, Muhammet Reha; Ulutas, Hakki; Gulcek, Ilham; Kalkan, MuhammedRapunzel syndrome is a form of trichobezoar, a rare form of bezoar, especially seen in individuals with hair pulling (trichotillomania) and hair eating (tricophagia) habits, that extends from the pylorus into to the duodenum, jejunum and even the colon. We report the case of a 37-year-old woman with a trichobezoar in the esophagus, causing esophageal rupture that required an urgent surgical intervention.Öğe The first uniportal VATS sleeve lobectomy in Türkiye: A case report(2024) Ulutaş, Hakkı; Gülçek, İlham; Kalkan, MuhammedIn recent years, video-assisted thoracic surgery (VATS) has become the gold standard approach in the surgical treatment of early-stage non-small cell lung cancer. Especially in cases of central tumors, sleeve lobectomies that preserve parenchyma and respiratory reserves are performed instead of pneumonectomies by experienced clinics. Here, we present the first case of uniportal VATS right bronchial sleeve upper lobectomy for right main bronchial invasion in Turkey, which was successfully performed in August 2022. A patient diagnosed with laryngeal carcinoma who had been in remission for 5 years complained of a cough. Computed thoracic tomography showed hilar peribronchial thickening and an endobronchial lesion (EBL) extending from the right upper lobe bronchus to the main bronchus, almost completely obstructing the upper lobe bronchus. Bronchoscopy revealed that the right upper lobe entrance was obstructed with EBL, and its distance to the carina was 1.6 cm. Bronchoscopic biopsy revealed squamous cell carcinoma. The thorax was entered through an incision of approximately 3 cm in the right fifth intercostal space. First, the right upper lobe pulmonary arteries and superior pulmonary vein were dissected and cut. The main bronchus was divided until the intermediate bronchus. With the help of an endoscissor, the main and intermediate bronchus were incised with appropriate surgical margins, and the lobectomy material was removed. Both macroscopic appearance and frozen and microscopic main and intermediate bronchus surgical margin tumor negativity were confirmed. One suture was passed through the lateral cartilage from the inside out, and the needle was fixed to the posterior pleura. Membranous and cartilage parts were continuously anastomosed with a double-needle 3/0 prolene suture at 2–3 mm intervals. Pathological evaluation confirmed squamous cell carcinoma with a tumor diameter of 1.7 cm, hilar 1/11 lymph node metastasis, and negative surgical margin. Adhering to oncologic principles, sleeve resections, which are difficult even with the currently known open techniques, can be performed effectively and safely with uniportal VATS in experienced centers.Öğe Management of spontaneous pneumothorax in patients with COVID-19(Oxford Univ Press, 2022) Ulutas, Hakki; Celik, Muhammet Reha; Gulcek, Ilham; Kalkan, Muhammed; Agar, Mehmet; Kilic, Talat; Gulcek, EmineOBJECTIVES: The coronavirus disease 2019 (COVID-19) pneumonia may cause cystic features of lung parenchyma which can resolve or progress to larger blebs. Pneumothorax was more likely in patients with neutrophilia, severe lung injury and a prolonged clinical course. The timely diagnosis and management will reduce COVID-19-associated morbidity and mortality. METHODS: We present 11 cases of spontaneous pneumothorax managed with chest tube thoracostomy or high-dose oxygen therapy. Isolated spontaneous pneumothorax was detected in all cases. RESULTS: Eight cases were male and 3 cases were female. There were bilateral ground-glass opacities or pulmonary infiltrates in the parenchyma of the 10 cases. We detected neutrophilia, lymphopaenia and increased C-reactive protein, Ferritin, lactate dehydrogenase, D-Dimer, interleukin-6 levels in almost all cases. Chest tube thoracostomy was sufficient to treat pneumothorax in our 9 of case. In 2 cases, pneumothorax healed with high-dose oxygen therapy. Favipiravir and antibiotic treatment were given to different 10 patients. In our institution, all patients with COVID-19 infection were placed on prophylactic or therapeutic anticoagulation, unless contraindicated. The treatments of patients diagnosed with secondary spontaneous pneumothorax during the pandemic period and those diagnosed with secondary spontaneous pneumothorax in the previous 3 years were compared with the durations of tube thoracostomy performed in both groups. CONCLUSIONS: The increased number of cases of pneumothorax suggests that pneumothorax may be a complication of COVID-19 infection. During medical treatment of COVID-19, pneumothorax may be the only reason for hospitalization. Although tube thoracostomy is a sufficient treatment option in most cases, clinicians should be aware of the difficulties that may arise in diagnosis and treatment.
