Draining of the chest cavity with two chest tubes after pulmonary lobectomy is a common practice. This study aimed to investigate whether using two tubes after a pulmonary lobectomy is more effective than using a single tube. This prospective randomised study included 100 consecutive patients who underwent lobectomy or bilobectomy for any pathological condition between May 2006 and November 2007. In the 50 patients in the 'single-tube group', only one 32F chest tube was inserted, and in the 50 patients in the 'double-tube group', two 32F chest tubes were inserted. Pre-, intra- and postoperative variables in both the groups were compared. The pre- and intraoperative characteristics of the patients were similar in both groups. The mean amount of drainage from chest tubes was 600+/-43.2cc in the single-tube group and 896+/-56.2cc in the double-tube group (p<0.001). The mean values of postoperative pain assessed on the visual analogue scale (VAS) in the early (second day) period were 4.28+/-0.21 in the single-tube group and 5.10+/-0.23 in the double-tube group (p=0.014). The VAS scores in the late (second week) period were 1.48+/-0.13 in the single-tube group and 2.00+/-0.17 in the double-tube group (p=0.01). All other related parameters were similar in both groups. Insertion of two chest tubes is not more effective than the insertion of a single chest tube after pulmonary lobectomy. Moreover, using a single tube is in fact more effective than using two tubes in that it causes less postoperative pain and less pleural fluid loss.

Chronic empyaema deteriorates lung function and causes thoracic asymmetry due to intercostal narrowing in the diseased hemithorax. This study aims to investigate the rates of improvement in the pulmonary function tests (PFTs) and the thoracic deformity in late postoperative period of lung decortication, performed for chronic empyaema. A total of 50 patients who underwent standard open decortication for empyaema were included. The PFTs and computed tomographic (CT) scans of the chest were analysed in all patients after 6-58 months postoperatively. The measurements of antero-posterior and transverse diameters of both hemithoraxes were performed on both preoperative and postoperative chest CTs. The thoracic asymmetry was calculated as the ratio of the measurements of the diseased side to the normal side. The pre- and postoperative parameters were compared statistically. The mean preoperative forced expiratory volume in first second (FEV(1)) and forced vital capacity (FVC) increased from 61.40% and 60.89% to 78.92% and 77.48%, respectively, in the late postoperative period (p<0.001). The mean preoperative transverse diameter of affected hemithorax increased from 11.22 cm to 11.98 cm (p<0.001) and, the transverse asymmetry improved from 11.52% to 5.94%, postoperatively (p<0.001). The mean preoperative antero-posterior chest diameter improved from 15.58 cm to 16.67 cm (p<0.001), and the antero-posterior asymmetry improved from 11.42% to 5.42% (p<0.001) in the late postoperative period. The open decortication for chronic pleural empyaema significantly increases FEV(1) and FVC. Due to the re-expansion of the lung and enlargement of the intercostal spaces, the chest wall deformity also improves considerably after the operation.

Background: Following lower lung lobe resection, prolonged air leaks and residual pleural space are common. We investigated whether an artificially induced prophylactic intraoperative pneumoperitoneum would prevent these complications. Method: Sixty patients who underwent lower lobectomy or bilobectomy were prospectively randomized into 2 groups according to the use of intraoperative pneumoperitoneum. Air was delivered via a catheter placed under the diaphragm in the pneumoperitoneum group. Parameters related to pleural drainage, complications, and hospital stay were compared. Results: No difference between the preoperative characteristics of both groups was present. The mean duration of chest tube drainage was shorter (3.47 ± 1.04 days vs. 4.87 ± 1.43 days, p < 0.001) and the mean amount of chest drainage was lower (305.0 ± 76.9 ml vs. 488.3 ± 215.2 ml, p < 0.001) in the pneumoperitoneum group. Residual pleural space was observed in 1 pneumoperitoneum patient (3.3 %) and in 8 controls (26.7 %). Pneumoperitoneum patients were discharged 1.1 days earlier on average than the controls. Conclusion: Artificial prophylactic intraoperative pneumoperitoneum is a simple and safe procedure that decreases the postoperative amount of fluid drainage, residual pleural space, duration of chest tube drainage, and hospital stay. 1 This study was presented as a digital interactive presentation at the 5th ESTS/EACTS Joint Meeting, September 9–13, 2006, Stockholm, Sweden.

Background : Mediastinal staging is crucial to determine the prognosis and treatment options for patients with non-small cell lung cancer (NSCLC). In this study, we compared the results of integrated positron emission tomography-computerised tomography (PET/CT) with those of mediastinoscopy in mediastinal staging of NSCLC patients. Methods : PET/CT and mediastinoscopy was performed on 250 consecutive patients diagnosed with NSCLC between September 2005 and March 2008. Thirty-eight patients were excluded from the study. Standard cervical mediastinoscopy was performed in all patients, and simultaneous extended cervical mediastinoscopy was performed in 52 patients with left sided lesions. Patients with negative mediastinoscopy underwent resection. The pathological results were correlated with PET/CT findings. Results : A total of 212 patients (199 male, 13 female; mean age: 58.3 years) were evaluated. In PET/CT analysis 60 true-positive, 45 false-positive, 103 true-negative and 4 false-negative patients were found. The rate of PET/CT positivity of mediastinal lymph nodes was 49.5%. The sensitivity, specificity, positive and negative predictive values and accuracy for PET/CT were 93.8%, 69.6%, 57.1%, 96.3% and 76.9% respectively. The incidence of N2 disease in NSCLC patients with negative mediastinal lymph node uptake on PET/CT was 3.7% (4 of 107). In univariate analysis, right upper lobe tumours were significantly (p < 0.05) more associated with occult N2 disease. Conclusions : In patients with positive mediastinal lymph node uptake on PET/CT invasive mediastinal staging appears necessary for exact staging. Mediastinoscopy can be omitted in NSCLC patients with negative mediastinal uptake on PET/CT in regions where the rate of PET/CT positivity of mediastinal lymph nodes is high.

Background We compared the efficiency of videomediastinoscopy (VM) and standard mediastinoscopy (SM) in detecting mediastinal lymph node (MLN) metastasis in non-small-cell lung cancer (NSCLC) patients. Methods By SM method a surgeon sampled bilateral paratracheal and subcarinal lymph node stations and then by VM method, another surgeon resampled all lymph node stations once more through the same incision in the same operative setting. Results of the pathologic examinations of two methods were compared. Results Twenty-seven consecutive mediastinoscopies were included. The numbers of nodal stations biopsied in SM and VM were 97 and 103, respectively. Lymph node metastasis was found in six patients with SM and nine patients with VM. Lymph node dissection by thoracotomy revealed metastases, which were not found by mediastinoscopy, in two patients. Our study showed an accuracy of 92.3% for VM versus 80.7% for SM and corresponding negative predictive values of 88.2% and 75%, respectively (p = 0.002; [Fig. 1]). Conclusion This study showed that VM is superior to SM in detecting MLN metastasis in patients with NSCLC. This study was presented at the 18th European Conference on General Thoracic Surgery organized by European Society of Thoracic Surgeons (ESTS), Valladolid, Spain, May 30 to June 2, 2010.

Background/Objectives: This study examined whether dynamic systemic inflammation- and nutrition-based scores measured at baseline (T0) and during follow-up (T1: days 7–10) are associated with treatment response and surgical requirement in first-episode primary spontaneous pneumothorax (PSP). Methods: A total of 216 consecutive patients with first-episode PSP, treated between January 2020 and December 2024, were retrospectively analyzed. All patients initially underwent tube thoracostomy. During follow-up, 117 patients recovered with drainage therapy, whereas 99 required VATS because of a prolonged air leak. The CAR, SIII, SIRI, PIII, NLR, PLR, and PNI, measured at T0 and T1, were analyzed. Δ-values (T1–T0 differences) were evaluated, and diagnostic performance was assessed using ROC curve analysis. Results: At T0, inflammation- and nutrition-based indices did not differ significantly between groups. In contrast, at T1, CAR, SIII, SIRI, PIII, NLR, and PLR values were significantly higher in the VATS group than in the drainage group (all p < 0.05). Over time, inflammatory indices increased markedly in the VATS group, whereas changes in the drainage group remained limited. PNI decreased significantly at T1 in both groups. ROC analysis demonstrated that CAR, SIII, and NLR showed moderate discriminative performance for identifying patients who required VATS (area under the curve ≈ 0.65). Conclusions: Dynamic assessment of systemic inflammation-based biomarkers provides clinically relevant insight for surgical risk stratification in first-episode PSP. While baseline measurements alone are insufficient, follow-up values and temporal changes—particularly in CAR, SIII, and NLR—may reflect progression toward a surgical phenotype and could serve as adjunctive, non-directive decision-support indicators in PSP management.