Background: Post-pneumonectomy bronchopleural fistula (PPBPF), although infrequent, represents one of the most devastating complications after pneumonectomy, carrying high morbidity and mortality. Accurate risk stratification is essential for timely management. Systemic inflammation-based hematologic indices—such as neutrophil-to-lymphocyte ratio (NLR), C-reactive protein/albumin ratio (CAR), systemic inflammation response index (SIRI), systemic immune-inflammation index (SIII), prognostic immune-inflammation index (PIII), and platelet-to-lymphocyte ratio (PLR)—serve as accessible, low-cost biomarkers reflecting host immune status and inflammatory burden. This study aimed to evaluate their association with mortality risk in patients with PPBPF. Methods: A multicenter retrospective cohort of 33 PPBPF patients (2014–2023) was analyzed. Demographic, clinical, and laboratory data at diagnosis were retrieved. Inflammatory indices were calculated from hematologic parameters. Associations with mortality were assessed using receiver operating characteristic (ROC) curves and univariate logistic regression. Post hoc power analyses were performed for key biomarkers. Results: Nine patients (27.3%) died during follow-up. Non-survivors had significantly higher levels of all biomarkers (p < 0.05). ROC analysis identified NLR as the most powerful discriminatory marker (AUC: 0.862), while SIII, SIRI, and CAR also demonstrated high accuracy (AUC > 0.83). Optimal thresholds of NLR ≥ 12 and CAR ≥ 10 yielded 88.9% sensitivity, >80% specificity, and excellent negative predictive values (NLR: 94.4%; CAR: 94.7%). Post hoc power analysis demonstrated robust statistical power for SIRI (94.9%), CAR (87.2%), and SIII (84.5%). Conclusions: Systemic inflammation-based biomarkers, particularly NLR and CAR, show strong associations with mortality in PPBPF. Incorporating these indices into clinical practice may help identify patients at increased risk and facilitate tailored surveillance and management strategies.

Background: This study aims to assess the outcomes and prognosis of surgical interventions aimed at removing esophageal foreign bodies in patients with mental retardation. Methods: Between January 2010 and January 2021, a total of 30 consecutive patients (20 males, 10 females; median age: 29.5 years; range, 2 to 57 years) with mental retardation who were diagnosed with esophageal foreign bodies and underwent surgical treatment were retrospectively analyzed. Age and sex of the patients, symptoms, type of the foreign body, esophageal stricture level, methods used for preoperative diagnosis, type of surgical procedure, postoperative complications, and length of hospital stay were recorded. Results: Seventeen (56.6%) patients had a foreign body in the first narrowing, 12 (40%) in the second narrowing, and one (3.3%) in the third narrowing. A rigid esophagoscopy was performed in all cases. However, successful removal was not achieved in two (6.6%) cases, and foreign bodies were removed through cervical esophagotomy in one (3.3%) patient and through esophagotomy with right thoracotomy in one (3.3%) patient. Postoperative complications included esophagitis in seven patients (23.3%) and wound infection and pneumonia in two patients (6.6%). The median length of hospital stay after treatment was 1.09 days in patients without complications and 3.3 days in patients with complications. There was a significant correlation between the occurrence of complications and the length of hospital stay (p=0.002). The foreign body was successfully removed in all patients, and no mortality was observed. Conclusion: Early diagnosis and emergency intervention can reduce complications, particularly considering the possibility of non-food and sharp-edged foreign bodies that pose a higher risk of damaging the digestive system, in patients with mental retardation than those without such conditions.

Background: This study aims to evaluate the diagnosis, surgical outcomes, and prognosis of patients with traumatic diaphragmatic rupture and discuss recent advancements in diagnostic technologies. Methods: Between January 2014 and January 2024, a total of 35 patients (27 males, 8 females; mean age: 45.3±14.2 years; range, 13 to 68 years) who underwent diaphragmatic repair for traumatic diaphragmatic rupture in three centers were retrospectively analyzed. Data including demographic characteristics of the patients, medical history, type of trauma, clinical findings, diagnostic methods used preoperatively, preoperative interventions, the establishment of an intraoperative diagnosis, associated organ injuries, side of the diaphragmatic rupture, type of surgical procedure, postoperative complications, and length of hospital stay were recorded. Results: Among the cases, penetrating trauma was the most common mechanism (62.9%). Among the 25 patients who underwent computed tomography, a preoperative diagnosis of diaphragmatic rupture was established in 14 (56%). The median defect size in the diaphragm was 5.7 cm in blunt trauma cases and 4.04 cm in penetrating trauma cases. The morbidity rate was 40%, and the mortality rate was 5.7%. The length of hospital stays for the surgically treated patients ranged from 4 to 16 days. Comparing the laparotomy and thoracotomy groups, the laparotomy group had a longer hospital stay (p=0.017) and had statistically significant data in terms of participation in multidisciplinary surgery (p=0.001). Conclusion: Diaphragmatic rupture should be considered in cases involving high-energy blunt trauma, particularly when multiple lower rib fractures, liver lacerations, or splenic lacerations are present, or in patients with a history of penetrating trauma to the thoracoabdominal region. As delays in diagnosis and treatment may increase morbidity and mortality, early recognition and prompt management are essential. The choice of surgical procedure should be guided by the presence or absence of concomitant injuries.

Background: Pneumonectomy is a major surgical option for non-small cell lung cancer (NSCLC). This study evaluates the predictive value of three-dimensional computed tomography (3D-CT)-based lung volume analysis for postoperative function and explores its potential role in preoperative planning, risk assessment, and surgical decision-making. Methods: We evaluated 59 NSCLC patients who underwent pneumonectomy. Pre- and 12-month postoperative spirometry results were compared with anatomical and 3D-CT-based predictions. Residual lung expansion was calculated, and patients were grouped by a 3D-CT-derived volume ratio of ≥1.2 or <1.2. Results: There was a significant correlation between 3D-CT-based predicted FVC and FEV1 and postoperative spirometric values (p < 0.001). The mean residual lung volume expansion ratio was 1.23. Patients with a ratio ≥1.2 had significantly higher postoperative FVC (p = 0.028). Lung expansion was observed in 81.4% of cases. Predicted postoperative FVC (p = 0.023) and FEV1 (p = 0.013) were significantly higher in patients with left pneumonectomy compared to right. Conclusions: 3D-CT-based lung volume calculation reliably predicts postoperative function and matches conventional methods. Contralateral lung expansion positively affects respiratory outcomes. Additionally, 3D-CT analysis supports preoperative planning and risk assessment, contributing to more accurate diagnosis and surgical decisions in NSCLC management.

SUMMARY OBJECTIVE: Mediastinal neoplasms are relatively rare tumors that require surgical or non-surgical treatment, and they harbor a wide variety of cell types. The aim of this study was to evaluate the surgical outcomes and prognosis of patients who underwent surgery for mediastinal masses. METHODS: The age, gender, symptoms, comorbid factors, radiological findings, preoperative diagnostic steps, surgical procedure, mortality, complications, length of hospital stay, histopathological diagnosis, and survival of 118 patients with mediastinal masses operated on for diagnosis and treatment between January 2013 and December 2018 were retrospectively analyzed. RESULTS: When the mediastinal masses were evaluated according to compartments, the most common mass was found in the anterior mediastinum (n=72, 61%). While 83.3% of malignant lesions were located in the anterior mediastinum, no malignant lesion was detected in the posterior mediastinum. There was a significant correlation between the compartment where the mass was located and its malignancy. A significant increase in the malignancy rate was observed among male patients. The likelihood of malignancy increased with increasing tumor size (p=0.002). Complications were shown to significantly extend the length of hospitalization (p=0.018). Overall survival was found to be at an average of 71.46±2.1 months. The 5-year survival rate was found to be 88.1%. There was a significant difference in survival between genders, in favor of the female sex (p=0.02). CONCLUSION: Considering the low morbidity and mortality rates of mediastinal masses, surgical intervention should be performed promptly for the diagnosis and treatment of mediastinal masses. With videothoracoscopy, adequate biopsies can be obtained from unresectable masses and complete excision of benign lesions can be achieved safely.