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    Composing an Adhesion Barrier Using Hyaluronic Acid and Carboxymethylcellulose to Prevent Mediastinal Adhesion
    (2023) Akçıl, Ali Murat; Demirkaya, Ahmet; Erşen, Ezel; Ceviz, Fatma Şimşek; Ramazanoglu, Sultan Rana; Öz, Buge; Kaynak, Mehmet Kamil
    Objective: Remediastinal intervention is an indispensable procedure to assess mediastinal lymph node metastasis after induction chemotherapy in patients with non-small cell lung cancer. Remediastinal interventions can be a difficult procedure because adhesions from a prior mediastinoscopy may reduce the surgeon’s field of view and may cause difficulty in diagnosing a lymph node, which causes suspicion about invasion. There are several adhesion barrier procedures, which were used to prevent postoperative adhesions, but none of them provided remarkable results. There are studies including abdominal, gynecologic, and neurochirurgic surgery; however, there is no sufficient study regarding mediastinum. In this study, we have explored the role of hyaluronic acid and carboxymethylcellulose in preventing mediastinal adhesion. Methods: In our study, 21 New Zealand-type male and female rabbits—each with a weight of 2500-3500 g—were used. Three groups, each including 7 rabbits, were set up using randomized sampling method. Mediastinal dissection was performed in the first group and Seprafilm® was used to build adhesion inhibition. Mediastinal dissection was performed in the second group, and 0.9% NaCl was used to build adhesion inhibition. In the control group, all layers were sutured primarily after mediastinal dissection. The rabbits were sacrificed after 30 days and each group was compared with the control group, using macroscopic and microscopic adhesion criteria. Results: According to the results of our study, Seprafilm® was found to be statistically efficient in preventing and decreasing adhesion in mediastinum (P < .01 in macroscopic criteria, P < .05 in inflammation, and vascular proliferation criteria). Conclusion: Seprafilm® can be used as an adhesion barrier in prevention of adhesions that develop as a result of surgery.
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    Outcomes of minimally invasive surgery for pulmonary metastasis: who benefits the most?
    (Termedia Publishing House Ltd., 2024) Kılıç, Burcu; Sağlam, Ömer Faruk; Chikvaidzade, Levani; Erşen, Ezel; Kara, Hasan Volkan; Turna, Akif; Kaynak, Kamil
    Introduction: Metastatic disease is one of the main causes of death and factors affecting overall survival. It is known that selected patients with pulmonary oligometastases whose primary tumor is under control and who have adequate respiratory capacity may benefit from metastasectomy by resecting all detected lesions. Aim: To report our findings on the use of video-assisted thoracoscopic surgery (VATS) for pulmonary metastasectomy, with a focus on identifying suitable candidates. Material and methods: Between August 2010 and 2023 a total of 532 pulmonary metastasectomy procedures were performed in our institution. Metastasectomy was performed with VATS for 281 of those patients. Results: VATS metastasectomy was performed in 131 patients with a single lesion on preoperative imaging, while 110 patients underwent metastasectomy for multiple lesions. The rate was significantly (p < 0.05) lower in the group with multiple lesions removed during surgery (38 months) than in the group with only one lesion removed during surgery (60 months). The predicted survival time in the group with other tumor histology (79 months) was significantly (p < 0.05) higher than in the groups with tumor histology carcinoma (41.4 months) and sarcoma (55.5 months). Conclusions: The best prognosis after metastasectomy is provided in cases with a single nodule. Grade is also an important prognostic factor affecting survival, particularly for grade 1 tumor. The histopathological type of the primary tumor is also a significant prognostic factor affecting survival after pulmonary metastasectomy in secondary pulmonary neoplasms, particularly for sarcoma and carcinoma. © 2024 Termedia Publishing House Ltd.. All rights reserved.