Video-assisted thoracic surgery (VATS) is widely used for thoracic surgery operations, and day by day it becomes routine for the excision of undetermined pulmonary nodules. However, it is sometimes hard to reach millimetric nodules through a VATS incision. Therefore, some additional techniques were developed to reach such nodules little in size and which are settled on a challenging localization. In the literature, coils, hook wires, methylene blue, lipidol, and barium staining, and also ultrasound guidance were described for this aim. Herein we discuss our experience with CT-guided methylene blue labeling of small, deeply located pulmonary nodules just before VATS excision. From April 2013 to October 2016, 11 patients with millimetric pulmonary nodules (average 8, 7 mm) were evaluated in our clinic. For all these patients who had strong predisposing factors for malignancy, an 18F-FDG PET-CT scan was also performed. The patients whose nodules were decided to be excised were consulted the radiology clinic. The favorable patients were taken to CT room 2 hours prior to the operation, and CT-guided methylene blue staining were performed under sterile conditions. Mean nodule size of 11 patients was 8.7 mm (6, 2-12). Mean distance from the visceral pleural surface was 12.7 mm (4-29.3). Four of the nodules were located on the left (2 upper lobes, 2 lower lobes), and seven of them were on the right (four lower lobes, two upper lobes, one middle lobe). The maximum standardized uptake values (SUV max) on 18F-FDG PET/CT scan ranged between 0 and 2, 79. CT-guided methylene blue staining of millimetric deeply located pulmonary nodules is a safe and feasible technique that helps surgeon find these undetermined nodules by VATS technique without any need of digital palpation.

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Background: In this study, the age and cardiac risk factors on mortality, and complications after surgical treatment in lung cancer patients were investigated. Materials and Methods: Between January 2014 and November 2016, 485 patients who underwent lung resections for lung cancer in our clinic, were retrospectively evaluated. Under the age of 70, 412 patients and over 70, 73 patients were grouped as group 1 and 2. Results: Lobectomy was performed in 333 patients (80.8%), pneumonectomy in 43 (10.4%), bilobectomy in 30 (0.7%), segmentectomy in 3 (0.7%) and sleeve lobectomy in 3 (0.7%) in group 1; lobectomy in 65 (89%), pneumonectomy in 4 (5.4%), and sleeve lobectomy in 4 (5.4%) in group 2. Surgical mortality was observed in 5 patients (1.2%) in group 1 and 6 patients (8.2%) in group 2. Complications were observed in 99 patients (24%) in group 1 and 23 patients (17%) in group 2. The mean expected mortality with cardiac risk score in group 1 was 1.24 and 3.5 in group 2. The expected mortality with cardiac risk score and complication rates were tabulated as low, moderate, high and there was no statistically significant difference between score and complication (p = 0.551). Conclusions: According to our study, there were no significant differences in terms of complications, morbidity, mortality and survival rates. There was only a relative increase in surgical mortality over the age of 70, so patients should be carefully treated during and after the surgery. Surgery should be the first treatment to perform in selected patients with lung cancer over the age of 70.

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