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    Comparison of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases: A prospective multicenter randomized trial
    (Baycinar Medical Publ-Baycinar Tibbi Yayincilik, 2019) Kocaturk, Celalettin; Kutluk, Ali Cevat; Usluer, Ozan; Onat, Serdar; Cinar, Huseyin Ulas; Yanik, Fazli; Cesur, Ezgi
    Background: This study aims to compare the safety and diagnostic accuracy of awake and intubated video-assisted thoracoscopic surgery in the diagnosis of pleural diseases. Methods: This prospective randomized study was conducted between October 2016 and April 2018 and included 293 patients (201 males, 92 females; mean age 53.59 years; range, 18 to 90 years) from five medical centers experienced in video-assisted thoracoscopic surgery. The patients were randomized into two groups as awake video-assisted thoracoscopic surgery with sedoanalgesia (non-intubated) and video-assisted thoracoscopic surgery with general anesthesia (intubated). Patients with undiagnosed pleural effusions and pleural pathologies such as nodules and masses were included. Conditions such as pain, agitation, and hypoxia were indications for intubation. The groups were compared in terms of demographic data, postoperative pain, operative time, complications, diagnostic accuracy of the procedures, and cost. All patients completed a follow-up period of at least 12 months for samples that were non-specific, suspicious for malignancy or inadequate. Results: Awake video-assisted thoracoscopic surgery was performed in 145 and intubated video-assisted thoracoscopic surgery was performed in 148 patients. Pleural disease was unilateral in 83% (243/293) and bilateral in 17% (50/293) of the patients. There was no difference between the groups in terms of presence of comorbidity (p=0.149). One patient in the awake video-assisted thoracoscopic surgery group (0.6%) was converted to general anesthesia due to refractory pain and agitation. As postoperative complications, fluid drainage and pneumonia were observed in one patient in the awake video-assisted thoracoscopic surgery group (0.6%) and fluid drainage was detected in one patient in the video-assisted thoracoscopic surgery group (0.6%). There were no differences in pain intensity measured with visual analog scale at postoperative 4, 8, 12, or 24 hours (p>0.05). Distribution and rates of postoperative pathological diagnoses were also similar (p=0.171). Both operative cost and total hospital cost were lower in the awake video-assisted thoracoscopic surgery group (p<0. 001, p=0.001). Conclusion: Our study showed that awake video-assisted thoracoscopic surgery is safe, has similar reliability and diagnostic accuracy compared to video-assisted thoracoscopic surgery performed under general anesthesia, and is less costly. Awake video-assisted thoracoscopic surgery can be the first method of choice in all patients, not only in those with comorbidities.
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    Patient and doctor delays in the diagnosis and treatment of non-small cell lung cancer in Turkey
    (European Respiratory Soc Journals Ltd, 2013) Yurdakul, Ahmet; Kocaturk, Celalettin; Bayiz, Hulya; Gursoy, Soner; Bircan, Ahmet; Ozcan, Aysenaz; Akkoclu, Atilla
    [Abstract Not Available]
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    Patient and physician delay in the diagnosis and treatment of non-small cell lung cancer in Turkey
    (Elsevier Sci Ltd, 2015) Yurdakul, Ahmet Selim; Kocaturk, Celalettin; Bayiz, Hulya; Gursoy, Soner; Bircan, Ahmet; Ozcan, Aysenaz; Akkoclu, Atilla
    Aim: The early diagnosis and treatment of lung cancer are important for the prognosis of patients with lung cancer. This study was undertaken to investigate patient and doctor delays in the diagnosis and treatment of NSCLC and the factors affecting these delays. Materials and methods: A total of 1016 patients, including 926 (91.1%) males and 90 (8.9%) females with a mean age of 61.5 +/- 10.1 years, were enrolled prospectively in this study between May 2010 and May 2011 from 17 sites in various Turkish provinces. Results: The patient delay was found to be 49.9 +/- 96.9 days, doctor delay was found to be 87.7 +/- 99.6 days, and total delay was found to be 131.3 +/- 135.2 days. The referral delay was found to be 61.6 +/- 127.2 days, diagnostic delay was found to be 20.4 +/- 44.5 days, and treatment delay was found to be 24.4 +/- 54.9 days. When the major factors responsible for these delays were examined, patient delay was found to be more frequent in workers, while referral delay was found to be more frequent in patients living in villages (p < 0.05). We determined that referral delay, doctor delay, and total delay increased as the number of doctors who were consulted by patients increased (p < 0.05). Additionally, we determined that diagnostic and treatment delays were more frequent at the early tumour stages in NSCLC patients (p < 0.05). Discussion: The extended length of patient delay underscores the necessity of educating people about lung cancer. To decrease doctor delay, education is a crucial first step. Additionally, to further reduce the diagnostic and treatment delays of chest specialists, multidisciplinary management and algorithms must be used regularly. (C) 2015 Elsevier Ltd. All rights reserved.