Cem Kaan Parsak; U?ur Topal; Merih Altiok; Emir Capkinoglu; Cagla Bali; Orcun Yalav; Ahmet Rencuzogullari; Gurhan Sakman
Volume 25, Issue 11 , 2023
Abstract
Background: Gastric cancer is the fifth most common cancer worldwide.Objectives: This study investigated the risk factors associated with mediastinal lymph node metastases due to proximal gastric cancer.Methods: The study included patients with curative surgical resection and transcural lymphadenectomy ...
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Background: Gastric cancer is the fifth most common cancer worldwide.Objectives: This study investigated the risk factors associated with mediastinal lymph node metastases due to proximal gastric cancer.Methods: The study included patients with curative surgical resection and transcural lymphadenectomy for proximal gastric tumors between January 2012 and January 2020. The patients (n=88) were divided into Group 1 (n=54, negative) and Group 2 (n=34, positive) according to the positivity of mediastinal lymph nodes. The diagnostic value of composite immunonutritional and inflammatory indices in predicting lymph node positivity was examined.Results: It was found that only C-reactive protein (CRP) (P=0.044), the rate of postoperative respiratory complications (P=0.002), tumor size (P=0.0001), the total number of lymph nodes, and the number of metastatic lymph nodes were higher in Group 2. Moreover, pT stage (P=0.008) and pN stage (P<0.001) were more advanced in Group 2. Among the composite indices, only the neutrophil-to-lymphocyte ratio (NLR) had a diagnostic value, with a sensitivity of 67.65% and a specificity of 55.56% at a cut-off point of > 2.19. According to the multivariate analysis, a tumor size of > 3 cm, a CRP value of > 7, and tumor localization were independent risk factors.Conclusion: Our study found that mediastinal lymph node positivity was associated with elevated CRP and that these patients had more advanced tumors and poor histopathological characteristics. Mediastinal lymph node positivity was also associated with increased postoperative respiratory complications. We established the diagnostic value of the NLR in predicting lymph node positivity. It is helpful to establish the relationship between clinicopathological characteristics and mediastinal lymph node positivity in proximal gastric tumors since it can be useful in determining the surgical strategy for esophagogastric junction tumors.
U?ur Topal
Volume 25, Issue 6 , 2023
Abstract
Background: Mesenchymal tumors are part of a heterogeneous group of neoplasms.
Objectives: The present study investigated the clinicopathological properties and surgical outcomes of patients with gastric mesenchymal tumors who underwent surgical treatment.
Methods: This study included all cases who underwent ...
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Background: Mesenchymal tumors are part of a heterogeneous group of neoplasms.
Objectives: The present study investigated the clinicopathological properties and surgical outcomes of patients with gastric mesenchymal tumors who underwent surgical treatment.
Methods: This study included all cases who underwent surgical treatment for mesenchymal tumors in Ba?ak?ehir Çam and Sakura City Hospital, Turkey, between August 2020 and August 2022. The demographic data and clinical properties of the patients, operative details, postoperative assessments, pathological specifications of the tumor, and immunohistochemical analysis results were evaluated.
Results: The study included 14 patients, 57% of whom were male. Patients had a mean age of 59.7±9.3 years. The most frequent American Society of Anesthesiologists (ASA) score was ASA 2 in 10 (72%) patients, and the mean hemoglobin level was 12±1.9 g/dl. All patients underwent wedge resection, 5 (35.7%) by a minimally invasive method. The mean duration of operation was 98.9±29.4 min. There were no intraoperative complications, conversions, or postoperative mortalities, and the mean duration of hospital stay was 6.2±3.2 days. One patient made an unplanned re-admission to the hospital due to inadequate oral intake. As an adjuvant treatment, three patients were prescribed imatinib. The tumor location was most frequently the corpus in 5 (36%) patients, and the mean tumor diameter was 62±35.2 mm. Stromal tumors were the most common histological type in 10 (72%) patients, and the other histological types were leiomyoma in 3 (21%) and pancreatoblastoma in 1 (7%) patient. The median and maximum Ki-67 index were 3 and 80, respectively, and the median and maximum mitotic index were 3 and 18, respectively. The number of dissected lymph nodes was nine in one patient and five in another. The surgical margin was positive in one patient, and no patient had a perforated tumor.
Conclusion: Among the different types of mesenchymal tumors of the gastrointestinal system, which are rare, stromal tumors are the most common histological type. Gastric mesenchymal tumors can be safely treated with wedge resection, an approach that is associated with low postoperative morbidity and mortality.
Huseyin Kilavuz; Murat Demir; Ugur Topal
Volume 24, Issue 3 , 2022
Abstract
Background: Various techniques can be used for the closure of the appendiceal stump in laparoscopic appendectomy, although no consensus exists on the optimum approach.
Objectives: The present study was conducted to compare three different stump closure techniques in cases of complicated appendicitis.
Methods: ...
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Background: Various techniques can be used for the closure of the appendiceal stump in laparoscopic appendectomy, although no consensus exists on the optimum approach.
Objectives: The present study was conducted to compare three different stump closure techniques in cases of complicated appendicitis.
Methods: A total of 172 patients who underwent laparoscopic appendectomy for complicated appendicitis were selected for conducting the present retrospective cohort study. The patients were divided into three groups according to the appendiceal stump closure technique: Hem-o-lok clips; extracorporeal knots which were pushed into the abdomen; and laparoscopic knots which were tied manually within the abdomen. The three groups of patients were compared for demographic and clinical characteristics as well as follow-up data.
Results: A total of 85 patients were in Group 1, 43 patients in Group 2, and 44 patients in Group 3. The most common surgical finding was a necrotic appendix in all three groups (67.1% vs. 81.4% vs. 68.2%; p: 0.448). The rate of drain use (42.4% vs. 34.9% vs. 31.8%; p: 0.455) and the readmission rates (10.6% vs. 14% vs. 11.4%; p: 0.178) were also similar in all groups. The median postoperative hospital stay was 2 days in all groups.
Conclusion: No superiority was identified in any of the approaches to stump closure for the laparoscopic treatment of complicated appendicitis cases. All three techniques can be used safely. Accordingly, the technique should be selected based on the assessment of the surgeon, patients characteristics, and cost.
Fatih Dal; U?ur Topal; Erdogan Mutevelli Sozuer; Muhammet Akyuz; Tutkun Talih; Hizir Yakup Akyildiz
Volume 24, Issue 2 , 2022
Abstract
Objective: In this five-year study, we aimed at investigating the factors related to strangulation and mortality in patients who underwent urgent surgery to treat incarcerated abdominal wall hernias.Methods: Patients presenting to the emergency department with an incarcerated abdominal wall hernia (incisional, ...
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Objective: In this five-year study, we aimed at investigating the factors related to strangulation and mortality in patients who underwent urgent surgery to treat incarcerated abdominal wall hernias.Methods: Patients presenting to the emergency department with an incarcerated abdominal wall hernia (incisional, umbilical, femoral, or inguinal) between October 2015and October 2019 were included in the study. The presence of intraoperative ischemia and necrosis was defined as "strangulation." Depending on the presence or absence of strangulation in the incarcerated segment, patients were divided into two groups: Group 1 (nonstrangulated) and Group 2 (strangulated). Between the groups, length of time between incarceration and hospital admission, demographic and clinical data, and physical examination findings, Risk factors for strangulation and mortality were determined with univariate and multivariate analyses.Results: A total of 161 patients were enrolled in the study. Group 1 consisted of 119 patients and Group 2 consisted of 42 patients. In multivariate analysis, the prominent risk factors for strangulation were: high ASA score (p=0.008), acute abdomen findings with distension and elevated body temperature (p<0.001), delayed hospital admission (p<0.001), procalcitonin >0.5 ng/ml (p<0.001), D-Dimer > 500 µg/L (p<0.001), lactate > 2 mmol/L (p<0.001),and creatinine levels > 2 mg/dl (p<0.001). For mortality, the presence of strangulation (p<0.001), lactate levels > 2 mg/dl (p=0.004), and ASA scores > 3 (p =0.035) were the leading risk factors.Conclusion: The most significant risk factors for strangulation were delay of more than 48 hours, high procalcitonin, creatinine, lactate and D-Dimer levels while for mortality, strangulation, high lactate and ASA levels were significantly effective. Mortality rates may be lowered with an earlier diagnosis, more specifically, one made before the development of metabolic and radiologic impairment.
Muhammet Akyuz; Ugur Topal; Mahmut Kulturo?lu; Erdogan Sozuer; Fatih Dal; Tutkun Talih; Kemal Deniz; Hizir Akyildiz
Volume 23, Issue 11 , 2021
Abstract
Background: A majority of colorectal neoplasms are adenocarcinomas; however, there is a small percentage of tumors from other histological cell lines.
Methods: A total of 1100 patients were applied for surgical treatment due to colorectal cancer at a general surgical clinic between 2010 and 2020. The ...
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Background: A majority of colorectal neoplasms are adenocarcinomas; however, there is a small percentage of tumors from other histological cell lines.
Methods: A total of 1100 patients were applied for surgical treatment due to colorectal cancer at a general surgical clinic between 2010 and 2020. The selected patients were divided into four groups of Diffuse large B-cell lymphoma (DLBCL), Malignant melanoma (MM), Medullary carcinoma (MC), and Neuroendocrine tumor (NET). Following that, clinicopathological data of patients and their survival periods have been compared in this study.
Results: A total of 20 patients were included in this study and were divided into the DLBCL (n=5), MM (n=4), MC (n=3), and NET (n=8) groups. The emergency application rate (60%) was the highest in the DLBCL group (P=0.004). The mean age of the patients was above 50 years in all groups, and there was no difference among groups in this regard (P=0.966). The mean tumor diameter values were 8, 6.55, 5.4, and 3.75 cm, respectively (P=0.73) in the groups. Furthermore, the numbers of lymph nodes dissected were 13, 14.5, 19, and 19, respectively (P=0.373), and the numbers of metastatic lymph nodes were determined at 0 ,1.5, 0, and 0.5, respectively (P=0.188). The survival rate was significantly the shortest in the MM group, and the longest survival rate was noted in the NET group (15.625, 8.5, 20, 40.857, respectively; P=0.001).
Conclusion: Although clinicopathological features and postoperative follow-up results were similar, there were differences in the survival rates among patients. Malignant melanoma histopathological type had a worse prognosis than the other tumors.
Mevlut Harun A?ca; U?ur Topal; Cem Kaan Parsak; ismail Cem Eray; Mehmet Onur Gul; ?shak Ayd?n
Volume 23, Issue 10 , 2021
Abstract
Background: Esophageal cancer is the eighth most common cancer and the sixth most common cause of death from cancer. Esophagectomy is still the essential treatment for esophageal cancer despite its high morbidity rate. The prediction of complications that are likely to appear after surgery can be the ...
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Background: Esophageal cancer is the eighth most common cancer and the sixth most common cause of death from cancer. Esophagectomy is still the essential treatment for esophageal cancer despite its high morbidity rate. The prediction of complications that are likely to appear after surgery can be the most critical factor in reducing morbidity.
Objectives: The present study aimed to examine the postoperative complications and causes of mortality in patients undergoing esophagectomy for esophageal cancer.
Methods: Data from 34 patients with esophageal adenocarcinoma or squamous cell carcinoma undergoing esophagectomy in the general surgery clinic of Çukurova University Medical School Hospital were collected and analyzed retrospectively between January 1, 2011, and January 1, 2020. Postoperative complications were identified according to the Clavien-Dindo classification (CD). "The patients were assigned into two groups (Group 1 and Group 2). Group 1 and Group 2 included patients with CD grade <3 and CD grade >3, respectively."
Results: The mean±SD age of patients (n=34) undergoing resection for esophageal cancer was obtained at 56.38±11.00 years. The ratio of female to male patients was equal. The most common accompanying disease was diabetes mellitus. The number of patients with the American Society of Anesthesiologists score 3 was higher in Group 2 (P=0.034). The tumor was most frequently located in the lower thoracic esophagus of patients in Group 1 and Group 2, and the rate of cervical anastomosis was higher in Group 2. The rate of manual anastomosis was higher in both groups. Respiratory complications were the most frequent complication in both groups; however, a higher rate of respiratory complications was observed in Group 2 (P=0.038). The postoperative 30-days mortality and the reoperation rate were higher in Group 2.
Conclusion: Radical surgery for esophageal cancer results in a high rate of complications and death due to the location of the tumor and diagnosis at the advanced stage. Complications and mortality may result from patient-related factors and the surgical technique. The diagnosis and treatment of the correctable causes before surgery can enhance the chance of survival and the quality of life in patients.
