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    Acute Pancreatitis: A Rare but Serious Complication for Living Liver Donors; Risk Factors and Outcomes
    (Baskent Univ, 2022) Baskiran, Adil; Kement, Metin; Barut, Bora; Ozsay, Oguzhan; Karakas, Serdar; Koc, Cemalettin; Yilmaz, Sezai
    Objectives: The purposes of this study were to determine the incidence of acute pancreatitis after living donor hepatectomy and to investigate potential risk factors and outcomes. Materials and Methods: Clinical data of all donors who underwent donor hepatectomy between January 2015 and December 2016 in our liver transplant institute were reviewed. Donor data were obtained from a prospectively maintained database. The donors were divided into 2 groups according to whether they developed postoperative pancreatitis. The following data were compared between the 2 groups: demo graphic information (age, sex), body mass index, type of hepatectomy (right, left, or left lateral), intraoperative cholangiographic findings, operative time, blood loss, graft data (graft weight, remnant liver ratio), duration of postoperative hospital stay, and postoperative morbidity and mortality (if any). Pancreatitis severity and treatment outcomes were also examined in patients with postoperative pancreatitis. Results: Our study included 348 donors who underwent donor hepatectomy for living-donor liver transplant. Postoperative pancreatitis developed in 6 donors (1.7%). We found no statistical differences between patients with and without postoperative pancreatitis in terms of demographic and intraoperative findings. Neither loco-regional nor systemic complications of pancreatitis developed in any of the patients. Therefore, all were classified as having mild pancreatitis according to revised Atlanta classification. The mean APACHE II score was 5.2 +/- 1.2 points (range, 4-7 points). All patients with postoperative pancreatitis received conservative-supportive treatment. Conclusions: Although postoperative pancreatitis is a rarely reported complication in living liver donors, it should always be considered, especially in patients who unpredictably deteriorate in the postoperative period. Proper recognition and timely treatment can help avoid serious consequences.
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    Efficacy of negative pressure wound therapy in the management of acute burns
    (Turkish Assoc Trauma Emergency Surgery, 2018) Kement, Metin; Baskiran, Adil
    BACKGROUND: The aim of the present study was to evaluate the outcomes and efficacy of negative pressure wound therapy in the management of acute burns. METHODS: Patients with acute burns who have received negative pressure wound therapy at the Dr. Lutfi Kirdar Kartal Research and Training Hospital Tertiary Burn Care Center between January 2014 and December 2015 were included in the study. Patient data were retrospectively reviewed by analyzing data from our prospective patient database. RESULTS: A total of 38 patients were evaluated for the study. Three patients were excluded due to mortality prior to the completion of the treatment course. There were 32 (91.6%) male and 3 (8.4%) female patients. The mean age of the patients was 49.5 +/- 16 years. The etiological factors included electrical burn injury in 19 (54.3%), chemical burn injury in 7 (20%), flame burn injury in 6 (17.2%), and hot water burns in 3 (8.4%) patients. The severity of the burns was grade 3 or 4 in all of the patients included in the study. The mean duration of negative pressure wound therapy was 10.1 +/- 3.9 days. There were no procedure-related complications throughout the duration of the study. During the standard application of the device, one patient experienced local pain; therefore, low pressure (75 mmHg) was applied during therapy, and pressure was steadily increased. As a result of the application of this therapy, a decrease in the surface area, edema, and secretion of the wound and an increase in the granulation tissue and perfusion of the wound were observed in all treated patients. Wound cultures revealed no bacterial growth in any of the patients. The mean duration of surgical wound closure was 11.2 +/- 3.7 days. No complication was observed related to wound closure. The mean duration of hospital discharge in the postoperative period was 6.7 +/- 2.1 days. CONCLUSION: Well-designed, randomized control studies showing the efficacy of negative pressure wound therapy in patients with burns are lacking. The results of the present study showed that negative pressure wound therapy may reduce the number of wound debridement sessions, time of wound closure, and hospitalization in major burn injuries exposing the underlying tendons and bones.
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    Gastrointestinal stromal tumors: Factors affecting prognosis and single-center surgery results
    (2019) Gundogan, Ersin; Gundogan Alinak, Gokcen; Kement, Metin; Cetin, Kenan; Acar, Aylin; Bildik, Nejdet
    Aim: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The aim of this study was to investigate the clinical features and histopathological findings of GIST cases who underwent surgical treatment in our clinic in terms of prognostic criteria. Material and Methods: The patients operated for GIST between January 1, 2007 and May 31, 2014 were included in this study. Demographic data, presenting symptoms, ASA scores, diagnostic methods, tumor localizations, use of imatinib before surgery, surgical treatment methods, postoperative complications, tumor size, mitotic activity, immunohistochemical markers, prognostic risk classification, follow-up periods, use of imatinib after surgery, recurrence status and survival data were examined Results: A total of 60 patients were included in the study. The median age was 56.5 (29-81) years . Fifty five of patients were males. Synchronous tumors in more than one location existed in approximately 7% of the patients. The surgical margin was positive in 14 (23.3%) patients after the surgical procedure. The recurrence and metastasis rates of these patients were 14.3% and 42.8%, respectively. On the other hand, these rates were 10.8% and 17.3% respectively in the patients with negative surgical margin. The expected 5-year survival rates according to the risk classification was 66.7% for very low-risk patients, 85.7% for low-risk patients, 59.7% for moderate-risk patients and 47.7% for high-risk patients. Conclusion: GISTs have relatively good prognosis compared to epithelial malignant tumors but require long-term follow-up. In addition, satisfactory results can be obtained with the use of tyrosine kinase inhibitors and adequate surgical margins
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    Gastrointestinal stromal tumors: Factors affecting prognosis and single-center surgery results
    (2019) Gündoğan, Ersin; Alınak Gündoğan, Gökçen; Kement, Metin; Çetin, Kenan; Acar, Aylin; Bildik, Nejdet
    Abstract: Aim: Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. The aim of this study was to investigate the clinical features and histopathological findings of GIST cases who underwent surgical treatment in our clinic in terms of prognostic criteria. Material and Methods: The patients operated for GIST between January 1, 2007 and May 31, 2014 were included in this study. Demographic data, presenting symptoms, ASA scores, diagnostic methods, tumor localizations, use of imatinib before surgery, surgical treatment methods, postoperative complications, tumor size, mitotic activity, immunohistochemical markers, prognostic risk classification, follow-up periods, use of imatinib after surgery, recurrence status and survival data were examined Results: A total of 60 patients were included in the study. The median age was 56.5 (29-81) years . Fifty five of patients were males. Synchronous tumors in more than one location existed in approximately 7% of the patients. The surgical margin was positive in 14 (23.3%) patients after the surgical procedure. The recurrence and metastasis rates of these patients were 14.3% and 42.8%, respectively. On the other hand, these rates were 10.8% and 17.3% respectively in the patients with negative surgical margin. The expected 5-year survival rates according to the risk classification was 66.7% for very low-risk patients, 85.7% for low-risk patients, 59.7% for moderate-risk patients and 47.7% for high-risk patients. Conclusion: GISTs have relatively good prognosis compared to epithelial malignant tumors but require long-term follow-up. In addition, satisfactory results can be obtained with the use of tyrosine kinase inhibitors and adequate surgical margins.
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    Long-Term Results and Prognostic Significance of Non-ANATOMIC Liver Resection for Colorectal Liver Metastasis: Single Center Experience
    (Springer India, 2020) Civil, Osman; Okkabaz, Nuri; Sahin, Tevfik Tolga; Tiryaki, Cagri; Yazicioglu, Murat Burc; Kement, Metin
    Development of liver metastasis is a single poor prognostic indicator if left untreated, and therefore management of colorectal liver metastasis (CRLM) is a subject of active multidisciplinary approach. We aimed to evaluate the long-term results and poor prognostic indicators in patients undergoing liver resection for CRLM from a single center in Turkey. All patients who underwent hepatic resection due to colorectal metastasis between March 2007 and November 2011 in our institute were included. Demographic data, operative and postoperative parameters, and long-term follow-up data were analyzed. A total of 44 patients [29 (65.9%) male, median age: 61 (32-81) years] were included to the study. Most of the patients [28 (63.6%) had metachronous liver metastasis, and almost half of the patients [19 (45.2%)] was oligometastatic. Major resection was performed in 18 (40.9%) patients. Intraoperative US changed the operative strategy in 7 (19.4%) patients. Thirty-day mortality was observed in 4 (9.1%) patients. Reasons for mortality were uncontrolled sepsis [catheter infection (n = 1), anastomotic leak (n = 1), and intraabdominal abscess (n = 1)] and hepatic insufficiency (n = 1). Follow-up period excluding patients with early mortality was 30.4 (3-138) months. Kaplan-Meier survival analysis revealed that estimated median survival time after hepatic resection was 28 (95% CI: 20.6-35.4) months. Five-year and 10-year survival probabilities were 20.5% and 13.3%, respectively. Multivariate Cox regression analyses showed that surgical margin positivity was the only significant factor affecting survival. Our results suggest that tumor margin and number of metastasis are the two determinant prognostic indicators in patients with CRLM. Surgery seems to offer a chance for cure, and surgeons in the field should try to perform liver resections in order to obtain negative margins. Major hepatic resections are justified provided that patient selection and preparation is thorough and surgical procedure can be performed safely.