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Öğe Comprehensive analysis of impacts of lymph node yield on patient survival and recurrence in patients with stage II rectal cancer: A single institution study(2019) Civil, Osman; Okkabaz, Nuri; Sahin, Tevfik Tolga; Yazicioglu, Murat Burc; Tiryaki, Çağrı; Gunes, Abdullah; Ciftci, Ali; Aydin, DincerAim: Pathologic evaluation of rectal cancer is very important. Lymph node yields may be related to surgical technique or inadequate harvesting in the pathology department. The importance of lymph node yields >12 have been emphasized by many researchers to be adequate for staging. In stage II rectal cancer, the impacts of lymph node yield on locoregional recurrence and patient survival have not been studied. The aim of the present study is to evaluate the impact of lymph node yield on outcome and prognosis of the patients with stage II rectal cancer. Material and Methods: Patients with stage II rectal cancer who were operated in our institution between 2008 and 2013 were retrospectively analyzed to determine the impact of lymph node yield on survival, locoregional and distant metastasis.Results: Overall, local and distant recurrence rates were 13.9%, 4.65% and 9.30%; respectively. We did not find any significant difference in terms of locoregional and distant metastasis rates among Group I (lymph node12) (p>0.05). The 5-year survival of the patients in Group 1 versus Group 2 were 86.7% versus 82%; respectively (p>0.05). Conclusions: Results of the present study emphasize that lymph node yields may not have an impact on patient survival or recurrence. However, the patient groups were heterogeneous and the volume was low, therefore, more studies with higher volumes are needed. Keywords: Rectal Cancer; Staging; Lymph Node Metastasis.Öğe Comprehensive analysis of impacts of lymph node yield on patient survival and recurrence in patients with stage II rectal cancer: A single institution study(2019) Civil, Osman; Okkabaz, Nuri; Şahin, Tevfik Tolga; Yazıcıoğlu, Burc M.; Tiryaki, Çağrı; Güneş, Abdullah; Çiftci, AliAbstract: Aim: Pathologic evaluation of rectal cancer is very important. Lymph node yields may be related to surgical technique or inadequate harvesting in the pathology department. The importance of lymph node yields >12 have been emphasized by many researchers to be adequate for staging. In stage II rectal cancer, the impacts of lymph node yield on locoregional recurrence and patient survival have not been studied. The aim of the present study is to evaluate the impact of lymph node yield on outcome and prognosis of the patients with stage II rectal cancer.Material and Methods: Patients with stage II rectal cancer who were operated in our institution between 2008 and 2013 were retrospectively analyzed to determine the impact of lymph node yield on survival, locoregional and distant metastasis.Results: Overall, local and distant recurrence rates were 13.9%, 4.65% and 9.30%; respectively. We did not find any significant difference in terms of locoregional and distant metastasis rates among Group I (lymph node<12) and II (lymph nodes>12) (p>0.05). The 5-year survival of the patients in Group 1 versus Group 2 were 86.7% versus 82%; respectively (p>0.05).Conclusions: Results of the present study emphasize that lymph node yields may not have an impact on patient survival or recurrence. However, the patient groups were heterogeneous and the volume was low, therefore, more studies with higher volumes are needed.Öğe J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results(Elsevier Science Bv, 2017) Okkabaz, Nuri; Haksal, Mustafa; Atici, Ali Emre; Altuntas, Yunus Emre; Gundogan, Ersin; Gezen, Fazli Cem; Oncel, MustafaPurpose: To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Methods: Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Results: Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Conclusions: Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.Öğe 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, MetinDevelopment 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.