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    Cytoreductive surgery with or without perioperative intraperitoneal chemotherapy for the management of peritoneal carcinomatosis: Our initial experience
    (2020) Teke, Zafer; Yalav, Orcun; Unal, Ayse Gizem; Parsak, Cem Kaan
    Aim: We studied to present our initial experience of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) or early postoperative intraperitoneal chemotherapy (EPIC) in the treatment of peritoneal carcinomatosis. Material and Methods: The results of 20 consecutive patients treated with CRS±HIPEC or EPIC for peritoneal carcinomatosis in our hospital between November 2014 and February 2019 were evaluated retrospectively. Demographic, clinical and histopathological data of the patients were analyzed. The patients were also divided into two groups as PCI score 10 and PCI score ≥ 10 and a comparison was made between the groups.Results: There were 20 patients in our study. Fifteen patients were female and 5 were male. The mean age was 52.2±15.7 years. Primary tumor was ovarian cancer in 8 patients, colorectal cancer in 8 patients, malignant mesothelioma in 3 patients and gastric cancer in 1 patient. In the ovarian cancer group, CRS alone was applied in 4 patients, CRS+HIPEC in 3 patients and CRS+EPIC in 1 patient. All patients with colorectal cancer underwent CRS+HIPEC. Two of the patients with malignant mesothelioma were treated with CRS+HIPEC and one with CRS+EPIC. The patient with gastric cancer received CRS+HIPEC. The mean peritoneal carcinomatosis index (PCI) was 12.35±7.71. The median completeness of cytoreduction (CC) score was 0 (0-1). The mean operating time was 292.5±59.9 minutes. Perioperative morbidity was developed in 11 patients, and HIPEC-induced toxicity occured in 2 patients. Perioperative mortality was seen in 1 patient. The median overall survival was 17.7 (1.1-56) months. In addition, when two groups were compared, there was no statistically significant difference in terms of age, gender, origin of tumor, surgical method, CC score, operative time, Clavien-Dindo score, postoperative hospital stay and survival (p>0.05). Conclusion: Cytoreductive surgery and intraperitoneal chemotherapy provide satisfactory results in the treatment of patients with peritoneal carcinomatosis. Good preoperative evaluation, appropriate patient selection and multidisciplinary approach are essential for the success of the curative approach to peritoneal carcinomatosis.
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    Diagnostic Benefits and Surgical Implications of Methods for Tumor Localization in Sigmoid and Rectum Tumors
    (Mdpi, 2024) Gul, Mehmet Onur; Akcicek, Mehmet; Iflazoglu, Nidal; Corbaci, Kadir; Emir, Cuma Ali; Guzel, Mehmet; Parsak, Cem Kaan
    (1) Background: In our study, we aimed to determine the accuracy rates of imaging methods for sigmoid, rectosigmoid colon, and rectum cancer. (2) Methods: Patients with tumors located in the rectosigmoid colon, sigmoid colon, and rectum who were operated on were included. Upon admission, we examined the patients' first diagnostic colonoscopies and their preoperative repeat control colonoscopies and computed tomography (CT) report. (3) Results: In this study, 23 patients (57.5%) were male. The overall accuracy rates were 80.0% (32/40) in colonoscopy, 65.0% (26/40) in preoperative CT, and 87.5% (35/40) in retro CT, and the differences among the examination methods were statistically significant (p = 0.049). The sensitivity levels decreased to 50.0% for colonoscopy and preoperative CT and 75.0% for retro CT in rectosigmoid colon tumors. In rectal tumors, the sensitivity levels were 75.0% in colonoscopy, 60.0% in preoperative CT, and 80.0% in retro CT. In two patients, the tumor location was given incorrectly, and postoperative pathological evaluations indicated T3N0 tumors; the initially planned treatment was thus changed to include radiotherapy in addition to chemotherapy in the postoperative period because the tumor was located in the middle rectum. (4) Conclusions: Accuracy in tumor localization in sigmoid, rectosigmoid, and rectum tumors still needs to be improved, which could be accomplished with prospective studies. CT evaluations for cancer localization in this patient group should be re-evaluated by a radiologist.
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    Sentinel lymph node dissection in colorectal cancers: A single-center, prospective study
    (2019) Iflazoglu, Nidal; Eren Erdogan, Kivilcim; Duran, Ali; Parsak, Cem Kaan; Doran, Figen
    Aim: In this study, we aimed to investigate the feasibility of ex vivosentinel lymph node (SLN) mapping and to evaluate efficacy of this technique on staging in patients with colorectal cancer.Material and Methods: : This single-center, prospective study included a total of 35 patients (25 males, 10 females; mean age: 55 years; range, 35 to 85 years) who were diagnosed with Stage 2 colorectal cancer between May 2015 and August 2017. All patients underwent curative surgery and SLN dissection.Results: Tumor was located in rectum in 17, in sigmoid colon in six, in right colon in seven, and in left colon in five patients. Total abdominal colectomy was performed in six, left hemicolectomy in three, right hemicolectomy in six, low anterior resection in 14, anterior resection in two, and abdominoperineal resection in four patients. Of 17 patients with clinical Stage 2 rectal cancer, 15 underwent neoadjuvant chemoradiotherapy (CRT). All patients were histopathologically diagnosed with an adenocarcinoma. Median total number of SLNs dissected was 13 with 16.9 per patient. In two patients receiving neoadjuvant CRT due to rectal cancer, a pathological complete response was achieved. The failure rate of SLNs detection was statistically significantly higher for rectal tumors than the other tumors (p=0.041) and in the patients in whom ≤7 lymph nodes dissected (p=0.023). Conclusion: Our study results suggest that SLN mapping is a useful technique with high success ratesas well as further immunohistochemical examination of the SLNs doesn’t cause stage migration. However, the success rate is lower in rectal tumors than the other tumors and in the patients with ≤7 lymph nodes dissected.