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    The impact of tumor localization on prognosis of the patients following liver transplantation for hepatocellular carcinoma
    (2020) Baskiran, Adil; Sarigoz, Talha; Sahin, Tevfik Tolga; Ince, Volkan; Usta, Sertac
    Aim: Hepatocellular carcinoma usually occurs in the setting of liver cirrhosis and therefore, resection is not possible in majority of the cases. Orthotopic liver transplantation (OLS) is a gold standard treatment option in hepatocellular carcinoma. The aim of the present retrospective study was to evaluate the prognosis of hepatocellular carcinoma localized in left or right side of the liver in patients who underwent OLS. Materials and Methods: 120 patients received OLS for hepatocellular carcinoma between 2007 and 2018 in the institute of liver transplantation. Tumors that were centrally located were excluded from the analysis. The remaining 104 patients were divided into two groups; Group 1 (right lobe, n=85 [81.7%]), Group 2 (left lobe, n=19 [18.3%]). The clinical and demographic data of the patients along with preoperative laboratory values such as alpha fetoprotein (AFP), gamma-glutamyl transpeptidase (GGT) and thrombocyte count were retrospectively evaluated. Results: The Median age in Group 1 and 2 were 54 (4-72) and 50.5 (37-68) years, respectively. Preoperative AFP levels in Group 1 and 2 were 9.25 (1-10800) ng/ml and 13 (1.5-317) ng/ml, respectively. The Model for end stage liver disease (MELD) scores in Group 1 and 2 were 12 (6-52) and 9 (6-21), respectively. None of the clinical, demographic and laboratory values along with disease-free survival, early mortality and recurrence were significantly different among the study groups (p>0.05). Conclusions: Although there is a big discrepancy in terms of patient’s numbers in right and left-sided tumors, our data failed to show any survival difference among the groups. Further studies, especially in hepatocellular carcinoma beyond the Milan criteria, are needed to validate our results.
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    Minimally invasive parathyroidectomy in a community based teaching hospital: The role of dual-phase parathyroid scintigraphy and surgeon experience
    (2019) Sarigoz, Talha; Topuz, Omer; Ertan, Tamer; Aydemir, Ugur
    Aim: In a community based teaching hospital setting, to explore role of dual-phase parathyroid scintigraphy and surgeon experience in minimally invasive parathyroidectomy.Material and Methods: During 4-year period, from January 2013 to December 2016, 136 of 170 patients those were diagnosed with primary hyperparathyroidism were selected for this retrospective study. For detection of hyper-functioning parathyroid tissue, routine neck ultrasound and 99mTc-MIBI dual phase parathyroid scintigraphy were performed. All scintigraphy scans were evaluated by nuclear medicine physicians and surgeons together. Patients with suspected multiglandular diseases and familial cases were excluded. Enlarged glands were identified by surgeons intraoperatively. Specimens were sent for frozen section analysis.Results: Without using intraoperative parathormone monitoring or gamma probe, combination of neck ultrasound, surgeon-nuclear physician evaluated parathyroid scintigraphy scan and resection of surgeon-identified diseased gland resulted in 100% cure rate for this group of patients. Conclusion: Operative experience of surgeon and review of preoperative parathyroid scintigraphy scan had remarkable impact on outcomes. Minimally invasive parathyroidectomy can be held successfully at community-based hospitals under specific conditions without using intraoperative parathormone or gamma probe.
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    The Significance of Serum Tumor Markers CEA, Ca 19-9, Ca 125, Ca 15-3, and AFP in Patients Scheduled for Orthotopic Liver Transplantation: Do Elevated Levels Really Mean Malignancy?
    (Springer, 2023) Baskiran, Deniz Yavuz; Sarigoz, Talha; Baskiran, Adil; Yilmaz, Sezai
    Aim and Background Preparation of the patients for liver transplantation is a meticulous process and includes evaluation of tumor markers to rule out occult malignancy. The present study evaluated the significance of serum tumor markers in patients bound for liver transplantation due to viral and other etiologies of liver failure. Patients and Methods Three hundred eighty-one patients who underwent liver transplantation were included in the study. Demographic data, model for end stage liver disease (MELD) scores, and serum tumor marker levels were prospectively collected. Results AFP levels were significantly higher in viral etiologies when compared to other etiologies (p < 0.05). Ca 19-9 was significantly higher in viral etiologies (p < 0.05). Among the viral etiologies, HCV-related liver failure had higher carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (Ca 19-9) levels (p < 0.05). A correlation was found between increasing MELD scores and serum levels of tumor markers (p < 0.05). Conclusions Tumor markers such as AFP, CEA, Ca 125, and Ca 19-9 can be elevated in end stage liver disease. Their levels vary according to etiology and severity of disease. The diagnostic capabilities of these markers are reduced in end stage liver disease setting but they contribute to the evaluation of the pathophysiology of chronic liver disease. Transplantation can be performed safely in cases with high tumor marker levels provided that any occult malignancy is ruled out by means of imaging and endoscopic techniques. Tumor markers can guide the physician in determining the severity of liver cirrhosis, and further studies are needed to validate such a relationship.