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  • Küçük Resim
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    Analysis of feasibility and safety of laparoscopic complete mesocolic excision with central vascular ligation for right-sided colon cancer: A single centre experience
    (2020) Erdogan, Osman; Teke, Zafer; Unal, Ayse Gizem; Yalav, Orcun; Eray, Ismail Cem
    Aim: Colectomies performed according to complete mesocolic excision (CME) principles have demonstrated an improvement in the quality of surgical specimen and a potential improvement of long-term results. The procedure is technically challenging and has a risk of serious complications, especially when performed laparoscopically. We here aimed to analyze our short-term results in relation to laparoscopic CME right hemicolectomy carried out for right-sided colon cancers. Material and Methods: Demographic data and preoperative, perioperative and postoperative parameters of twenty-three patients who underwent laparoscopic CME between January 2017 and January 2019 in our clinic for right-sided colon adenocarcinoma were retrospectively analysed.Results: There were 23 patients in our study and the mean (SD) age was 61.9±14.8. In the present series, 30% of patients were ≥70 years old, and three were ≥80 years old. Four patients were ASA class 3. Fifty-two percent of patients had comorbidities, and two had different system malignancies in their medical history. While the mean (SD) body mass index (BMI) was 25±4.3, BMI of 4 patients were over 30. Six of patients had a history of previous abdominal surgery. No perioperative mortality was observed. Thirteen percent of the patients developed wound site infection. Anastomotic leakage occurred in 2 cases, and one of them underwent reoperation. The mean (SD) operation time was 168±33 min. Good quality specimens were obtained with a mean (SD) length of 34.2±9.7 cm, a proximal margin of 14±8.2 cm and a distal margin of 16.6±8.9 cm. The mean (SD) number of harvested lymph nodes was 31.9±7.7. The radial surgical margin of all specimens was negative. The mean (SD) postoperative hospital stay was 7.2±2.8 days.Conclusion: We believe that our CME technique performed by laparoscopic method for right-sided colon cancers is safe and applicable, and allows obtaining good quality specimens when evaluating the short-term results. However, there is still a need for randomized controlled trials to evaluate the contribution to survival.
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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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    Effects of carbon dioxide pneumoperitoneum on hepatic function in obstructive jaundice: an experimental study in a rat model
    (Springer, 2010) Bostanci, Erdal Birol; Yol, Sinan; Teke, Zafer; Kayaalp, Cuneyt; Sakaogullari, Zisan; Turkcu, Ummuhani Ozel; Bilgihan, Ayse
    The physiology of the patient during laparoscopy differs from that of open surgery. Both pneumoperitoneum and obstructive jaundice impair the hepatic function, but the combined insult has not been previously examined. In this study, we aimed to investigate the effects of carbon dioxide (CO2) pneumoperitoneum on hepatic function in a rat model of obstructive jaundice. Forty-four male Sprague-Dawley rats were divided into four groups: group 1 (n = 10), sham-operated group; group 2 (n = 12), obstructive jaundice group; group 3 (n = 10), CO2 pneumoperitoneum group; and group 4 (n = 12), obstructive jaundice and CO2 pneumoperitoneum group. Common bile duct was ligated and divided in the obstructive jaundice groups. After 6 days, a 12-mmHg pneumoperitoneum was induced, maintained for 60 min, and released for 120 min. Blood samples were drawn for the measurement of white blood cell and platelet counts, serum liver enzymes (aspartate aminotransferase [AST], alanine aminotransferase [ALT], total bilirubin). Tissue samples were obtained for analyses of malondialdehyde (MDA), glutathione (GSH), and superoxide dismutase (SOD) levels. We evaluated the degree of liver injury on a grading scale from 0 to 4, histopathologically. Pneumoperitoneum after biliary obstruction resulted in an increase in AST and ALT levels and a decrease in white blood cell and platelet counts. However, changes in liver tissue MDA, GSH, and SOD levels did not correlate with the changes in AST and ALT levels and white blood cell and platelet counts. After sham operation with pneumoperitoneum, the GSH levels in liver homogenate were significantly decreased in the group 3 when compared to the group 2. On the other hand, obstructive jaundice itself caused significant reduction in the SOD activity of liver homogenate in comparison to the group 3. Histopathologically, sinusoidal congestion and vacuolization were more severe in the group 3. Alterations in hepatic function occur in pneumoperitoneum applied jaundiced subjects. However, there were no statistically significant differences between the groups 2 and 4 with regard to white blood cell and platelet counts, serum liver enzymes including AST, ALT, and total bilirubin values, MDA and GSH levels and SOD activity of liver homogenate, and histologic damage. These results indicate that there is no additional risk on liver function associated with pneumoperitoneum performed in obstructive jaundice.