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    Does hyperthermic intraperitoneal chemotherapy influence the rate of infective complications and change the pattern of infectious agents in patients undergoing cytoreductive surgery for peritoneal carcinomatosis?
    (2021) Mercan, Umit; Ersen, Ogun; Yuksel, Cemil; Unal, Ali
    Aim: When CRS, in which complex surgical procedures are applied combined with HIPEC in which high dose cytotoxic agents are applied, many serious postoperative complications, especially infection-related complications, may develop in the patient group with peritoneal carcinomatosis whose general condition is impaired. In this study, it was aimed to investigate the effect of HIPEC application after SRC on infection rates and microbial agent spectrum alone.Materials and Methods: Between January 2012 and January 2020, one thousand six hundreds forty eight patients diagnosed with peritoneal carcinomatosis were scanned from hospital database and two hundred thirty-five eligible patients were included in the study. Demographic and clinical data, perioperative results and culture results were analyzed by grouping the patients as HIPEC and non-HIPEC.Results : It has been found that the incidence of surgical site infections was significantly higher in HIPEC group. (23.6%vs11.5%p=0.011).When the culture results were analyzed. The number of patients with E.coli (13.7% vs 5.7% p = 0.001), Klebsiella pneumoniae (9.9% vs 2.8% p = 0.001) and Pseudomonas aeruginosa (2.2% vs 0.9% p = 0.034) growth was significantly higher in the HIPEC group.Conclusions: It has been found that HIPEC application not only increases the infection rates but also expands the potential pathogen spectrum. Prediction of possible pathogens responsible for postoperative infections may affect the choice of prophylactic and ultimate treatment and so the risk of developing morbidity and mortality which may result from a possible septic progression, can be minimized with an effective antimicrobial therapy.
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    Hematopoietic Stem Cell Transplantation for Patients with Paroxysmal Nocturnal Hemoglobinuria with or without Aplastic Anemia: A Multicenter Turkish Experience
    (Galenos Yayincilik, 2021) Yilmaz, Fergun; Soyer, Nur; Seval, Guldane Cengiz; Bozdag, Sinem Civriz; Topcuoglu, Pervin; Unal, Ali; Kaynar, Leylagul
    Objective: Although inhibition of the complement system at different steps is a promising therapy modality in patients with paroxysmal nocturnal hemoglobinuria (PNH), allogeneic hematopoietic stem cell transplantation (HCT) is still the only curative therapy, especially for patients with intractable hemolysis or bone marrow failure. The aim of this study is to evaluate the outcomes of allogeneic HCT in PNH patients with aplastic anemia (PNH-AA) or without. Materials and Methods: Thirty-five PNH/PNH-AA patients who were treated with allogeneic HCT in 10 transplantation centers in Turkey were retrospectively analyzed. Results: Sixteen (45.7%) and 19 (54.3%) patients were diagnosed with classical PNH and PNH-AA, respectively. The median age of the patients was 32 (18-51) years. The 2-year overall survival (OS) rate and rate of graft-versus-host disease-free, failure-free survival (GFFS) was 81.2% and 78.1%, respectively. The 2-year OS in cases of classical PNH and PNH-AA was 81.3% and 79.9%, respectively (p=0.87), and 2-year GFFS in cases of PNH and PNH-AA was 79% and 76% (p=0.977), without statistical significance. The OS and GFFS rates also did not differ between transplantations with matched sibling donors (MSDs) and matched unrelated donors (MUDs). Conclusion: Allogeneic HCT with MSDs or MUDS is a good option for selected patients with classical PNH and PNH-AA. In particular, patients with debilitating and refractory hemolysis and patients with bone marrow failure might form an excellent group of candidates for allogeneic HCT.
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    Impact of body mass index on short-term outcomes following gastric and colorectral cancer surgery
    (2022) Yuksel, Cemil; Gojayev, Afig; Aydin, Ferit; Unal, Ali; Demirci, Salim
    Aim: The present study aims to investigate the effect of high body mass index (BMI) on short-term outcomes and survival in patients following intra-abdominal malignancy surgery. Materials and Methods: The study was carried out in Ankara University, Department of Surgical Oncology. We retrospectively analyzed the data of patients who underwent gastrectomy and colectomy for malignancy in our clinic between August 2019 and August 2020. BMI was calculated by dividing body weight (kg) by height (m) squared. The patients were classified into two groups as normal (< 25.0 kg/m2 ) and overweight (≥ 25 kg/m2 ) in terms of BMI. Results: 158 patients were included in our study. 78 (49.3%) had undergone surgery for gastric cancer and 80 (50.7%) for colorectal cancer. 73 (46.2%) patients were female and 85 (53.8%) male. The mean age was 61.50±13.37. Fifty four (34.2%) patients had BMI < 25 kg/m 2 and 104 (65.8%) of them were ≥25 kg/m 2 . 57.6% of the patients operated on for gastric cancer and 75.6% for colorectal cancer had high BMI, and the difference between the two groups was statistically significant (p = 0.01). An investigation of relationship between BMI and mortality revealed that 37 with BMI ≥25kg/m2 and 5 with BMI < 25kg/m2 died. The difference was statistically significant (p < 0.001). Conclusion: BMI is an important factor affecting postoperative morbidity and mortality in patients with gastric and colorectal malignant tumors. In the present study, we show that overweight may be associated with severe postoperative complications and poor prognosis in these patients. We suggest that surgeons be highly aware of BMI to make effective treatment plans in gastric and colorectal cancer cases
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    Multicenter Retrospective Analysis of Turkish Patients with Chronic Myeloproliferative Neoplasms
    (Galenos Yayincilik, 2017) Soyer, Nur; Haznedaroglu, Ibrahim C.; Comert, Melda; Cekdemir, Demet; Yilmaz, Mehmet; Unal, Ali; Cagliyan, Gulsum
    Objective: Chronic myeloproliferative neoplasms (CMPNs) that include polycythemia vera (PV), essential thrombocythemia (ET), and primary myelofibrosis (PMF) are Philadelphia-negative malignancies characterized by a clonal proliferation of one or several lineages. The aim of this report was to determine the demographic features, disease characteristics, treatment strategies, and survival rates of patients with CMPNs in Turkey. Materials and Methods: Across all of Turkey, 9 centers were enrolled in the study. We retrospectively evaluated 708 CMPN patients' results including 390 with ET, 213 with PV, and 105 with PMF. Results: The JAK2V617F mutation was found positive in 86% of patients with PV, in 51.5% of patients with ET, and in 50.4% of patients with PMF. Thrombosis and bleeding at diagnosis occurred in 20.6% and 7.5% of PV patients, 15.1% and 9% of ET patients, and 9.5% and 10.4% of PMF patients, respectively. Six hundred and eight patients (85.9%) received cytoreductive therapy. The most commonly used drug was hydroxyurea (89.6%). Leukemic and fibrotic transformations occurred at rates of 0.6% and 13.2%. The estimated overall survival in PV, ET, and PMF patients was 89.7%, 85%, and 82.5% at 10 years, respectively. There were no significant differences between survival in ET, PV, and PMF patients at 10 years. Conclusion: Our patients' results are generally compatible with the literature findings, except for the relatively high survival rate in PMF patients. Hydroxyurea was the most commonly used cytoreductive therapy. Our study reflects the demographic features, patient characteristics, treatments, and survival rates of Turkish CMPN patients.
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    Retrospective evaluation of patients with primary mediastinal large B-Cell lymphoma: Real life experience
    (2021) Guven, Zeynep Tugba; Celik, Serhat; Kaynar, Leylagul; Keklik, Muzaffer; Eser, Bulent; Cetin, Mustafa; Unal, Ali
    Aim: Primary mediastinal large B-cell lymphoma (PMBCL) is a type of lymphoma that forms approximately 3 % of non-Hodgkin lymphomas that often encounter with mass. The aim of this study was to present the epidemiological characteristics, response rates of the treatment and the survival of PMBCL patients in our single center. Materials and Methods: Patient demographics, treatment regimens, survival rates of PMBCL patients were retrospectively analyzed. Results: There are 15 patients in our study. Most of the patients were female (n:9, 60%). The median age at the time of diagnosis was 35.4. Nine patients applied with a bulky lesion in the mediastinum. Most of the patients have been treated with DA-EPOCH-R (dose-adjusted etoposide, doxorubicin, cyclophosphamide, vincristine and prednisone with rituximab) (n:13, 87%) and 2 (n:2, 13%) patients have been treated with R-CHOP (doxorubicin, cyclophosphamide, vincristine and prednisone with rituximab) regimens for 6 cycles. Eight patients (53.3%) received involved-field radiotherapy on the mediastinum. After the first-row chemotherapy, total remission rate was 93.3%. Thirteen (87%) of the patients were still in remission and alive. The median follow-up time in our study was 43 months (13 -81). Mean disease-free survival was 67.43 months and overall survival was 72.87 months. The overall and disease-free survival rate was 86.7 % and 80%. Conclusions: In our study, most patients responded to the treatment and are still being followed in remission.