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Öğe 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 CemAim: 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.Öğe Clinical value of neutrophil/lymphocyte ratio in predicting postoperative complications, lymph node positivity and prognosis in gastric cancer patients who underwent curative surgical resection(2019) Topal, Ugur; Unal, Ayse Gizem; Yalav, OrcunAim: In this study, we aimed to determine the clinical value of neutrophil / lymphocyte ratio (NLR) in predicting postoperative complications, lymph node positivity and prognosis in patients who underwent curative surgical resection.Material and Methods: Patients who underwent total gastrectomy for gastric adenocarcinoma between 2015 and 2018 were included in the study. Two groups, Group 1 (LowNLR) and Group 2 (HighNLR), were formed. Demographic and clinical characteristics, intraoperative and postoperative outcomes, and mean survival were compared. The value of NLR in predicting lymph node positivity and postoperative complications was evaluated at the cutoff value determined for NLR.Results: Patients were divided into two groups according to the cutoff value of 2.14. Group 1 consisted of 36 patients and Group 2 consisted of 68 patients. Female sex was higher in Group 2 (72% vs 52%) (p:0.41). Postoperative complication rates according to Clavien Dindo classification were similar (p:0.9). The number of dissected positive lymph nodes was higher in Group 2 than in Group 1 (9 vs 6) (p:0.041). Pathological stage (p:0.188), and overall survival (24.61vs21.12,p:0.206) were similar between the groups. We found NLR as a risk factor for survival in multivariate analysis (HR=0.255, 95%CI: 0.024–0.427, p:0.029). If the NLR value was less than 2.14, the patient had According to Clavien Dindo classification Grade 2 and above complications, with a sensitivity of 46.3% and specificity of 76.0%. A positive lymph node was detected with 44.26% sensitivity and 65.12% specificity. Conclusion: Preoperative high NLR is a risk factor for survival in patients with gastric cancer. High NLR is also closely associated with the risk of postoperative complications.Öğe Comparison of results of laparoscopic and open surgical techniques in adrenal masses larger than 6 cm(2019) Topal, Ugur; Dalci, Kubilay; Yalav, Orcun; Unal, Ayse Gizem; Eray, Ismail Cem; Sakman, GurhanAim: In this study, we aimed to compare the results of conventional and laparoscopic adrenalectomy in patients with adrenal masses greater than 6 cm.Material and Methods: Thirty-six patients with tumor size greater than 6 cm who underwent adrenalectomy between January 2011 and January 2018 were included in the study. Patients were divided into two groups as Group 1 conventional and Group 2 Laparoscopic surgery. The two groups were retrospectively compared in terms of age, sex, mass localization, mass size, duration of operation, amount of bleeding, duration of hospitalization, duration of onset of food intake, perioperative mortality, early period complications and re-admission to the hospital within 90 days. P0.05 was considered statistically significant.Results: There were 13 patients in Group 1 and 23 patients in Group 2. There was no statistically significant difference between the groups in terms of age, sex, tumor localization, tumor size, indications for operation, postoperative complications, perioperative mortality and readmission within 90 days. Duration of operation (min), amount of bleeding (ml), duration of oral intake (day) and duration of hospitalization (day) were higher in Group 1 and statistically significant.Conclusion: Laparoscopic adrenalectomy has demonstrated advantages in patients with a mass greater than 6 cm compared to conventional surgery, such as short operation duration, less blood loss, early onset of oral food intake and shorter hospital stay. It can be safely used in patients with a mass larger than 6 cm.Öğe 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 KaanAim: 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.Öğe The impact of previous open abdominal surgery on the outcome of laparoscopic colorectal surgery(2021) Eray, Ismail Cem; Topal, Ugur; Yalav, Orcun; Dalci, Kubilay; Saritas, Ahmet Gokhan; Rencuzogullari, AhmetAim: Although the laparoscopic approach is increasingly being used in colorectal surgery, it is anticipated that the technical problems caused by previous abdominal open surgery (PAOS) will adversely affect the outcomes. The aim of this study was to evaluate the outcomes of previous abdominal surgery in patients with colorectal cancer who underwent laparoscopic surgery for treatment. Material and Methods: Among the patients who underwent laparoscopic surgery for colorectal cancer between January 2015 and December 2018, those who had a history of previous abdominal surgery and those who did not were compared. Those with a history of laparoscopic abdominal surgery are not included in the PAOS group and short-term postoperative complications, conversion to open surgery, reoperations, hospital readmissions, and mortality rates were analyzed between the groups. Results: 21 of 140 patients who underwent laparoscopic surgery for colorectal cancer had PAOS. The groups with and without PAOS were similar in terms of age, sex, body mass index, ASA score, and comorbid disease. No difference was observed regarding conversion to open surgery (p = 0.513), postoperative complications (p> 0.05), reoperations (p = 0.162), unplanned hospital readmissions (p = 0.154), and perioperative mortality (p = 0.136) between the two groups. Conclusion: We believe that laparoscopy can be safely performed in patients with colorectal cancer who had previous abdominal open surgery with similar clinical and postoperative complication rates as in patients without a history of PAOS.Öğe Predictive factors associated mortality after gastrectomy(2020) Yalav, Orcun; Topal, UgurAim: In this study, we aimed to identify the risk factors associated with postoperative mortality after gastrectomy.Surgical resection is the only potentially curative method for gastric cancer and is associated with severe morbidity and mortality. Material and Methods: Patients who underwent gastrectomy for gastric cancer in a single center between September 2015 and September 2018 were evaluated retrospectively. The relationship between postoperative mortality and clinical variables of the patients, tumor characteristics and 10 variables related to intraoperative characteristics were analyzed.Results: 133 patients were included in our study. Postoperative mortality occurred in 10 patients. Our postoperative mortality rate was 7.5%. Male sex (HR = 0.664, 95% CI =0.460–0.961, p=0.030), tumor localization (linitis plastica (HR = 3.594, 95% CI =1.375–9.390, p=0.009), tumor stage 3C (HR =1.713, 95% CI =0.906–3.239, p=0.0032) total gastrectomy (HR = 1.918 95% CI =1.042–3.532, p=0.036), conventional (open) surgery (HR = 2.807 95% CI =1.546–5.096, p= 0.001), operation duration >240 min (HR = 1.758, 95 % CI =1.064–2.906, p= 0.028), was independently associated with an increased risk of postoperative mortality. Age >60 (p=0.463), body mass index (p=0.414), ASA score >3 p=0.862, intraoperative blood loss >300 (p=0.083) and additional organ resection (p=0.649) were not independent risk factors for mortality.Conclusion: Anastomotic leakage was associated with male sex, obesity, and tumor localization. Anastomotic leakage is related with poor survival. Determining the risk factors after gastrectomy guides us in the management of patients at risk for postoperative mortality.Öğe Risk factors for leakage after total gastrectomy(2020) Yalav, Orcun; Topal, UgurAim: Although many studies report risk factors for anastomotic leakage after gastrectomy for gastric cancer (GC), there are conflicting results in the literature. In this study, we aimed to identify the risk factors associated with anastomotic leakage after gastrectomy. Material and Methods: Patients who underwent total gastrectomy for gastric cancer in a single center between September 2015 and September 2018 were evaluated retrospectively. The relationship between anastomotic leakage and clinical variables, tumor characteristics and intraoperative characteristics of 18 parameters were analyzed. The relationship between anastomotic leakage and survival was evaluated.Results: A total of 102 patients were included in the study. Anastomotic leakage rate was 9.81% (10/102). A significant relationship was not determined between anastomotic leakage and age >60 (p:0.232), diabetes mellitus (p:0.334), ASA score >3 (p:0.587), albumin 300 (p:0.582), and operation duration >300 min (p:0.176). Multivariate regression analysis, showed female sex (p: 0.05), body mass index (BMI) >30 (p:0.024) and tumor localization (p:0.005) are independent risk factors for anastomotic leakage. There was a significant difference in mean survival between patients with and without anastomotic leakage (13.9 vs 34.9 months, p: 0.006). Conclusion: Anastomotic leakage was associated with female sex, obesity, and tumor location. We also found that anastomotic leakage adversely affects long-term survival. Detecting risk factors after gastrectomy guides us in the management of patients at the risk for anastomotic leakage.
