Browsing by Author "Oncel, Mustafa"

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    Management and Outcomes of Major Pelvic Hemorrhage in Complex Abdomino-Pelvic Surgery
    (2023) Aytac, Erman; Sokmen, Selman; Ozturk, Ersin; Rencuzogullari, Ahmet; Sungurtekin, Ugur; Akyol, Cihangir; Demirbas, Sezai; Leventoglu, Sezai; Karakayali, Feza; Korkut, Mustafa Ali; Oncel, Mustafa; Gulcu, Baris; Canda, Aras Emre; Eray, Ismail Cem; Ozgen, Utku; Ersoz, Siyar; Ozer, Tahir; Ozerhan, Ismail Hakki; Bozbiyik, Osman; Haksal, Mustafa; Oral, Berke Mustafa; 0000-0002-6481-1473; 37816336; HKO-5077-2023
    Introduction: Hemorrhage is a challenging complication of pelvic surgery. This study aimed to analyze the causes, management and factors associated with morbidity in patients experiencing major pelvic hemorrhage during complex abdomino-pelvic surgery.Methods: Patients who had major intraoperative pelvic hemorrhage during complex abdomino-pelvic surgery at 11 tertiary referral centers between 1997-2017 were included. Patient characteristics, management strategies to control bleeding, short and long term postoperative outcomes were evaluated retrospectively.Results: There were 120 patients with a mean age of 56.6 +/- 2.4 years and a mean BMI of 28.3 +/- 1 kg/m(2). While 104 (95%) of the patients were operated for malignancy, 16(5%) of the patients had surgery for a benign disease. The most common bleeding site was the presacral venous plexus 90(75%). Major pelvic hemorrhage was managed simultaneously in 114(95 %) patients. Electrocauterization 27(23%), pelvic packing 26(22%), suturing 7(6%), thumbtacks application 7(6%), muscle welding 4(4%), use of energy devices 2(2%) and topical hemostatic agents 2(2%) were the management tools. Combined techniques were used in 43(36%) patients. Short-term morbidity and mortality rates were 48(40%) and 2(2%), respectively. High preoperative CRP levels(p=0.04), history of preoperative radiotherapy (p=0.04), longer bleeding time (p=0.006) and increased blood transfusion (p=0.005) were the factors associated with postoperative morbidity.Discussion/Conclusion: Postoperative morbidity related to major pelvic hemorrhage can be reduced by optimizing the risk factors. Prehabilitation prior to surgery to moderate inflammatory status and prompt action with proper technique to control major pelvic hemorrhage can prevent excessive blood loss in complex abdomino-pelvic surgery.
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    THE POTENTIAL PROGNOSTIC ROLE OF PERITUMORAL EOSINOPHILS WITHIN WHOLE TUMOR-ASSOCIATED INFLAMMATORY CELLS AND STROMAL HISTOLOGICAL CHARACTERISTICS IN COLORECTAL CANCER
    (2020) Ramadan, Saime; Saka, Burcu; Yarikkaya, Enver; Bilici, Ahmet; Oncel, Mustafa; 33112111
    We aimed to determine the prognostic role of whole tumor-associated inflammatory cells, especially eosinophils, and stromal histological characteristics in relation to other prognostic parameters in patients with colorectal carcinoma (CRC). A total of 122 patients who underwent an operation for CRC were included in this retrospective study. Conventional (tumor grade, TNM stage and venous invasion [VI]) and other histopathological (intratumoral/peritumoral budding {ITB/PTB], desmoplasia) tumor parameters were recorded and classified by density, as were the tumor-associated inflammatory parameters (intratumoral/peritumoral lymphocytes {ITL/PTL], eosinophils [IE/PTE], overall inflammation [ITI/PTI], Crohn-like inflammation [CLI]). Cancer-specific survival data were analyzed with respect to all tumor parameters. High ITB and PTB were significantly correlated with a higher rate of pT4, VI and desmoplasia (p < 0.05). An association of moderate ITL and extensive PTL with lesser likelihood of VI and metastasis; an association of extensive CLI with a significantly lower rate of metastasis and TNM stage IV; and minimal PTE with a significantly higher rate of pT4 stage, metastasis and ITB were detected (p < 0.05 for each). Our findings revealed that low score tumoral budding and an increase in tumor-related inflammation were associated with lesser likelihood of poor prognostic tumor parameters. Nonetheless, given the association of an increase in PTE with lesser likelihood of ITB, pT4, metastasis, and with non-significantly for better survival rates, our findings emphasize the potential role of peritumoral eosinophils as an additional prognostic parameter in CRC.