Tıp Fakültesi / Faculty of Medicine
Permanent URI for this collectionhttps://hdl.handle.net/11727/1403
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Item Determination of Risk Factors for Postoperative Acute Kidney Injury in Patients With Gynecologic Malignancies(2023) Doganci, Melek; Zeyneloglu, Pinar; Kayhan, Zeynep; Ayhan, Ali; 37575800; IVV-1127-2023; C-3736-2018; AAJ-4623-2021BackgroundPostoperative acute kidney injury (AKI) is an important cause of mortality and morbidity among surgical patients. There is little information on the occurrence of AKI after operations for gynecologic malignancies. This study aimed to determine the incidence of AKI in patients who underwent surgery for gynecological malignancies and determine the risk factors in those who developed postoperative AKI. MethodologyA total of 1,000 patients were enrolled retrospectively from January 2007 to March 2013. AKI was defined according to the Kidney Disease Improving Global Outcomes 2012 Clinical Practice Guideline for Acute Kidney Injury. Perioperative variables of patients were collected from medical charts.ResultsThe incidence of postoperative AKI was 8.8%, with stage 1 occurring in 5.9%, stage 2 in 2.4%, and stage 3 in 0.5% of the patients. Patients who had AKI were significantly older, had higher body mass index (BMI) higher preoperative C-reactive protein (CRP) levels, and more frequently had a history of distant organ metastasis when compared with those who did not have AKI. When compared with patients who did not develop AKI postoperatively, longer operation times and intraoperative usage of higher amounts of erythrocyte suspension and fresh frozen plasma were seen in those who developed AKI. ConclusionsPatients who had AKI were older, had higher BMI with higher preoperative CRP levels, more frequent distant organ metastasis, longer operation times, and higher amounts of blood transfused intraoperatively. Defining preoperative, intraoperative, and postoperative risk factors for postoperative AKI and taking necessary precautions are important for the early detection and intervention of AKI.Item Carrier Screening Programs for Rare Diseases in Developed Countries and the Case of Turkey: A Systematic Review(2023) Fidan, Caglar; Akdur, Recep; Unver, Cigdem Naz; Sahin, Omer Can; Alper, Asli Begum; Ayhan, Ali; 37662625Effective control of rare diseases requires health programs based on principles of protection and prevention. Carrier screening programs serve as preventive measures by identifying at -risk groups. This review examines the impact, implementation, advantages, and disadvantages of carrier screening, incorporating examples from ten countries: the United States, Canada, the United Kingdom, Israel, China, Australia, Italy, Germany, the Netherlands, and Turkey. Data on carrier screening and related policies were collected from July to November 2022 and presented in a tabular format using a coding system devised by the authors. Variability was observed in the diseases/disorders and populations screened, screening expenses, and government provision across the countries. The number of diseases/disorders examined, ranging from 3 to 47, was determined by committee guidelines, government resources, pilot studies, and national institute resources. Notably, carrier screening programs exhibited greater worldwide inconsistency compared to newborn screening programs. The comparative analysis of developed countries serves to guide emerging nations. To address inequalities at both local and global levels, there is a need to enhance the establishment, development, and implementation of carrier screening programs. Furthermore, cost analyses of screening should be conducted, and adequate funding should be allocated to countries. In conclusion, this review highlights the preventive potential of carrier screening for rare diseases and emphasizes the importance of improving carrier screening programs globally to achieve equitable healthcare outcomes.Item Evaluation of Colposcopy After the Addition of Human Papillomavirus Testing to the Turkish Cervical Cancer Screening Program(2023) Gunes, Ali Can; Ozgul, Nejat; Turkyilmaz, Murat; Kara, Fatih; Unlu, Fahriye; Ayhan, Ali; Gultekin, Murat; 37994572Objective: To evaluate colposcopy performance following the human papillomavirus (HPV) DNA screening program in Turkey. Methods: Women aged 30-65 years are screened for cervical cancer every 5 years, with individuals positive for HPV 16 and/or 18 or other high-risk HPV types with abnormal cytology referred for colposcopy. Both HPV test and cytology are obtained at the same visit. If HPV is negative, cytology will not be assessed. However, if HPV is positive, both cytology and HPV genotyping will be performed. Colposcopy-require was defined as HPV 16/18 positivity or abnormal smear results with any hrHPV positivity, and the remaining patients (normal smear with hrHPV positivity other than HPV 16/18) were grouped as colposcopy non-required. National data on colposcopy outcomes and unnecessary performance rates in February 2018-2019 were evaluated via a questionnaire. Results: A total of 9808 patients were included, divided based on colposcopy requirement: 5751 (58.6%) patients required colposcopy and 4057 (41.4%) did not. Unnecessary colposcopy was performed on 90.1% of the non-required group (3657 of 4057 patients). In the colposcopy-required group, 4455 patients (79.9%) underwent punch biopsy; 3194 (57.1%), endocervical curettage (ECC); and 421 (7.5%), "see and treat" in the non-required group, the results were 2790 (76.3%), 1957 (53.2%), and 211 (5.7%), respectively. A total of 746 cervical intraepithelial neoplasia (CIN)-3 isolates were detected, including 702 using existing screening and triage with 94.1% sensitivity (702/746). Multiple biopsies were taken in 69.8% (n = 3110) of patients from the colposcopy-required group and 63.7% (n = 1777) from the non-required group. The ECC samples included 19 cervical cancers and 212 >= CIN-3 lesions in the colposcopy-required group, and four cancers and 41 >= CIN-3 lesions in the non-required group. The proportion of >= CIN-3 lesions detected by ECC only was 4.7% (35 of 746 >= CIN-3 lesions). Conclusion: Our results showed high rates of unnecessary colposcopies, and a high percentage of multiple and random punch biopsies and ECC.Item The Impact of Hospital Surgical Volume on Survival in Early-Stage Cervical Cancer Treated with Radical Hysterectomy: A Sub-Analysis of the Sccan Study(2022) Bizzarri, Nicolo; Dostalek, Lukas; Lonkhuijzen, Luc R. C. W.; Giannarelli, Diana; Lopez, Aldo; Falconer, Henrik; Querleu, Denis; Ayhan, Ali; Kim, Sarah H.; Isla Ortiz, David; Klat, Jaroslav; Obermair, Andreas; Landoni, Fabio; Rodriguez, Juliana; Manchanda, Ranjit; Kostun, Jan; Ramirez, Pedro T.; Meydanli, Mehmet M.; Odetto, Diego; Laky, Rene; Zapardiel, Ignacio; Weinberger, Vit; Dos Reis, Ricardo; Anchora, Luigi Pedone; Amaro, Karina; Salehi, Sahar; Akilli, Huseyin; Abu Rustum, Nadeem R.; Salcedo Hernandez, Rosa A.; Javurkova, Veronika; Mom, Constantijne H.; Scambia, Giovanni; Cibula, David; 0000-0002-5240-8441; AAX-3230-2020Item Role of Adjuvant Therapy in Intermediate-Risk Cervical Cancer Patients - Sccan Study Sub-Analysis(2022) Cibula, David; Akilli, Huseyin; van Lonkhuijzen, Luc R. C. W.; Fagotti, Anna; Dostalek, Lukas; Isla Ortiz, David; Meydanli, Mehmet Mutlu; Abu-Rustum, Nadeem R.; Odetto, Diego; Landoni, Fabio; Presl, Jiri; Klat, Jaroslav; Falconer, Henrik; Lopez, Aldo; dos Reis, Ricardo; Zapardiel, Ignacio; Laky, Rene; Mom, Constantijne H.; Bizzarri, Nicolo; Ayhan, Ali; 0000-0002-5240-8441; AAX-3230-2020Item Deep Cervical Injection: A Novel Technique to Increase Bilateral Sentinel Lymph Node Detection Rate in Endometrial Cancer Patients with Indocyanine Green (Trsgosln-008)(2022) Vatansever, Dogan; Altin, Duygu; Giray, Burak; Taskin, Salih; Donmez, Emin; Tokgozoglu, Nedim; Guler, Abdul Hamid; Tasci, Tolga; Bese, Tugan; Turan, Hasan; Kahramanoglu, Ilker; Yalcin, Ibrahim; Celik, Cetin; Demirkiran, Fuat; Gungor, Mete; Ortac, Firat; Kose, Faruk; Arvas, Macit; Ayhan, Ali; Taskiran, Cagatay; 0000-0003-1902-8014; HIR-3028-2022Item The utility of 1.5 tesla MR-guided adaptive stereotactic body radiotherapy for recurrent ovarian tumor - Case reports and review of the literature(2022) Yavas, Guler; Kuscu, Ulku Esra; Ayhan, Ali; Yavas, Cagdas; Onal, Cem; 36261943Introduction: Although epithelioid ovarian cancer (EOC) is a radiosensitive tumor and radiotherapy (RT) played a significant role in adjuvant treatment management in the past, the role of RT has evolved with the advent of platinum-based chemotherapy regimens. Nonetheless, modern RT techniques may be useful in certain patients particularly those with recurrent disease.Presentation of case: After surgery and chemotherapy, two patients, aged 57 and 70, presented with recurrent lesions in the parailiac region. The recurrent lesions were treated with high field 1.5-Tesla MR-Linac treatment in 5 fractions at a dose of 30 Gy. The patients tolerated the treatment well and were disease free after 12 and 20 months of magnetic resonance guided radiotherapy (MRgRT), respectively.Discussion: MRgRT is a novel and rapidly evolving technology that allows for the highly precise treatment of even mobile targets through direct visualization of the tumor. The majority of patients with EOC frequently present with abdominal-pelvic recurrences. It has been demonstrated that EOC requires high radiation doses for curative treatment. MR-Linac enables monitoring of organ motion during treatment, which is necessary for delivering higher doses to target volumes while sparing surrounding organs.Conclusion: To reduce radiation doses to nearby normal tissues, MRgRT allows for the delivery of hypofractio-nated RT with tight safety margins. Regardless of initial resistance or gradual development of intolerance to standard chemotherapy regimens, the role of RT in patients with persistent or recurrent EOC should be reconsidered.Item Perioperative SARS-CoV-2 infection among women undergoing major gynecologic cancer surgery in the COVID-19 era: A nationwide, cohort study from Turkey(2021) Ayhan, Ali; Oz, Murat; Ozkan, Nazli Topfedaisi; Aslan, Koray; Altintas, Mufide Iclal; Akilli, Huseyin; Demirtas, Erdal; Celik, Osman; Ulgu, Mustafa Mahir; Birinci, Suayip; Meydanli, Mehmet Mutlu; 0000-0002-5240-8441; 33223221; AAJ-5802-2021; AAX-3230-2020Objective. The objective of this study was to determine the rate of perioperative SARS-CoV-2 infection among gynecologic cancer patients undergoing major surgery. Methods. The database of the Turkish Ministry of Health was searched in order to identify all consecutive gynecologic cancer patients undergoing major surgery between March 11, 2020 and April 30, 2020 for this retrospective, nationwide, cohort study. The inclusion criteria were strictly founded on a final histopathological diagnosis of a malignant gynecologic tumor. COVID-19 cases were diagnosed by reverse transcriptase polymerase chain reaction testing for SARS-CoV-2. The rate of perioperative SARS-CoV-2 infection and the 30-day mortality rate of COVID-19 patients were investigated. Results. During the study period, 688 women with gynecologic cancer undergoing major surgery were identified nationwide. The median age of the patients was 59 years. Most of the surgeries were open (634/688, 92.2%). There were 410 (59.6%) women with endometrial cancer, 195 (28.3%) with ovarian cancer, 66 (9.6%) with cervical cancer, 14 (2.0%) with vulvar cancer and 3 (0.4%) with uterine sarcoma. The rate of SARS-CoV-2 infections confirmed within 7 days before or 30 days after surgery was 46/688 (6.7%). All but one woman was diagnosed postoperatively (45/46, 97.8%). The rates of intensive care unit admission and invasive mechanical ventilation were 4/46 (8.7%) and 2/46 (4.3%), respectively. The 30-day mortality rate was 0%. Conclusion. In the COVID-19 era, gynecologic cancer surgery may be performed with an acceptable rate of perioperative SARS-CoV-2 infection if the staff and the patients strictly adhere to the established infection control measures. (c) 2020 Elsevier Inc. All rights reserved.Item Factors affecting parametrial involvement in cervical cancer patients with tumor size <= 4 cm and selection of low-risk patient group(2021) Akilli, Huseyin; Tohma, Yusuf Aytac; Gunakan, Emre; Kucukyildiz, Irem; Tunc, Mehmet; Haberal, Nihan Reyhan; Ayhan, Ali; 0000-0002-5240-8441; 0000-0001-9418-4733; 0000-0001-8854-8190; 0000-0001-9852-9911; 33506671; AAX-3230-2020; AAE-6482-2021; ABI-1707-2020; AAK-4587-2021Objective: The primary aim of this study was to evaluate the factors affecting parametrial involvement in cervical cancer patients with tumor size <= 4 cm and selection of the low-risk patient group based on long-term oncologic outcomes. Material and Methods: Cervical cancer patients operated in the gynecologic oncology division between 2007 and 2013 were retrospectively evaluated. One-hundred and sixty-eight patients with tumor size <= 4 cm were identified. Of these, 159 (86.8%) underwent radical hysterectomy plus pelvic-para- aortic lymphadenectomy and nine (13.2%) underwent fertility-sparing surgery [radical trachelectomy (n= 7); large conization (n=2)]. Factors affecting parametrial invasion, including lymphovascular space invasion (LVSI), deep stromal invasion (DSI), lymph node metastases, and tumor size, were evaluated. Statistical analyses were performed using SPSS 23.0 (IBM Corp., Armonk, NY, USA). Results: Median age was 49.5 years and median tumor size was 2.5 cm ( 0.45-4 cm). In both univariate and multivariate analyses, the risk of parametrial involvement was increased with LVSI with a hazard ratio (HR) of 3.45 [95% confidence interval (CI): 1.1-10.8] and DSI with a HR of 4.1 (95% CI: 1.18-14.8), while tumor size of <= 2 cm was only significant in univariate analyses. Furthermore, 26 early-stage patients were identified with low-risk factors and they had no parametrial involvement, lymph node metastases, recurrence, or death from disease over 77 months. Conclusion: Parametrial involvement in low-risk cervical cancer is very rare and less radical procedures may be safe in these patients.Item Feasibility of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer During COVID-19 Pandemic(2021) Ayhan, Ali; Yilmaz Baran, Safak; Vatansever, Dogan; Dogan Durdag, Gulsen; Celik, Husnu; Taskiran, Cagatay; Akilli, Huseyin; 0000-0001-5874-7324; 0000-0002-5240-8441; 33858953; AAX-3230-2020Objective This study aims to evaluate the effect of the COVID-19 pandemic and related restrictions on patients who underwent cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (HIPEC) for ovarian cancer. Methods We retrospectively evaluated ovarian cancer patients who underwent HIPEC following complete cytoreductive surgery performed during the outbreak of the COVID-19 pandemic in three different centers specializing in gynecological oncology. All patients who underwent cytoreduction plus HIPEC for a primary, interval, and recurrent surgery were evaluated. Primary outcomes was postoperative 30-day morbidity and mortality. The secondary outcome was infection of patient and/or related staff with COVID-19 during the perioperative or early postoperative period. Results We performed a total of 35 HIPEC procedures during the pandemic: 15 (42.9%) patients underwent primary/interval surgery, while 20 (57.1%) patients had recurrent disease. Grade 3-4 complications occurred in one patient (2.9%) (chronic renal failure), while mortality did not occur in any patient. Neither the patients nor related staff were infected with the coronavirus during the perioperative or early postoperative period. One patient, who was diagnosed with COVID-19 pneumonia on postoperative day 80 died from the infection. Another patient died on postoperative day 85 due to progressive ovarian cancer, a disorder in vital functions, and organ failure. Conclusion HIPEC during the COVID-19 pandemic seems a safe and feasible procedure, with acceptable morbidity and mortality rates. Careful selection of patients is important and precautions should be taken before the procedure.