PubMed İndeksli Yayınlar Koleksiyonu
Permanent URI for this collectionhttps://hdl.handle.net/11727/4810
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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 Survival impact of number of removed para-aortic lymph nodes in stage I epithelial ovarian cancer(2021) Gunakan, Emre; Akilli, Huseyin; Kara, Atacan Timucin; Altundag, Ozden; Haberal, Asuman Nihan; Meydanli, Mehmet Mutlu; Ayhan, Ali; 0000-0002-5240-8441; 0000-0003-0197-6622; 0000-0001-8854-8190; 34410474; AAX-3230-2020; W-9219-2019; ABI-1707-2020Purpose The survival effect of presence or absence of lymphadenectomy in early-stage epithelial ovarian cancer (EOC) was priorly shown but the effect of number of removed lymph nodes kept in background. We aimed to evaluate the survival impact of number of removed lymph nodes and their localizations in stage I EOC. Methods This study included 182 patients. The best cut-off levels for number of pelvic and para-aortic lymph nodes (PaLN) were 24 and 10, respectively. Univariate and multivariate survival analyses were performed for these cut-offs and other prognostic factors. Results The median age of the patients was 49. The median number of removed pelvic and paraartic lymph nodes were 29 and 9, respectively. The median overall (OS) and progression-free survival (PFS) were 67 and 50 months, respectively. The 5-year OS rate was 89.6%. Recurrence occured in 24 (19.5%) patients. In univariate analyses tumor grade (p: 0.005), pelvic LN number (p: 0.041) and PaLN number (p: 0.004) were the factors that were significantly associated with PFS. Tumor grade and PaLN number were independently and significantly associated with PFS in multivariate analyses (p: 0.015 and p: 0.017, respectively). In OS analyses, age, tumor grade, presence of LVI, number of pelvic and PaLNs were the significantly associated factors (p < 0.05 for all). In multivariate analyses, age and PaLN number were independently and significantly associated with OS (p: 0.011 and p: 0.021, respectively). Conclusions The number and localizations of removed lymph nodes may have a survival affect in stage I EOC. We also think that this study may constitute a kernel point for larger prospective series on lymph node number and lymphatic regions.Item Perspectives, fears and expectations of patients with gynaecological cancers during the COVID-19 pandemic: A Pan-European study of the European Network of Gynaecological Cancer Advocacy Groups (ENGAGe)(2020) Ayhan, Ali; Akilli, Huseyin; 33205595; AAJ-5802-2021; AAX-3230-2020Background The impact of the COVID-19 pandemic on European gynaecological cancer patients under active treatment or follow-up has not been documented. We sought to capture the patient perceptions of the COVID-19 implications and the worldwide imposed treatment modifications. Methods A patient survey was conducted in 16 European countries, using a new COVID-19-related questionnaire, developed by ENGAGe and the Hospital Anxiety & Depression Scale questionnaire (HADS). The survey was promoted by national patient advocacy groups and charitable organisations. Findings We collected 1388 forms; 592 online and 796 hard-copy (May, 2020). We excluded 137 due to missing data. Median patients' age was 55 years (range: 18-89), 54.7% had ovarian cancer and 15.5% were preoperative. Even though 73.2% of patients named cancer as a risk factor for COVID-19, only 17.5% were more afraid of COVID-19 than their cancer condition, with advanced age (>70 years) as the only significant risk factor for that. Overall, 71% were concerned about cancer progression if their treatment/follow-up was cancelled/postponed. Most patients (64%) had their care continued as planned, but 72.3% (n = 892) said that they received no information around overall COVID-19 infection rates of patients and staff, testing or measures taken in their treating hospital. Mean HADS Anxiety and Depression Scores were 8.8 (range: 5.3-12) and 8.1 (range: 3.8-13.4), respectively. Multivariate analysis identified high HADS-depression scores, having experienced modifications of care due to the pandemic and concern about not being able to visit their doctor as independent predictors of patients' anxiety. Interpretation Gynaecological cancer patients expressed significant anxiety about progression of their disease due to modifications of care related to the COVID-19 pandemic and wished to pursue their treatment as planned despite the associated risks. Healthcare professionals should take this into consideration when making decisions that impact patients care in times of crisis and to develop initiatives to improve patients' communication and education.Item Frontline fighters: the continued fight against COVID-19(2020) Akilli, Huseyin; Celik, Husnu; Taskiran, Cagatay; Bilir, Esra; Gultekin, Murat; 0000-0003-4499-6543; 32447293; J-3456-2015Item Risk factors for sexual dysfunction in pregnant women during the COVID-19 pandemic(2020) Karakas, Latife A.; Azemi, Asli; Simsek, Seda Y.; Akilli, Huseyin; Esin, Sertac; 0000-0001-9577-4946; 0000-0001-7369-5470; 33141928; AAI-8810-2021; AAI-8793-2021Objective To evaluate the level of sexual function during the COVID-19 pandemic in pregnant women followed up in Baskent University Faculty of Medicine, Turkey, using the Female Sexual Function Index (FSFI). Methods An observational analysis was performed on pregnant women who were not infected with COVID-19. A total of 135 pregnant women (group 1), 45 of whom were in the first trimester, 45 in the second trimester, and 45 in the third trimester, and 45 healthy women who were not pregnant (group 2), were included in the study. The FSFI was used to assess sexual dysfunction status. Results A total of 118 (87.4%) pregnant participants and 31 (68.9%) non-pregnant participants were diagnosed as having sexual dysfunction according to the FSFI. When comparing groups 1 and 2, FSFI scores were significantly lower in group 1 (p = 0.002). It was also found that women who had university degrees, were multiparous, and in the third trimester were more likely to develop sexual dysfunction (p = 0.030, p = 0.029, and p = 0.001, respectively). FSFI scores were found to be significantly higher in planned pregnancies than in unplanned pregnancies (p = 0.001). Conclusion The sexual function of uninfected pregnant women decreased during the COVID-19 pandemic, negatively influenced by restrictive social distancing measures.