Fakülteler / Faculties
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Item Survival Associated with Extent of Radical Hysterectomy in Early-Stage Cervical Cancer: A Subanalysis of the Surveillance in Cervical Cancer (SCCAN) Collaborative Study(2023) Bizzarri, Nicolo; Querleu, Denis; Dostalek, Lukas; van Lonkhuijzen, Luc R. C. W.; Giannarelli, Diana; Lopez, Aldo; Salehi, Sahar; Ayhan, Ali; Kim, Sarah H.; Ortiz, David Isla; Klat, Jaroslav; Landoni, Fabio; Pareja, Rene; 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; Akilli, Huseyin; Abu Rustum, Nadeem R.; Salcedo Hernandez, Rosa A.; Javurkova, Veronika; Mom, Constantijne H.; Scambia, Giovanni; Falconer, Henrik; Cibula, David; 37336255BACKGROUND: International guidelines recommend tailoring the radicality of hysterectomy according to the known preoperative tumor characteristics in patients with early-stage cervical cancer.OBJECTIVE: This study aimed to assess whether increased radicality had an effect on 5-year disease-free survival in patients with early-stage cervical cancer undergoing radical hysterectomy. The secondary aims were 5-year overall survival and pattern of recurrence.STUDY DESIGN: This was an international, multicenter, retrospective study from the Surveillance in Cervical CANcer (SCCAN) collaborative cohort. Patients with the International Federation of Gynecology and Obstetrics 2009 stage IB1 and IIA1 who underwent open type B/C1/C2 radical hysterectomy according to Querleu-Morrow classification between January 2007 and December 2016, who did not undergo neoadjuvant chemotherapy and who had negative lymph nodes and free surgical margins at final histology, were included. Descriptive statistics and survival analyses were performed. Patients were stratified according to pathologic tumor diameter. Propensity score match analysis was performed to balance baseline characteristics in patients undergoing nerve-sparing and non-nerve-sparing radical hysterectomy.RESULTS: A total of 1257 patients were included. Of note, 883 patients (70.2%) underwent nerve-sparing radical hysterectomy, and 374 patients (29.8%) underwent non-nerve-sparing radical hysterectomy. Baseline differences between the study groups were found for tumor stage and diameter (higher use of non-nerve-sparing radical hysterectomy for tumors >2 cm or with vaginal involvement; P<.0001). The use of adjuvant therapy in patients undergoing nerve-sparing and non-nerve-sparing radical hysterectomy was 27.3% vs 28.6%, respectively (P=.63). Five-year disease-free survival in patients undergoing nerve-sparing vs non-nerve-sparing radical hysterectomy was 90.1% (95% confidence interval, 87.9-92.2) vs 93.8% (95% confidence interval, 91.1-96.5), respectively (P=.047). Non-nerve-sparing radical hysterectomy was independently associated with better disease-free survival at multivariable analysis performed on the entire cohort (hazard ratio, 0.50; 95% confidence interval, 0.31-0.81; P=.004). Furthermore, 5-year overall survival in patients undergoing nerve-sparing vs non-nerve-sparing radical hysterectomy was 95.7% (95% confidence interval, 94.1-97.2) vs non-nerve-sparing 96.5% (95% confidence interval, 94.3-98.7), respectively (P=.78). In patients with a tumor diameter <= 20 mm, 5-year disease-free survival was 94.7% in nerve-sparing radical hysterectomy vs 96.2% in non-nerve-sparing radical hysterectomy (P=.22). In patients with tumors between 21 and 40 mm, 5-year disease-free survival was 90.3% in non-nerve-sparing radical hysterectomy vs 83.1% in nerve sparing radical hysterectomy (P=.016) (no significant difference in the rate of adjuvant treatment in this subgroup, P=.47). This was confirmed after propensity match score analysis (balancing the 2 study groups). The pattern of recurrence in the propensity-matched population did not demonstrate any difference (P=.70).CONCLUSION: For tumors <= 20 mm, no survival difference was found with more radical hysterectomy. For tumors between 21 and 40 mm, a more radical hysterectomy was associated with improved 5-year disease free survival. No difference in the pattern of recurrence according to the extent of radicality was observed. Non-nerve-sparing radical hysterectomy was associated with better 5-year disease-free survival than nerve sparing radical hysterectomy after propensity score match analysis.Item Diagnosis and Treatment of Takayasu Arteritis in Turkey: A Single Center Results(2015) Akay, Tankut; Harman, Ali; Yucel, Eftal; Ozyer, Umut; Gultekin, Bahadir; 0000-0002-4300-009X; 0000-0002-7386-7110; AAK-9071-2021; ABA-7388-2021; K-9824-2013Background: This study aims to evaluate clinical, laboratory, and radiological features as well as the surgical and endovascular procedure outcomes of patients with Takayasu arteritis in our hospital. Methods: Hospital records of 38 patients who were followed with the diagnosis of Takayasu arteritis between April 2002 and January 2014 were retrospectively evaluated. Records included the clinical history of Takayasu arteritis, comorbid diseases, laboratory and angiographic findings at the time of diagnosis, and mode of treatment. Results: The female/male ratio was 3.75:1. According to angiographic classification; 11 patients were type 1, three patients were type 2a, three patients were type 2b, four patients were type 3, six patients were type 4, and 11 patients were type 5. Eighteen of 38 patients were administered endovascular or surgical intervention (8 surgeries and 10 endovascular procedures). There was no early mortality. Conclusion: Demographic and angiographic features of our patients were similar to those of Japan and Mediterranean populations. The long-term follow-up of endovascular procedure success, and the management of restenosis may be among challenges to be faced in the future. Bypass surgery remains the gold standard for achieving long-term patency. Endovascular treatment may provide short-term symptom relief in patients who are not suitable for surgical treatment.Item Emergency Cholecystectomy vs Percutaneous Cholecystostomy Plus Delayed Cholecystectomy for Patients with Acute Cholecystitis(2014) Karakayali, Feza Y.; Akdur, Aydincan; Kirnap, Mahir; Harman, Ali; Ekici, Yahya; Moray, Gokhan; https://orcid.org/0000-0002-1874-947X; https://orcid.org/0000-0002-8726-3369; https://orcid.org/0000-0002-7386-7110; https://orcid.org/0000-0003-2498-7287; 24919616; AAB-3888-2021; AAA-3068-2021; AAH-9198-2019; K-9824-2013; AAE-1041-2021BACKGROUND: In low-risk patients with acute cholecystitis who did not respond to nonoperative treatment, we prospectively compared treatment with emergency laparoscopic cholecystectomy or percutaneous transhepatic cholecystostomy followed by delayed cholecystectomy. METHODS: In 91 patients (American Society of Anesthesiologists class I or II) who had symptoms of acute cholecystitis 272 hours at hospital admission and who did not respond to nonoperative treatment (48 hours), 48 patients were treated with emergency laparoscopic cholecystectomy and 43 patients were treated with delayed cholecystectomy at 24 weeks after insertion of a percutaneous transhepatic cholecystostomy catheter. After initial treatment, the patients were followed up for 23 months on average (range 7-29). RESULT: Compared with the patients who had emergency laparoscopic cholecystectomy, the patients who were treated with percutaneous transhepatic cholecystostomy and delayed cholecystectomy had a lower frequency of conversion to open surgery [19(40%) vs 8(19%); P=0.029], a frequency of intraoperative bleeding >= 100 mL [16(33%) vs 4(9%); P=0.006], a mean postoperative hospital stay (5.3 +/- 3.3 vs 3.0 +/- 2.4 days; P=0.001), and a frequency of complications [17(35%) vs 4(9%); P=0.003]. CONCLUSION: In patients with acute cholecystitis who presented to the hospital 272 hours after symptom onset and did not respond to nonoperative treatment for 48 hours, percutaneous transhepatic cholecystostomy with delayed laparoscopic cholecystectomy produced better outcomes and fewer complications than emergency laparoscopic cholecystectomy.Item Mid-Term Results of Patients with Transposition of Great Arteries Who Underwent Senning Procedure(2014) Gursu, Hazim Alper; Varan, Birgul; Ozkan, Murat; Tokel, Kursat; Erdogan, Ilkay; https://orcid.org/0000-0002-0707-2678; https://orcid.org/0000-0002-6719-8563; https://orcid.org/0000-0002-6759-1795; https://orcid.org/0000-0001-6887-3033; AHI-4502-2022; ABB-1767-2021; AAF-3253-2021; ABB-2220-2021Background: This study aims to evaluate mid-term follow-up results for patients with transposition of great arteries to whom Senning procedure was performed. Methods: Files of 95 child patients (63 boys, 22 girls; mean age 15.2 +/- 23.9 months; range 1 month to 12.5 years), who were diagnosed with transposition of great arteries and underwent atrial switch operation in our institute, were retrospectively evaluated. In the follow-ups; physical examination, electrocardiography, and echocardiography were performed. In addition, ambulatory electrocardiography monitorization was conducted on 25 patients. Results: Out of 95 patients who were performed atrial switch operation, 10 died in the postoperative period. The mean follow-up period was 33.4 +/- 43.7 months (1-16 years; mean 18 months). During the follow-ups, arrhythmia was detected in 25.8% of the patients, stenosis of pulmonary venous baffle was detected in 21.2%, systolic dysfunction of the right ventricle was detected in 19%, severe tricuspid valve insufficiency was detected in 18.9%, and baffle leak was detected in 15.3%. Of the patients, 11.7% were operated a second time, and 8.2% were reoperated due to stenosis of pulmonary venous baffle. Conclusion: Short and mid-term results of Senning procedure are not satisfactory. Patients should be monitored for possible right ventricle dysfunction, arrhythmia, systemic valve insufficiency, and stenosis of the tunnel.Item A Paratyhroid Adenoma Case in Intensive Care Unit: Prognosis and Treatment Approach(2015) Altun, Dilek; Demir, Guray; Tulubas, Evrim; Cukurova, Zafer; Turhan, Ahmet; AAR-7467-2020Parathyroid adenoma is the most common cause of primary hyperparathyroidism. More than 80% of the patients are asymptomatic and are usually diagnosed with incidentally detected high serum calcium levels. Concominant elevated levels of serum calcium (Ca++) and parathyroid hormone (PTH) is important in definitive diagnosis. Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Here, we report a patient with high serum calcium levels related to parathyroid adenoma and treated in intensive care unit (ICU). 54 years old female patient who is under treatment of osteoporosis had the symptoms of muscle weakness, fatigue, dizziness, vomiting, dehydration, polyuria and depression. High serum Ca+ and PTH levels were returned to normal after surgical excision.Item Treatment of Moderate Sized Renal Pelvis Calculi: Stone Clearance Time Comparison of Extracorporeal Shock Wave Lithotripsy and Retrograde Intrarenal Surgery(2016) Ercil, Hakan; Alma, Ergun; Bas, Okan; Sener, Nevzat Can; Vuruskan, Ediz; Kuyucu, Faruk; Unal, Umut; Goren, Mehmet Resit; Evliyaoglu, Yalcin; https://orcid.org/0000-0002-2001-1386; 26945652; Y-6143-2019Purpose: To compare the stone clearance times in patients undergoing extracorporeal shock wave lithotripsy (SWL) or retrograde intrarenal surgery (RIRS) for single radiopaque renal pelvis stones 10-20 mm in size. The results of this study may guide urologists and patients and aid in selecting the optimal preoperative treatment. Materials and Methods: Between January 2013 and February 2015, we conducted a retrospective study and collected data from 333 patients treated with SWL (n = 172) or RIRS (n = 161). We included successfully treated patients with a single radiopaque renal pelvis stone 10-20 mm in size to calculate stone clearance times. Results: The average stone size for the SWL group was 14.62 +/- 2.58 mm and 14.91 +/- 2.92 mm for the RIRS group. The mean Hounsfield unit (HU) of the patients was 585.40 +/- 158.39 HU in the SWL group and 567.74 +/- 186.85 HU in the RIRS group. Following full fragmentation, the mean stone clearance time was 26.55 +/- 9.71 days in the SWL group and 11.59 +/- 7.01 days in the RIRS group (P <.001). Conclusion: One of the most overlooked parameters in urinary stone treatments is stone clearance. We believe this study will shed light for those who aim to conduct larger randomized prospective studies.Item Pancreatic Tumors in Children(2021) Gezer, Hasan Ozkan; Temiz, Abdulkerim; Ezer, Semire; Yazici, Nalan; Demir, Senay; Hasbay, Bermal; Oguzkurt, Pelin; 0000-0002-4635-2613; 0000-0002-4209-9075; 0000-0001-6702-7265; A-4719-2018; AAJ-9529-2021; AAM-5138-2021; AAK-9310-2021Objective: Pancreatic rumors in children are exceedingly rare and hence present diagnostic and therapeutic challenges to pediatric surgeons. In this study, we aimed to present our experiences and treatment outcomes related to these rare tumors. Methods: The clinical data, laboratory investigations, radiological imaging, and the pathology and surgical details of patients with pancreatic tumors who were diagnosed between 2005 and 2019 were retrospectively reviewed. Results: A total of 9 patients (5 men) were included in the study. The most common symptom at the time of presentation was vague abdominal pain. A pancreatic rumor was detected incidentally in 4 patients. All tumors were non-functional primary rumors. Histopathological diagnosis of these tumors were solid-pseudopapillary tumors (n=3), congenital pancreatic cysts (n=3), pancreatoblastoma (n=1), rhabdomyosarcoma (n=1), and an undifferentiated carcinoma (n=1). In addition, 8 patients were treated surgically (through tumor excision, central pancreatectomy + distal pancreaticojejunostomy, distal pancreatectomy, and cystogastrostomy). Two deaths from tumor dissemination were recorded. The patients were followed-up at a mean duration of 72 months (range: 6-120 months). Conclusion: Pediatric pancreatic tumors arc rare and are usually benign in nature. They present symptoms that are often nonspecific. In non-metastatic cases, surgical tumor removal is the preferred method for the treatment. For most tumors, surgical resection is the optimal treatment that may be successfully performed with low morbidity rate when the lesion is either in the body or in the tail of the pancreas. The long-term outcomes with this approach are generally good.Item Surgical treatment of consecutive exotropia: Comparison of different surgical methods applied to one eye in one session(2021) Sefi-Yurdakul, Nazife; Oto, Sibel; Pelit, Aysel; 0000-0003-2005-9256; 34308671; AAF-4678-2020Purpose: To compare the different surgical methods performed on a single eye in a single session and the factors that affect the success of patients having consecutive exotropia (XT) developed after esotropia surgery. Methods: The medical data of the patients who underwent surgery for consecutive XT were reviewed retrospectively. Patients with followed of 6 months or more were divided into four groups; patients with medial rectus (MR) advancement (Group 1 = 10), MR advancement and MR resection (Group 2 = 12), MR advancement and lateral rectus (LR) recession (Group 3 = 13), MR advancement, MR resection, and LR recession (Group 4 = 14). Success results and possible risk factors were investigated. Results: Forty-nine patients with consecutive XT (21 female, 28 male) were enrolled in the study. The mean age of overall patients was 22.97 years at surgery for consecutive XT. The groups did not display significant differences in terms of surgery ages, gender, refraction values, visual acuity, amblyopia, inferior oblique overaction, limitation of adduction, surgical success rates, and follow-up time (p > 0.05). Patients of Group 4 had larger preoperative and postoperative deviation, while Group 1 had smaller (p < 0.05). The surgical success rates of Groups 1, 2, 3, 4 were 90%, 75%, 76.9%, and 50%, respectively (p = 0.192). Statistically, no factor was found to be effective in surgical success rates (p > 0.05). Conclusion: Surgical treatment of consecutive XT is successful in most of the patients with numerous surgical options performed on a single eye in a single session. Patients, particularly with a high amount of deviation should be warned about the possibility of additional surgery.Item Impact of lymph node ratio in patients with stage IIIC endometrial carcinoma treated with postoperative radiotherapy(2021) Onal, Cem; Sari, Sezin Yuce; Yavas, Guler; Guler, Ozan Cem; Yiğit, Ecem; Oymak, Ezgi; Gultekin, Melis; Yildiz, Ferah; 0000-0002-2742-9021; 34355983; D-5195-2014Aim: To evaluate the prognostic value of the lymph node ratio (LNR) and other clinicopathological factors in patients with stage IIIC endometrial cancer. Methods: Factors affecting overall survival (OS) and progression-free survival (PFS) were assessed in 397 patients with stage IIIC endometrial cancer treated with postoperative radiotherapy. Patients undergoing the removal of at least ten lymph nodes were included in the study. Results: The 5-year OS and PFS rates were 58% and 52%, respectively, with a median follow-up time of 35.7 months. The LNR cutoff value was 9.6%. In the multivariate analysis, advanced age (>= 60 years), grade III tumor, presence of cervical stromal invasion, higher LNR and lack of adjuvant chemotherapy were independent predictors for worse OS and PFS. Conclusion: The LNR is an independent predictor for OS and PFS in patients with stage IIIC endometrial cancer treated with postoperative radiotherapy.Item The safety of major gynaecologic cancer surgery without routine preoperative COVID-19 testing in the COVID-19 era: a multicentre, retrospective, case-control study(2021) Akilli, Huseyin; Yetkinel, Selcuk; Celik, Husnu; Ayhan, Ali; 0000-0002-5240-8441; 34704523; AAX-3230-2020Our goal was to address the safety of major gynaecologic cancer surgery without routine preoperative COVID-19 testing in the COVID-19 era. The databases of seven gynaecologic cancer centres were searched in order to identify all consecutive gynaecologic cancer patients undergoing major surgery between March 11, 2020 and May 15, 2020 for this retrospective, case-control study. The case group consisted of patients with histopathologically confirmed gynaecologic cancers, and each case was matched with two counterparts who had undergone primary surgery before the COVID-19 pandemic. The case and the control groups were compared in terms of length of hospital stay, admission to the intensive care unit (ICU), intraoperative and postoperative complications. During the study period, 154 women with gynaecologic cancer undergoing major surgery were identified. Although the case group had more co-morbidities compared to the control group (103/154 vs. 178/308, respectively; p = .04), the median length of hospital stays, the rate of ICU admission, intraoperative complication rates and postoperative complication rates were similar in the two groups. Gynaecologic cancer surgery may be performed safely in the COVID-19 era with similar rates of ICU admission, intraoperative and postoperative complications compared to the patients operated before the COVID-19 pandemic.IMPACT STATEMENT What is already known on this subject? Many societies have announced their guidelines about the surgical management of gynaecologic cancer patients during the COVID-19 pandemic. However, most of them are not evidence-based and mostly on expert opinions. What do the results of this study add? The main findings of this retrospective, case-control study indicate that the short-term (30 day) outcomes of gynaecologic cancer patients undergoing major surgery in the COVID-19 era are similar to those who had been operated before the COVID-19 pandemic. The length of hospital stays, the rates of admission to the ICU, intraoperative and postoperative complications were comparable between women undergoing major gynaecologic cancer surgery in the COVID-19 era and the women who had been operated before the pandemic. What are the implications of these findings for clinical practice and/or further research? We can suggest that definitive surgery may be performed for gynaecologic cancer patients in the COVID-19 era if the resources permit and appropriate precautions such as social distancing, isolation and the use of personal protective equipment are taken.