Should there be a specific length of the colon-rectum segment to be resected for an adequate number of lymph nodes in cases of colorectal cancers? A retrospective multi-center study.

OBJECTIVES: This study aimed to evaluate the question as to whether there should be a certain length of the colon-rectum segment to be resected for correct lymph node staging in cases with colorectal cancer. MATERIAL AND METHODS: The files and electronic datas of the patients had been undergone surgery for colorectal cancer between January 2011 and June 2016 were evaluated. The patients were divided into two groups; Group I= ≥ 12 lymph nodes, and Group II= lymph nodes less than 12 ( <12) lymph nodes. RESULTS: Mean age of the 327 participants in this study was 64.30 ± 12.20. Mean length of resected colon-rectum segment was 25.61 (± 14.07) cm; mean number of dissected lymph nodes was 20.63 ± 12.30. Median length of the resected colon was 24 cm (range: 145-6) in Group I and 20 cm (range: 52-9) in Group II; a significant difference was found between the groups (p= 0.002). Factors associated with adequate lymph node dissection included type of the operation (p= 0.001), tumor location (p= 0.005), tumor T stage (p= 0.001), condition of metastasis in the lymph node (p= 0.008) and stage of the disease (p= 0.031). Overall survival was 62.4 ± 1.31 months, and Group I and Group II survival was 61.4 ± 1.39 months and 66.7 ± 3.25 months, respectively (p= 0.449). CONCLUSION: Results of the study showed that ≥ 12 lymph nodes would likely be dissected when the length of the resected colon-rectum segment is > 21 cm. We conclude that the removed colonic size can be significant when performed with oncological surgical standardization.

Usefulness of FGSI and UFGSI scoring systems for predicting mortality in patients with Fournier's gangrene: A multicenter study.

BACKGROUND: This study aimed to evaluate the usefulness of Fournier's gangrene scoring index (FGSI) and Uludag FGSI (UFGSI) for predicting mortality in patients with FG. METHODS: Patients who underwent treatment and follow-up in the A division department of general surgery at two education and research hospitals between January 2012 and December 2015 were evaluated for mortality-related factors. The sensitivities of FGSI and UFGSI scoring systems for predicting mortality-related factors and disease prognosis were evaluated. Patients were grouped as survivors (Group I) or non-survivors (Group II). RESULTS: In total, 29 patients were included in the study. The mean age (±SD) was 51.52±13.36 years. The mortality rate was 20.6% (six patients). Bacterial growth was observed in wound cultures of 17 patients (58.6%). Of the patients with bacterial growth, 11 (47.8%) were in Group I and six (100%) were in Group II. The presence of bacterial growth was significantly associated with mortality (p=0.028). Fourteen patients (48.3%) had comorbid conditions. The number of comorbid conditions was related (p=0.049). FGSI and UFGSI scores were significantly higher in Group II than in Group I (p=0.002 and p=0.001, respectively). Among UFGSI parameters, extent of disease, body temperature, pulse rate, and HCO3 values were significantly higher in Group II than in Group I (p<0.05). The FGSI and UFGSI scoring systems had 100% sensitivity and 78.2% and 73.9% specificity, respectively, for predicting mortality. CONCLUSION: The FGSI and UFGSI scoring systems are valuable for predicting mortality in patients with FG. The extent of the disease was an important prognostic parameter in this study. Whichever scoring system is used, we suggest the use of the extent of disease score in UFGSI.

Serum chitotriosidase activity in acute appendicitis: preliminary results.

Chitotriosidase is one of the most quantitative proteins secreted by activated macrophages, so its activity has been proposed as a biochemical marker of macrophage accumulation. The clinical importance of the chitotriosidase is still largely unknown. Our aim was to evaluate diagnostic accuracy of serum chitotriosidase activity in acute appendicitis (AA). A total of 34 patients with preoperative AA diagnosis (18 men and 16 women; mean age, 28.8±10.9 years) were enrolled in this study. The appendix specimens were classified as normal appendix (10 patients) and AA (24 patients). The serum chitotriosidase activity was measured preoperatively. Diagnostic value of the preoperative chitotriosidase activity as assessed through the corresponding receiver operating characteristic curve was well (area under the curve, 0.771; 95% confidence interval, 0.647-0.877; P<.05). Preoperative serum chitotriosidase activity may be a useful marker for diagnosis of AA, and future studies are required to confirm the results presented here.

Serum visfatin levels in acute appendicitis.

The clinical importance of the novel adipokine visfatin are still largely unknown. Our aim was to evaluate diagnostic accuracy of visfatin serum concentrations in Acute appendicitis(AA). Total of 34 patients with preoperative AA diagnosis (18 men and 16 women, mean age 28.8 +/- 10.9 years) were enrolled this study. The appendix specimens were classified as normal appendix (10 patients), acute appendicitis (24 patients). The serum levels of visfatin measured Diagnostic value of the preoperative serum visfatin levels as assessed through the corresponding ROC curve was well. (area under the curve [AUC] = 0.926, P < .001). In this small case series, visfatin level was found to be useful marker for diagnosis of AA.

Risk factors for surgical site infection after gastrectomy with D2 lymphadenectomy.

Surgical site infection (SSI) is a potentially morbid and costly complication of surgery. We conducted this study to establish the preoperative and operative factors predisposing to SSI after gastric resection and D2 lymphadenectomy. Data on all patients undergoing gastrectomy and D2 lymphadenectomy within a 2-year period, at a tertiary reference hospital in Turkey, were collected retrospectively. The outcome of interest was a diagnosis of incisional SSI as defined by the Centers for Disease Control and Prevention. Multivariate analysis by stepwise logistic regression was then performed on those variables associated with incisional SSI. We identified 72 patients with SSI after gastrectomy and D2 lymphadenectomy. The median age of the patients was 61 years (range 31-81 years) and 43 were men. Incisional SSI was diagnosed in 15 (20.8%) patients. Of all the preoperative and operative variables measured, an increased patient body mass index was an independent predictor of incisional SSI. An increased incidence of SSI was found in overweight patients, but these infections were transient and not life threatening.

Receiver operating characteristic analysis of leukocyte counts in operations for suspected appendicitis.

STUDY OBJECTIVE: There has been no clear-cut value of the white blood cell (WBC) count in differential diagnosis of acute appendicitis in emergency medicine. Therefore, the aim of this study was to assess the preoperative WBC counts in 3 groups of patients operated on for a clinical suspicion of acute appendicitis with different findings at appendectomy: uninflamed appendix, uncomplicated acute appendicitis, or complicated acute appendicitis. METHODS: The medical records of 540 patients who underwent appendectomy for suspected acute appendicitis during a 17-month period were retrospectively reviewed. Data for 3 groups of patients were analyzed to calculate the sensitivity and specificity of the WBC count in the diagnosis of acute appendicitis, and we calculated likelihood ratios for 2 cut-points with either high sensitivity or high specificity. Receiver operating characteristic curves were used to evaluate the WBC count in relation to the true diagnosis and severity of acute appendicitis. RESULTS: We were able to identify patients with appendicitis on a statistically significant level using receiver operating characteristic curves of WBC counts (area under the curve = 0.756, P < .001), but the WBC count had no diagnostic value in differentiating between uncomplicated and complicated groups (area under the curve = 0.55, P = .086). Likelihood ratio ranged from 1.79 (95% confidence interval, 1.17-2.3) for WBC count of more than 10,500 cells/mm(3) to 3.20 (95% confidence interval, 2.72-3.24) for WBC count of more than 14,300 cells/mm(3). CONCLUSION: White blood cell count is helpful in the diagnosis and exclusion of appendicitis. However, there is no value to differentiate advanced appendicitis.