Prospective Study on Avoiding Seroma Formation by Flap Fixation After Modified Radical Mastectomy.

INTRODUCTION: Seroma development after mastectomy is a common complication. Continued seroma causes increased outpatient visits, repeated aspirations, infection, delayed healing, delayed adjuvant therapy, and increased cost. Various treatments are being attempted to prevent and reduce seroma development. We examined the effects of flap fixation on seroma using absorbable sutures after modified radical mastectomy (MRM). METHODS: The prospectively recorded data of patients who underwent surgery for breast cancer were analyzed retrospectively. 72 consecutive patients who underwent MRM were included in the study. Patients who underwent MRM in the same way by the same surgeon were divided into two groups: the group whose wound was closed by fixing the flap to the chest wall with an absorbable suture (group A), and the group whose wound was closed with the classical method (group B). The groups were compared in terms of seroma development, clinicopathological data, and early complications. RESULTS: Drain removal time and the total amount of drained fluid in group A patients were significantly lower than drain removal time and the total amount of drained fluid in group B patients (P < .001). Similarly, the amount of aspirated seroma in the control examinations of group A patients was significantly lower than that in group B (P < .05). Group B needed re-aspiration significantly more than group A (P < .05). CONCLUSIONS: Flap fixation with suture after MRM is a method that reduces seroma formation and the amount of drained fluid, enables early removal of the drain, prevents delay in starting adjuvant treatment, is more comfortable for the patient and physician, and is also inexpensive.

Machine learning in predicting gastric cancer survival Presenting a novel decision support system model.

BACKGROUND: Gastric cancer is the 4th most frequent cause of cancer-related deaths, with a 5-year survival rate of less than 40%. In recent years, many artificial intelligence applications have been used in the field of gastric cancer through their effective computing and learning ability. In this study, we aim to develop a software that can accurately detect overall survival in gastric cancer cases with the help of artificial intelligence and machine learning. METHODS: The study included 34417 patients' data diagnosed with gastric cancer between 2010 and 2015. The main hypothesis in the study was overall survival (OS) in years, defined from the date of diagnosis to the date of death or, for living patients, the last control date. In addition to survival, other variables selected for the analyzes were age at diagnosis, race, gender, behavior, primary site, grade, histology, T stage, N stage, M stage and size of the tumor, vital status, and follow-up time (months). RESULTS: The median overall survival of the patients was found to be 15.00±0.20 years. Median life expectancy was found to be 21.00±0.85 years for those younger than 50 years of age, 20.00±0.43 years for those aged 50-69 years, and 10.00±0.22 years for those aged 70 and over. Especially artificial intelligence techniques such as machine learning and deep learning lead to remarkable developments in the field of gastric cancer. CONCLUSION: With the ability to compute and learn we think that use of artificial intelligence will be revolutionary in gastric cancer in terms of diagnosis and prognosis. KEY WORDS: Artificial intelligence, Gastric cancer, Survival.

Determination of risk factors for conversion from laparoscopic to open appendectomy in patients with acute appendicitis.

BACKGROUND: Acute appendicitis is the most common cause of surgical emergencies. It can be difficult to distinguish cases of acute appendicitis that should be managed by laparoscopic appendectomy (LA) from those that should be managed by open surgery. This study aimed to prevent the inappropriate choice of technique and associated complications by identifying potential risk factors for conversion from laparoscopic to open appendectomy (OA) at the time of initial surgical assessment. METHODS: This is a retrospective analysis of patients who underwent laparoscopic exploration for acute appendicitis. The study included patients over 18 years of age between January 2016 and July 2021. Patients were divided into two groups according to the surgical approach: those who underwent a LA and those who initially underwent laparoscopic exploration first and then converted to OA. Demographics, perioperative factors, and outcomes were compared between groups. RESULTS: The study included 634 adults undergoing laparoscopic exploration for an appendectomy. About 80.8% had LA, and 19.2% (n=122) required COA. COA patients' average age was significantly higher than LA patients' (48.5 years vs. 37.8 years, P<0.001). The conversion rate for patients over 65 was 63.8%, compared to 15.6% for those under 65 (P<0.001). COA patients had higher bilirubin levels (36.1% vs. 13.5%, P<0.001), higher American Society of Anesthesiologists (ASA) scores (ASA >2, COA 52.5% vs. LA 7.8%, P<0.001), and a higher need for CT imaging (84.4% vs. 67.6%, P<0.001) than LA patients. An Alvarado score >6 significantly differenti-ated LA from COA (62.6% vs. 39.4%, P< p<0.001). COA patients experienced significantly increased periods until starting oral intake (31.6 vs. 9.9 h, P<0.001) and higher rates of complicated appendicitis (40.9% vs. 0.6%, P<0.001). After surgery, COA had higher rates of complications compared to LA: surgical site infections (8.2% vs. 2.7%, P=0.004), reoperation (13.1% vs. 0%, P<0.001), hospital re-admission (14.7% vs. 2.3%, P<0.001), and mortality (1.6% vs. 0%, P<0.004). CONCLUSION: Advanced age, especially over 65 years, elevated bilirubin levels, an ASA >2 score, and an increased need for pre-operative diagnostics using CT scans were found to be significant predictors of conversion to OA. In the conversion group, operative time, time to oral intake, and the incidence of complicated appendicitis were significantly higher. The conversion group had significantly higher rates of postoperative complications, surgical site infections, hospital readmissions, and mortality. To avoid the increased rate of complications associated with conversion to open surgery, the initial evaluation of a patient with prospective risk factors may be beneficial.

Preoperative ALBI grade predicts mortality in patients undergoing curative surgery for pancreatic head cancer.

The clinical significance of the albumin-bilirubin (ALBI) grade in patients with pancreatic head cancer (PHC) undergoing surgery is unknown. Preoperative ALBI grade is believed to be influenced by tumor burden. This study aimed to develop and validate the ALBI grade as a preoperative prognostic model for predicting the survival of patients with PHC. This is a retrospective study of Whipple procedures performed on PHC patients between January 2013 and December 2022. ALBI grade was compared to age, gender, type of operation, presence of complications, type of complications, Clavien-Dindo classification, total bilirubin levels, and albumin levels. Of the series, 46 (41.1%) of the 112 patients were female, while 66 (58.9%) were male. The rate of complications following Whipple procedures was 36.6% (n = 41). The overall mortality hazard ratio increased significantly with increasing ALBI grades (HR: 1538, hazard ratio mean: -1602). Hospital mortality increased 2.84 times as the ALBI grade increased. The model's accuracy of 88.4% showed that the ALBI grade directly affected both the overall mortality rate and the hospital rate. But there was no statistically significant difference between the ALBI grade and other variables. Multivariate regression analysis identified the preoperative ALBI grade as an independent predictor of mortality (P = .006). To the best of our knowledge, this is the first study to identify preoperative ALBI grade as an independent predictor of survival in PHC. It was found that the ALBI grade of -1602 was a new grading system that would be more predictive of mortality in PHC.

Liver Dysfunction After Use of Nathanson Retractor During Laparoscopic Gastrectomy for Gastric Cancer.

Background: Cardiopulmonary complications and liver dysfunction are also specific complications and problems associated with laparoscopic surgery. The main causes of postoperative liver dysfunction, which may often occur after laparoscopic surgery, include carbon dioxide pneumoperitoneum and ligation of the aberrant left hepatic artery. Hepatic steatosis may develop as a natural consequence of neoadjuvant therapy, although rarely, owing to chemotherapy. Nathanson retractor may cause a prolonged elevation in liver enzymes of these patients compared with those who do not receive neoadjuvant therapy. Materials and Methods: The data of 151 patients who underwent laparoscopic radical gastrectomy between January 2017 and January 2022 for histologically proven primary gastric cancer in our clinic were retrospectively reviewed. Results: The mean length of hospital stay was 6.21 days. The mean time normalization of the aspartate aminotransferase (AST) value was 2.45 ± 1.83 (range, 0-12) days postoperatively. The analysis of the correlation between the preoperative and postoperative 1-day values of alanine aminotransferase (ALT) and AST revealed a significant difference between the preoperative and postoperative 1-day median values of both parameters (P < .001). Each one unit increase in ALT led to an increase of 0.338 days in the length of intensive care stay and an increase of 0.345 days in the overall length of hospital stay. As the time to normalization of the AST value increased, the length of both intensive care stay and hospital stay increased. Each one unit increase in AST resulted in an increase of 0.316 days in the length of intensive care stay and an increase of 0.376 days in the overall length of hospital stay. Conclusion: Alternative retraction methods can be used safely in laparoscopic surgery for gastric cancer patients receiving neoadjuvant therapy. We are of the opinion that the Nathanson retractor should be used only during dissection of the relevant regions to shorten the intraoperative intermittent release or the time of use.

The contribution of laparoscopic distal pancreatectomy videos on YouTube to the learning curve in the COVID-19 pandemic.

There is no standardization in videos uploaded to Youtube. Were the videos capable of contributing to adequate technical quality and surgical training? We are aiming to answer these questions in this paper. It is a cross-sectional study. In January 2022, we searched the Youtube platform using the keyword "distal pancreatectomy." The substantiality, transparency, reliability, quality, popularity and educational values of the video content were evaluated after exclusion criteria. These parameters were evaluated using we the modified Journal of American Medical Association benchmark criteria, Global Quality Score (GQS), Video Power Index, modified laparoscopic pancreatectomy scoring system. The videos uploaded after the pandemic had a statistically significant higher GQS score (P < .001). Video Power Index, like GQS, had a statistically significant difference before and after the pandemic. (P = .046). There was no significant difference in the evaluation of the reliability and substantiality. Until the development of Youtube videos is completed, peer-reviewed, more reliable and content-rich online education platforms should be preferred in the first place. Care should be taken to watch selected videos on Youtube videos.

Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in appendix cancer A single-center experience.

AIM: The traditional treatment for appendiceal cancer with peritoneal spread is cytoreductive surgery (CRS) but added HIPEC chemotherapy to cytoreductive surgery and has shown that it improves overall survival. The aim of this study was to report the results of CRS and HIPEC treated patients with appendiceal cancers which is based on the experience of at Surgical oncology department. MATERIAL-METHOD: Ankara University School of Medicine, Deparment of Surgical Oncology. The data of patients who underwent CRS + HIPEC for appendiceal cancer between January 2008 - January 2019 was retrospectively analysed. 40 patients who underwent CRS + HIPEC were evaluated retrospectively. Patients with unresectable liver metastasis, large retroperitoneal tumor, tumoral infiltration in the intestinal mesentery and liver hilum were excluded from the study. RESULTS: The mean (±sd) PCI was 17.98 (±8.21). Twenty six patients's completeness of cytoreduction score was 0(65.0%), 10(25.0%) CCS-1, 3(7.5%) CCS-2 and 1(2.5%) CCS-3. There was statistically significant difference with prognosis between ccr score, ASA, lymphovascular invasion, PCI score, albumin categories. CONCLUSIONS: In selected patients survival can be increased. However, it is thought that cytoreductive surgery should be performed even if completeness of cytoreduction score is two. In our study we represent that >17PCI patients could be managed by CRS/HIPEC if the CC score ≤2 can be reached. Our results suggest that the CRS/HIPEC procedure can improve the benefits of larger patient group and provides longer survival. KEY WORDS: Appendiceal Neoplasms, Cytoreductive Surgery, Hyperthermic Intraperitoneal Chemotherapy.

Breast parenchymal density: does it affect oncological and surgical outcomes in conventional lumpectomy and oncoplastic surgery?

INTRODUCTION: Mammographic breast density (MBD) has been investigated as a risk factor for many years and has been determined to increase the risk of breast cancer in many studies. Research has shown that the correlation between MBD with breast cancer as both a risk factor and a prognostic factor is not limited to difficulty in diagnosis and patient age. This study was aimed to investigate the effect of MBD on the surgical effectiveness of different techniques applied for breast-conserving surgery (BCS). METHODS: We investigated the data of 460 patients who were prospectively registered in the database of the center between 2007-2017 and who were treated with level II Oncoplastic surgery (OPS) and conventional lumpectomy due to invasive breast cancer. RESULTS: BCS was applied to 223 (48.5%) patients, and OPS was applied to 237 (51.5%) patients. 213 (46.3%) patients had fatty breast density, and 247 (53.7%) had dense breasts. Mean surgical margin was 11.01 mm in the OPS group and 9.17 mm in the BCS group, with a statistically larger surgical margin in the OPS group (p=0.011). Regarding the surgical margin, mean distances were 10.59 mm infatty breasts and 9.70 mm in dense breasts. DISCUSSION AND CONCLUSIONS: In the present study, increased MBD was found to be associated with closer surgical margins and increased reoperation rates, albeit with a reduced risk for late complications. We think that level II OPS can eliminate this handicap in terms of surgical margin and reoperation in dense breasts. KEY WORDS: Breast Cancer, Breast Conserving Surgery, Breast Density, Oncoplastic Surgery.

10-years mortality risk estimation for gastric cancer patients based on clinicopathological factors.

AIM: In order to create a nomogram for the gastric cancer no comprehensive study has been performed in Turkey so far and in our study, we tried to forecast the 10-year survival by using risk factors in patients without distant metastasis, who have not previously been diagnosed with another cancer but who underwent curative surgery. MATERIAL METHOD: The data of 411 patients who underwent gastrectomy for gastric cancer between January 2010 and January 2020 in Surgical Oncology Department were retrospectively examined. RESULTS: It has been shown statistically that the high RDW value point to poor survival (p <0.001). There were 173 patients with ≤3.5g/dl and 238 patients with> 3.5g/dl. It was found out statistically significant that hypoalbuminemia indicated poor survival (p <0.001). Moreover, it was determined that high CEA and Ca19-9 with lymphovascular invasion were to be statistically significant with prognosis (p <0.001). On the based of all this data, we have created a dekstop application for the mortality estimation. CONCLUSION: We think that this model will ensure individualization of the treatment for patients and will contribute to the patient's compliance with the treatment by strengthening the communication between the physician. KEY WORDS: Gastric cancer, Gastrectomy, Survival analysis, Prognosis.

The effect of CEA/Albumin ratio in gastric cancer patient on prognostic factors.

AIM: Gastric cancer is an important disease worldwide with high mortality and morbidity rates. Novel targeted treatment approaches and recent improvements in immunotherapy have significantly improved survival. New indicators that can help determine the prognosis of stomach cancer have been of interest to researchers. We evaluated and recorded the patients' final preoperative CEA/albumin ratios and investigated the effect of this ratio on lymph node involvement, pathological tumor stage, and overall survival. MATERIAL AND METHOD: We retrospectively evaluated data from electronic files of patients who were operated for stomach cancer in our center between January 2012 and December 2017. The study included 195 patients who were followed up regularly and whose complete medical data were available. RESULTS: The effect of CEA/Albumin ratio on the number of Metastatic Lymph Nodes was analyzed using Linear Regression and was found to be statistically significant (p = 0.001). One unit increase in CEA/Albumin ratio increases the number of Metastatic Lymph Nodes by 0.223 (Confidence Interval: 0.097-0.380) units, and this variable alone explains 5.7% of the change in the number of Metastatic Lymph Nodes. CONCLUSION: Neoadjuvant treatment decisions can be made by estimating the T and N stages by using CEA/albumin ratio in cases where conventional radiological methods are insufficient. KEY WORDS: Albumin, Carcinoembryonic antigen, Gastric cancer, Lymph node, Prognosis.

Management of Aberrant Left Hepatic Artery During Laparoscopic Gastrectomy and Consequences.

Introduction: Aberrant left hepatic artery (ALHA) can exist in up to 25% of the population. The presence of ALHA during lymph node (LN) dissection in gastric cancer may complicate the process. In this study, we aimed to evaluate the existence rate, management, and consequences of ALHA in our laparoscopic gastrectomy series. Patients and Methods: Demographical and clinical data of laparoscopically operated 158 consecutive gastric cancer patients were collected retrospectively. Study patients were divided into three groups according to absence, existence and preservation, and existence and sacrification of ALHA. Harvested LN numbers, operation time, and postoperative alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase values on consecutive days were analyzed using Kruskal-Wallis and Mann-Whitney U tests. P < .05 is accepted as significant. Results: The median AST and ALT values of the ALHA-sacrificed group were higher than those of the group without ALHA and the ALHA-preserved group on the 1st, 3rd, and 5th postoperative days (P < .05). On the 10th day, liver enzymes returned to normal values. Conclusion: Adequate and appropriate dissection of LNs while preserving ALHA can be performed without prolonging the operation time. Sacrification of ALHA causes an increase in liver enzymes, with spontaneous recovery in most cases.

New learning area in laparoscopic gastrectomy for gastric cancer: YouTube® or WebSurg®?

BACKGROUND: Laparoscopic gastrectomy cannot be performed routinely in many centres, because there is still no standardisation in the centres where it is performed, and therefore, new learning areas are needed for residents working in these centres for surgical training. These areas are various courses, video training sets and video platforms watched over the internet. The most frequently used platforms are YouTube® and WebSurg®. Our aim is to compare these two online video platforms in terms of laparoscopic gastrectomy and to evaluate the contribution of video platforms to surgical training and whether they have sufficient technical quality. MATERIALS AND METHODS: We made a search on YouTube® and WebSurg® using the keyword 'laparoscopic gastrectomy' on 13 November 2020. A total of 143 videos were analysed, 111 of them on YouTube® and 32 on WebSurg®. All these videos were examined by two surgical oncologists experienced in laparoscopic gastrectomy and using laparoscopy in their daily practice. RESULTS: The average video duration was 53.54 min in the YouTube® group and 18.20 min in the WebSurg® group, and this difference was found to be statistically significant between the two groups. According to the LGSS based on surgical procedures, the average score of WebSurg® videos was 10.37 and of YouTube® videos was 5.55, and there was a statistically significant difference between the two groups. CONCLUSIONS: Today, video platforms have started to play a major role in surgical training. Of these platforms examined, WebSurg® is superior to YouTube® in terms of education and quality, but these platforms still have some deficiencies and need regulation.

The Effects of Modified Lymphoscintigraphy Techniques on Sentinel Lymph Node Biopsy Success During the COVID-19 Pandemic Period.

BACKGROUND AND OBJECTIVE: Sampling of the sentinel lymph node (SLN) in breast cancer provides accurate information about the condition of the axilla in 95% of cases. Technically in detecting SLN; radioactive substance, dyers or both are used. During the COVID-19 (Coronavirus disease 2019) pandemic, delayed images were not taken in lymphoscintigraphy to reduce the risk of transmission by shortening the waiting time in our center. In this study, the effects of early and delayed lymphoscintigraphic images and only early images on our clinical practice were evaluated. METHODS: We investigated the data of 147 patients in this study who underwent SLNB due to early-stage breast cancer at our institute during the COVID-19 pandemic period (PP) (March/April/May 2020) and within 3 months before the pandemic were evaluated. RESULTS: Patients were divided into two groups, before pandemic (BP) and PP. BP consisted of patients whose early and delayed images were taken in lymphoscintigraphy whereas PP consisted of those with early images only. There were 74 patients in the BP group and 73 patients in the PP group. Early phase increased uptake was not observed in 23 patients, and increased uptake was obtained from 22 of these patients with delayed imaging in BP period. In PP, increased uptake was not observed in 12 patients. SLN was not detected in 2 patients in the BP group and 7 in the PP group. It was found that the sensitivity, NPV and accuracy of the SLNB procedure performed after taking delayed images was higher. CONCLUSIONS: In the present study, we believe that if technically possible, delayed images taken during the lymphoscintigraphy can assist the surgeon in terms of SLN detection and the number of SLNs removed.

Effects of soy-containing infant formulas on thyroid gland in rats.

BACKGROUND: Effects of soy-containing infant formulas on the thyroid gland is not clear. We aimed to evaluate the effects of infant formulas with different quantities of soy content on the functional and histopathological characteristics of the thyroid gland. METHODS: Twenty-eight female Sprague-Dawley rats were divided into four groups. Group 1 was fed with standard pellet rat food (8 g/day); group 2 soy-free infant formula (8 g/day); group 3 low-dose (1.12 g/100 mL) soy-containing formula (8 g/day), and group 4 high-dose (2.64 g/100 mL) soy-containing formula (8 g/day). Blood samples were collected from the subjects on day 0, 30, 60, and 90 to evaluate thyroid functions. All subjects were sacrificed on day 90. Thyroid glands were excised and examined histopathologically. RESULTS: Serum levels of free T3, free T4, TSH, anti-TPO, and anti-TG were significantly higher in Group 4 compared to other groups (P<0.001, P<0.01, P<0.001, P=0.002). No differences were found in the histopathological findings between the groups. CONCLUSIONS: Infant formulas with high soy content induce hyperthyroidism with high TSH levels. High levels of anti-TPO and anti-TG suggest that observed changes might have occurred via inflammatory mechanism.

The diagnostic value of modified systemic inflammation score in predicting post-operative outcomes of cutaneous melanoma patients who underwent isolated limb perfusion.

BACKGROUND: In-transit metastasis is considered a locoregional disease in cutaneous melanoma (CM) patients. Isolated limb perfusion (ILP) is among the treatment options in selected cases. The aim of this study was to determine the success of pre- and post-perfusion mSIS values in predicting the potential complications and the prognosis of the disease by investigating the early and long-term results of mSIS values calculated before and after ILP in CM cases with in-transit metastases. MATERIALS AND METHODS: Patients who underwent ILP within the period from 2014 to 2020 in our department were retrospectively scanned. A total of 20 patients were found to undergo ILP. The scores obtained from modified inflammation score (mSIS) were formulated according to albumin (Alb) and lymphocyte to monocyte ratio (LMR) scores. RESULTS: The mean follow-up time was 20.47 months. Complications requiring surgical intervention developed in three patients. According to the Wieberdink local toxicity classification, the majority (70%) of the patients were found to be grade II. Based on pre-perfusion mSIS values, 8 patients were classified as mSIS 0 while six patients were classified as mSIS 1 and 2. Based on post-perfusion mSIS values, 14 patients and one patient were classified as mSIS 2 (70%) and mSIS 0, respectively. Accordingly, univariate analysis showed that mSIS 1 and mSIS 2 were negative prognostic factors for mean survival in the pre-perfusion period (HR 0.162, 95% CI 0.036-0.729; p = 0.018 and HR: 0.223, 95% CI 0.049-1.019; p = 0.053) whereas albumin (Alb) and lymphocyte to monocyte ratio (LMR) were not independent prognostic factors for mean survival. CONCLUSION: The mSIS values calculated in the pre-perfusion period can give an opinion about the OS of the patients whereas post-perfusion mSIS values may predict potential surgical complications and local toxicities.

The efficiency of D1(+) lymphadenectomy in signet ring cell carcinoma: comparison of postoperative early and late outcomes between standard lymphadenectomy and D1(+) lymphadenectomy.

Signet ring cell carcinoma (SRCC) is a poorly cohesive subtype of gastric cancer. It is more aggressive than other types of gastric cancer. There is no special method for its treatment, but gastrectomy and lymphadenectomy is the standard approach. The aim of this study is to investigate postoperative outcomes of D1 lymphadenectomy and D1(+)lymphadenectomy in gastric SRCC.A total of 358 cases whohad a gastrectomy performed forthe diagnosis of gastric cancer between 2013 and 2019 in Ankara University Medical Faculty, Surgical Oncology Department were retrospectively investigated. In all, 128 of the cases had SRCC in the final pathology. We separated the cases into two types,D1 lymphadenectomy and D1(+) lymphadenectomy. The 5-year survival, early mortality, hospital mortality and postoperative complication rates were evaluated.There were 59 patients in the D1 group and 64 patients in the D1(+) group.Metastatic lymph node amount and therefore N stage was found to be significantly higher in the D1(+) group (p=0.00 and p=0.03, respectively). Postoperative chyle fistula was found to be significantly higher in the D1(+) group (p=0.003). There was no statistically significant difference between the groups with regard tomean survival (p=0.065);the 5-year mean survival was 21% in the D1 group and 7% in the D1(+) group. Present findings suggest that extended lymphadenectomy does not provide a benefit in cases of SRCC.

The role of laparoscopic staging for the management of gastric cancer.

AIM Staging laparoscopy enables us to perform palliative treatment, neo-adjuvant therapy for curative resection or direct curative resection and making a decision with minimal morbidity by avoiding from unnecessary laparotomies. In the present study, the importance of staging lapafoscopy was retrospectively investigated by using clinical and pathologic data. METHODS Data of 70 out of 350 patients who underwent diagnostic laparoscopy due to gastric cancer at Surgical Oncology department between August 2013 and January 2020 were retrospectively analyzed. RESULTS Peritoneal biopsy was positive for malignity in 41 (58.5%) and negative in 29 (41.5%) of the patients who underwent SL. Peritoneal cytology (PC) results were negative in 32 (45.7%) patients and positive in 38 (54.3%) patients. Peritoneal biopsy and cytology results were concurrently positive in 35 patients and concurrently negative in 26 patients. CONCLUSIONS In conclusion, even the most developed imaging methods cannot provide 100% staging, therefore SL plays an important role in treatment of gastric cancer and laparoscopic staging is essential as a simple, inexpensive, safe and well tolerated method in patients who have the suspicion of peritoneal disease and who cannot be clearly evaluated with pre-operative methods.

Prognostic Role of Red Distribution Width (RDW) Value in Gastric Cancer.

OBJECTIVE: To investigate the prognostic effect of red distribution width (RDW) in patients with gastric cancer. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of Surgical Oncology, Ankara University School of Medicine, between November 2010 and January 2020. METHODOLOGY: Patients diagnosed with adenocarcinoma by biopsy, who underwent radical surgery and lymph node dissection, and had preoperative RDW value, were inducted. Patients who had history of active inflammation in the past three months, received treatment for hematology disorder, blood transfusion, malignancy other than gastric cancer, autoimmune disease, venous thrombosis, or under 18 years of age, and those having cardiac and cerebrovascular diseases and distant metastases were excluded from the study. Apart from diagnosis, preoperative blood values, clinicopathologial, demographic features, and follow-up data were included in the study. RESULTS: RDW average value was 15.11 ± 2.87 and median value was 14.3%. For RDW cut off value, 13.4% was accepted as reference from previous studies was divided into two groups as <13.4% and ≥13.4%. While it was <13.4% in 119 patients; in 292 patients, it was "≥13.4%". High RDW value showed poor survival (p<0.001). CONCLUSION: RDW, the current hematological marker, can be used as an important indicator for monitoring the progression and prognosis of gastric cancer. Key Words: Gastrectomy, Gastric cancer, Laparoscopy, Surgical oncology, Red distribution width, survival.

Relationship between lymphovascular invasion and molecular subtypes in invasive breast cancer.

PURPOSE: The aim of this study is to evaluate the relation between LVI and molecular subtypes in invasive breast cancers and to find out whether LVI which is a histopathologic indicator has a role in subtype classification or not. METHODS: One hundred and seventy-six patients who had mastectomy for breast cancer between 2013 and 2018 in the Department of Surgical Oncology, Faculty of Medicine, Ankara University were retrospectively analysed. One hundred and thirty-two patients who had LVI, ER, PR, Her 2 and Ki-67 index status information provided in their pathology results were included in the study. The relationship between molecular subtypes and LVI was investigated. RESULTS: One hundred and thirty-two patients were analysed retrospectively. Eighty-two patients had LVI and 50 patients had not. We found a relationship between Luminal B with Her2(-) and LVI, basal like and LVI (P = .00). No significant statistical difference was found between LVI and other molecular subtypes. We confirmed these results with multiple variable analysis (%77.3 correlation). CONCLUSIONS: As a result, we found that LVI can affect molecular subtypes. This showed that a histopathological factor may affect tumour biology. In other words, breast cancer is a heterogeneous disease with many different predictors and prognostic variables.

Colonic mucosal pseudolipomatosis: Are we aware of it?

OBJECTIVE: Colonic mucosal pseudolipomatosis is rare, and its pathogenesis is controversial. A number of mechanisms, including mechanical injury during an endoscopic procedure or chemical injury by disinfectant, seem to contribute to its pathogenesis. MATERIAL AND METHODS: This retrospective study examined the colonic biopsies of 1370 patients. These biopsies were preserved at the Department of Pathology of Istanbul Training and Research Hospital between January 2012 and June 2013. RESULTS: We found pseudolipomatosis in 14 of 1370 colonoscopy cases (1.02%). Of these 14 patients, 8 were male and 6 were female. The male patients were between 24 and 66 years, with a mean of 39; the female patients were between 26 and 58 years, with a mean of 42. CONCLUSION: Many endoscopists are unaware of the lesion, and the diagnosis is generally possible only after pathological assessment of multiple biopsies taken from suspect lesions. Here we report and discuss colonic pseudolipomatosis incidentally found in a series of patients undergoing routine colonoscopy, and we underline the endoscopic pattern and diagnostic difficulties.