Vascular variations of the kidney, retrospective analysis of computed tomography images of ninety-one laparoscopic donor nephrectomies, and comparison of computed tomography images with perioperative findings.

BACKGROUND: In this retrospective study, we aimed to determine the variations of kidney arteries and veins in kidney donor patients who underwent preoperative, computed tomography angiography (CTA). MATERIALS AND METHODS: We analysed kidney CTA findings of 91 donor nephrectomy patients operated from July 2016 through December 2017. Demographics, vascular diameters, abnormalities, numbers, branching variations, routing variations of arteries, and veins were assessed according to CTA images. We also compared the radiological findings with perioperative findings. Two radiologists evaluated CTA images, and the same surgical team performed all donor nephrectomies by laparoscopic approach. RESULTS: Ninety-one of the 96 patients involved to study. Forty-six (50.5%) patients were female. Thirty-five (38.4%) of 91 cases had accessory arteries. Seven (7.6%) right, 1 (1.1%) left and 8 (8.7%) bilateral double hilar artery was observed on CTA. No statistically significant difference was observed in the evaluation of the side of accessory/polar arteries (p > 0.05), and in the evaluation of the distribution of arterial/venous variations according to perioperative findings (p > 0.05). However, in the evaluation of CTA images, we found that the diameter of the kidney artery and vein differed according to gender and side. CONCLUSIONS: The knowledge of the vascular variations of the kidney is essential for surgeons performing kidney transplantation. It is also essential for urologist and vascular surgeons. Incompatible with the literature, the right kidney has more vascular variations and, one kidney artery is found in the majority of Turkish kidney donor patients.

Laparascopic Donor Nephrectomy Is Safe for Extremely Old Donors and Provides a Good Outcome for Their Recipients.

PURPOSE: This study sought to evaluate the outcomes of laparoscopic donor nephrectomy in donors age 70 years and older, who may be considered extremely old. PATIENTS AND METHODS: We compared the outcomes of grafts from donors age 70 years and older (group ≥ 70; n = 28) with donors younger than 55 years (group < 55; n = 28) after matching these 2 groups in terms of sex, date of surgery, body mass index, and immunological features, retrospectively. RESULTS: There was no statistical difference between the 2 groups in terms of operation duration, estimated blood loss, and cold ischemia time. However, warm ischemia time was found to be slightly longer in the younger group. The mean hospital stay length was similar for both groups, and no postoperative complications occurred in any donor. Early and intermediate-term serum creatinine levels of donors and their recipients were not statistically different in both groups. CONCLUSIONS: Laparoscopic donor nephrectomy can be performed safely in selected extremely old donors without concern for early and intermediate-term graft function, with the aim of extending donor pool.

Stress Coping Strategies in Hemodialysis and Kidney Transplant Patients.

OBJECTIVE: The aim of this study was to determine the levels of anxiety and depression, and stress coping strategies used by hemodialysis and kidney transplant patients. METHODS: This study included 138 hemodialysis patients treated at the two private dialysis centers and 76 kidney transplantation patients followed up at the private hospital. Data were collected with socio-demographic characteristics, the Hospital Anxiety and Depression Scale, and the Coping Strategies Questionnaire (COPE). RESULTS: The anxiety and depression scores were significantly lower among the transplant group versus the hemodialysis patients. The use of non-functional coping strategies was higher among the patients who were treated with hemodialysis, compared to the renal transplantation patients. The use of problem focused and emotional focused coping strategies were higher among the renal transplant patients, compared to hemodialysis patients. When all participants were evaluated together, turning to religion was the most frequent coping strategy followed by active coping, and positive reinterpretation. In hemodialysis patients, there was a significantly negative correlation between age and problem-focused, emotion-focused and non-functional coping strategies. In contrast, the correlation between education level and both problem-focused and emotion-focused coping strategies was significantly positive. In transplant patients, gender and education level were significantly negative correlated with emotion-focused coping strategies. CONCLUSION: The results of data analysis showed that the hemodialysis patients used fewer functional coping strategies and had more anxiety and depression than kidney transplant patients. It would be helpful to know an individual's coping strategies in the case of a stressful situation in order to determine treatment goals and monitor therapeutic efficacy.

Psychiatric symptomatology and health-related quality of life in children and adolescents with alopecia areata.

BACKGROUND: There is a very limited amount of data available regarding the relationship between alopecia areata (AA) and psychiatric morbidity and quality of life (QoL) in children and adolescents. OBJECTIVES: The aim of this study was to determine the psychiatric state and health-related quality of life (HRQL) of children and adolescents with AA, as well as their relationships with clinical parameters. METHODS: The sample consisted of 74 children with AA aged 8-18 years. Questionnaires were used to evaluate the psychiatric status and HRQL of the patients. The study and control groups were divided into child and adolescent groups to exclude the effect of puberty on psychological condition. RESULTS: In the child group, patients had higher state anxiety and trait anxiety scores; they also had lower parent-rated psychosocial and total area HRQL scores than the controls did. In addition, the depression score was prone to show a positive relationship with having AA in the children. In the adolescent group, however, only the state anxiety score had a significant association with AA. All of the parent-rated HRQL scores were also prone to being lower compared with controls in this age group. Regarding determinants of HRQL, prolonged disease duration and later disease onset had positive effects, whereas severity of scalp involvement, trait anxiety and depression had negative effects, for the sample as a whole. CONCLUSIONS: Alopecia areata is associated with poor psychiatric status and QoL, especially in childhood. The impact of the disease on QoL occurs through both clinical and psychiatric parameters.

Comparison of open and retroperitonoscopic donor nephrectomy in terms of lipid and protein peroxidation responses.

BACKGROUND: This study was designed to compare donors who underwent open (ODN) versus retroperitonoscopic nephrectomy (RDN) in terms of intra-operative oxidative stress and recipients graft function in the early postoperative period. METHODS: Among 40 patients who underwent donor nephrectomy, 23 were operated via an open method and 17 via retroperitonoscopic method. To analyze oxidative stress, we measured plasma levels of malondialdehyde (MDA), protein carbonyl, and protein sulfhydryl moieties in donor venous blood before induction of anesthesia and postoperatively at 0, 6, and 24 hours. The influence of oxidative stress on graft function was evaluated by means of the postoperative 5th day recipient creatinine and estimated glomerular filtration rate (eGFR) Modification of Diet in Renal Disease Formula (MDRD) to evaluate delayed graft function (DGF) status. RESULTS: ODN patients showed significantly higher 24-hour mean levels of MDA, (6,139 ± 1,854 vs 4,813 ± 1,771 nmol/L; P = .01), protein carbonyl (366 ± 64 vs 311 ± 62 µmol/L; P = .01) and protein sulfhydryl (468 ± 110 vs 386 ± 75 µmol/L; P = .01) moieties compared with those RDN patients. However, ODN and RDN recipients were similar in terms of 5th day mean creatinine and eGFR (1.1 ± 0.3 vs 1.4 ± 0.8 mg/dL and 69.15 ± 12.24 vs 56.31 ± 25.2, respectively) and DGF status (4.4% [1/23] vs 5.9% [1/17], respectively). CONCLUSIONS: Although ODN donors were more prone to intra-operative oxidative stress than RDN donors, based on significantly higher levels of oxidative stress markers, this difference seems to not significantly influence recipients early graft function.

Comparison of the right and left laparoscopic live donor nephrectomies: a clinical case load.

BACKGROUND: The aim of the present study was to retrospectively compare the results of right- and left-laparoscopic donor nephrectomy (LDN) performed in our Center. PATIENTS AND METHODS: Two hundred and eight patients who were operated on between October 2010 and October 2011 were included. Of the patients, 65 underwent right-LDN and 143 underwent left-LDN. The groups were compared in terms of duration of surgery, warm ischemia time, postoperative complications, length of hospital stay, and donor outcomes. RESULTS: The mean duration of surgery was 144±19.7 min and 147.8±20.2 min in the right- and left-LDN groups, respectively. The mean warm ischemia times were 139.1±54.1 s and 141.5±37.9 in the right- and left-LDN groups, respectively. The mean length of hospital stay was 2.4±1.0 days for both groups. No major complications were observed in the groups. There was no significant difference between the groups in terms of donor outcomes. CONCLUSIONS: The right-LDN is approached cautiously because of short length of vein and the risk for thrombosis. The results of the present study demonstrated that the right-LDN is as safe and effective as the left-LDN.

Investigating the effect of the poly(ADP-ribose) polymerase inhibitor 5-aminoisoquinolinone and the Na⁺-H⁺ exchanger inhibitor zoniporide on isolated perfused rat hearts during ischemia-reperfusion injury.

The goal of this study was to investigate whether the combination of the Poly(ADP-ribose) polymerase inhibitor 5-aminoisoquinolinone (5-AIQ) and the Na+-H+ exchanger inhibitor zoniporide (ZN) provides increased protection against ischemia-reperfusion (I/R) injury. Rats were separated into 5 groups (n=8): Group 1: Control group, Group 2: I/R, Group 3: 5-AIQ, Group 4: ZN and Group 5: Mix (5-AIQ+ZN). Isolated rat hearts were subjected to 30 min of global ischemia, followed by 120 min of reperfusion using Langendorff's apparatus. In groups 3, 4 and 5, 5-AIO (7.5 µM/L) and ZN (50 nM/L) were added to Tyrode Solution after a stabilization period. The level of lactate dehydrogenase (LDH) was determined in the sample perfusate. Myocardial infarct size was determined using the triphenyltetrazolium chloride method. Heart tissues were stored to determine the malondialdehyde (MDA) content, total oxidant status (TOS) and total antioxidant status (TAS). Compared to the 5-AIQ and ZN groups, there was no notable difference in the LDH, MDA, TOS, TAS and hemodynamic parameters of the 5-AIQ+ZN group, but myocardial infarct size decreased significantly, as determined by volume and weight measurements. These results show that the combined use of Zoniporide and 5-Aminoisoquinolinone provides increased protection against I/R injury by reducing myocardial infarct size.

Avoiding abdominal flank bulge after lumbotomy incision: cadaveric study and ultrasonographic investigation.

OBJECTIVE: The object of this study was to better define the relevant anatomy and innervation of the anterolateral abdominal wall musculature seeking to avoid abdominal wall complication after open donor nephrectomy. We dissected four cadavers and retrospectively assessed donor ultrasonographic imaging of anterolateral abdominal muscle atrophy after donor nephrectomy with a lumbotomy incision. METHODS: Anatomic study was performed on four cadavers using bilateral dissections. The 8th, 9th, 10th, 11th, and 12th (subcostal) intercostal nerves were dissected from the intercostal space to the rectus sheath. With the experience gained from anatomic study, we performed 40 living donor incisions 1.5 to 2 cm medial to the tip of 12th rib, toward the lateral border of the rectus muscle and the umbilicus. Donors were invited to the hospital at 1 year postoperative to examine abdominal wall complications. Ultrasonography (USG) was performed to assess the thickness of the abdominal wall muscles bilaterally to ascertain whether there was atrophy. RESULTS: All distal intercostal nerves ran as multiple mixed segmental nerves, communicating with each other widely within the neurovascular plane. The thick 12th nerve was located at 1.5 to 2 cm medial and under the tip of the 12th rib, running to the suprapubic area. Postoperative USG confirmed that the mean percent thickness of the abdominal muscles of the operative side was not significantly different from the other side (P < .05). CONCLUSION: Most significant intercostal nerve contributions to the anterolateral abdominal wall arise from T12. Damage to the intercostal nerves will be minimal if the lombotomy incision is performed above the safe line between the tip of the 12th rib and the umbilicus.

Exchange donor transplantation: ethical option for living renal transplantation.

PURPOSE: Taking in consideration the opinion of our team, which necessitates obligation of a relative relation between donors and recipients (genetic or matrimonial), we performed donor exchanges as an ethical alternative in living donor transplantations. We reviewed the outcomes of our exchange series. METHODS: Between July 2003 and August 2010 we performed 110 exchange donor transplantations in four hospitals: one four-way, two three-way, and 100 two-way cases. Donors were mostly spouses (n = 71) or mothers (n = 15). The mean age of the donors was 48.8 (range = 23-69) and the recipients 41.4 years (range = 5-66). Two were transplanted preemptively and the others had a mean dialysis duration of 43 months (range = 1-120). RESULTS: Among 110 patients, three compatible pairs joined the group voluntarily; 71, due to ABO incompatibility and 36, due to crossmatch positivity. Induction therapy was used in 92 patients. HLA mismatches (MM) were: one MM in three; two MM in three; three MM in 18, four MM in 36; five MM in 34; and six MM in 18. Among 90 patients tested for panel-reactive antibodies PRA, five showed class I and 10, class II positivity. In 11 patients, B-cell positivity was detected by flow cytometry. Delayed graft function (n = 2), acute rejection (n = 11), BK virus infection (n = 1), and cytomegalovirus infection (n = 3) were seen postoperatively. Three (2.7%) patients died due to sepsis. Five patients returned to dialysis program due to interstitial fibrosis tubular atrophy (IFTA) (n = 2), renal vein thrombosis (n = 1), de novo glomerulopathy (n = 1), or primary nonfunction (n = 1). The 1- and 5-year patient and graft survival rates were 96% and 96%, 95% and 89%, respectively. CONCLUSION: We believe that exchange donor transplantation is as successful as direct transplants; it is a good, ethical alternative to unrelated living transplantations.

Anastomosis of accessory arteries via microsurgical technique in renal transplantation.

PURPOSE: For many years there has been reluctance to use kidneys having multiple arteries of <2 mm diameter, especially where they supply the lower pole. The usage of these kidneys has increased using microsurgical anastomosis techniques. We reviewed the anastomotic techniques among renal transplantations with multiple arteries. MATERIALS AND METHODS: Between January 2008 and August 2010, we examined the perfusion of 605 live donor kidneys bearing multiple arteries at 1 week and after 3 months using Doppler ultrasonography and magnetic resonance imaging (MRI) angiography. In addition, we reviewed vascular and urinary complications. The diameters of the arteries were measured using multi-slice computerized tomographic (CT) angiography. RESULTS: Multiple arteries were detected in 49 (8.1%) kidneys, including 14 from the right and 35 left: namely, 45 with double and 4 with 3 arteries. In 26 patients an end-to-side microsurgical anastomosis was performed using the accessory artery; 23 organs underwent other techniques. The average diameter of all arteries was 3.89 ± 1.38 mm (thinnest, 1.2; widest, 8 mm). The average diameter of the main arteries was 5.12 ± 1.16 mm (thinnest, 3; widest, 8 mm) and the accessory arteries 2.81 ± 0.69 mm (thinnest, 1.2; widest, 3.8 mm). In patients with microsurgical techniques the average diameters of all arteries and accessory arteries were 3.7 ± 1.6 mm and 2.6 ± 0.69 mm, respectively. In those undergoing techniques other than microsurgery, the average diameters of all arteries and accessory arteries were 4.11 ± 1.34 mm and 3.1 ± 0.43 mm, respectively. The average diameters of the arteries in both groups were significantly different (P < .001). Kidney perfusion was intact upon ultrasonographic and MRI angiography of all patients. In 1 subject with a microsurgical technique used, anastomostic dehiscence with bleeding was observed after removal of the arterial clamps. Also in this group, 1 patient experienced a ureteral stricture beyond postoperative month one. CONCLUSION: Microsurgery is a reliable technique for kidneys with thin accessory renal arteries.

Conversion to proliferation signal inhibitors-based immunosuppressive regimen in kidney transplantation: to whom and when?

BACKGROUND: Despite significant advances in kidney transplantation, long-term graft survival has not dramatically improved leading to strategies to change immunosuppression during the posttransplantation period. Proliferation signal inhibitors (PSI) sirolimus or everolimus possess immunosuppressive and antiproliferative properties. METHODS: We evaluated 62 kidney transplant recipients who underwent conversion from a calcineurin inhibitors (CNI)- to a PSI-based regimen for various reasons. The statistical analysis used SPSS v.15.0 software. We compared calculated glomerular filtration rates (GFRs) before initiation of PSI (baseline) and at 6 months after conversion. RESULTS: We converted to a PSI-based triple regimen at 172.0 ± 116.5 days after transplantation. The mean serum creatinine at the time of conversion was 2.0 ± 1.1 mg/dL, and it was 1.5 ± 0.7 mg/dL at 6 months after conversion. The rate of change in serum creatinine was -17.1 ± 23.5%. The mean calculated GFR at the time of conversion was 53.6 ± 25.5 mL/min and at 6 months after conversion was 65.8 ± 23.7 mL/min. The rate of change in calculated GFR was 37.9 ± 71.7% (16.4/59.4) at 6 months. Thus we observed significant improvements in creatinine and GFR (P values <.001) after conversion. The Improved GFR significantly correlated with prior dialysis duration and time to conversion (P = .025; P = .012). Patients who had a shorter duration on dialysis and shorter time to conversion experienced more benefit from conversion. Four of the 62 patients reported gastrointestinal toxicity, which resolved with dose reduction in 3 patients: 15 patients experienced acne; 16 reported oral ulcers. None of these toxicities resulted in discontinuation of PSI therapy. Serum cholesterol and tryglyceride levels tended to increase among the conversion group, but they did not show statistical significance. CONCLUSION: We observed that minimization or withdrawal of CNI with addition of a PSI was a good treatment for deterioration of renal allograft function.

The influence of hepatitis B and C virus infections on patient and allograft outcomes in kidney transplantation.

BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are the most important causes of chronic liver diseases among end-stage kidney disease patients. Our aim was to evaluate the influence of HBV and HCV infections on patient and allograft outcomes after successful kidney transplantation. PATIENTS AND METHODS: We retrospectively analyzed 592 kidney transplantations performed between December 2008 and August 2010. We compared patient and graft survivals as well as age, gender, immunosuppression status, pretransplant dialysis duration, chronic allograft dysfunction, and causes of death. RESULTS: Thirty-two patients (5.4%; group 1) were positive for HCV antibody, whereas 16 (2.7%) were positive for hepatitis B surface antigen (HBsAg) (group 2). Two patients (0.3%) were positive concurrently for both HCV antibody and HBsAg. Five hundred forty-two patients (91.6%; group 3) were negative for both. Patients were divided into groups with respect to viral infection. The groups were analyzed for age, gender, immunosuppression, pretransplant dialysis duration, chronic allograft dysfunction, and causes of death, as well as patient and graft outcomes. There were no differences in patient and graft survivals among the groups. None of the patients showed signs of hepatic failure. No patient or graft loss was observed among hepatitis groups when compared with disease-free patients. CONCLUSION: Graft and patient survivals were not influenced by HBV and/or HCV infections. HBV and HCV infections are not contraindications for kidney transplantation.

Intensive polyoma virus nephropathy treatment as a preferable approach for graft surveillance.

BACKGROUND: Polyoma BK virus nephropathy (BKVN) is one of the important causes of graft failure and loss among renal transplant patients. Reduction of immunosuppression is the most important preferred treatment approach; however, there is no agreed protocol for additional treatments. OBJECTIVE: Our aim was to investigate the effects on graft survival of intensive treatment protocols for BKVN among renal transplant patients. METHODS: 214 patients were included in the study. All patients underwent investigation for the presence of BKV in plasma samples every 3 months starting from the third month after transplantation. Biopsies were obtained upon detection of graft dysfunction or viremia. If BKVN was positive, viremia was investigated monthly. RESULTS: Plasma plus biopsy-proven BKVN were detected in 19 patients (8.9%), whose mean age was 45.8 ± 12.0 years; 68.4% (n = 13) were male and 94.7% (n = 18) were recipients of a living-donor kidney. There were 5.2% (n = 1) diabetic subjects, and the mean time prior to dialysis was 39.6 ± 44.8 (3-125) months. BKVN was observed at a mean of 6.8 ± 2.9 (4-14) months after the transplantation. It positively correlated with the baseline serum creatinine level (r = 0.159; P = .02), application and cumulative dose of antithymocyte globulin (r = 0.177; r = 0.165; respectively; P = .01), mean tacrolimus dose (r = 0.303; P < .001), and hepatitis B virus positivity (r = 0.169; P = .01). Immunosuppression was decreased in all patients who developed BKVN. In addition, leflunomide was applied in 68%, intravenous immunoglobulin in 74%, and cidofovir in 32% of patients. Acute rejection rates did not increase significantly after lowering immunosuppression (P > .05). CONCLUSION: BKVN is one of the important problems in renal transplant patients. Intensive treatment of BKVN with heterogeneous regimens, including combined treatment with leflunamide + IVIG together with immunosuppressive dose reduction, was an effective approach to prolong graft survival.

Synthesis and effects of some novel tetrahydronaphthalene derivatives on proliferation and nitric oxide production in lipopolysaccharide activated Raw 264.7 macrophages.

In this study, novel N-(3,5,5,8,8-pentamethyl-5,6,7,8-tetrahydronaphthalene-2-yl)-carboxamide (6-15) and 5,5,8,8-tetramethyl-5,6,7,8-tetrahydronaphthalene-2-carboxamide (16-32) derivatives were synthesized and their in vitro effects at 5 µM and 50 µM concentrations on proliferation and nitric oxide (NO*) production in lipopolysaccharide (LPS) activated RAW 264.7 macrophage cells were determined. Compounds 12, 17, 24 and 26 were found to decrease nitrite levels in a dose-dependent manner in LPS-activated cells. At the tested concentrations, these compounds did not exhibit cytotoxic effects. Interestingly, compound 27 which contains nitroxide free radical was the most active compound in this series showing 59.2% nitrite inhibition in LPS-activated macrophage cells.

Low-dose calcineurin inhibitor regimen combined with mammalian target of rapamycin inhibitors preserves kidney functions in renal transplant recipients without allograft nephropathy.

OBJECTIVE: The present study was designed to investigate the effect of low-dose calcineurin inhibitor (CNI) tacrolimus combined with a mammalian target of rapamycin (mTOR) inhibitor on renal function in transplant recipients without allograft nephropathy. PATIENTS AND METHODS: Twelve patients including seven men (58.3%) of overall mean age of 34.8 ± 14.1 years underwent renal transplantation and were switched to a new second-line treatment of low-dose CNI combined with an mTOR inhibitor, either sirolimus or everolimus. RESULTS: The underlying cause of renal failure was not clear in half of the cases; for the others it was chronic glomerulonephritis, diabetic nephropathy, polycystic kidney disease, or hypovolemia. After 6 months of the new therapy, there was a significant increase in calculated creatinine clearance levels compared to baseline (75.5 ± 21.9 vs 89.6 ± 19.1 mL/min; P < .001), but no significant change in serum creatinine (1.3 ± 0.4 vs 1.2 ± 0.3 mg/dL) or urinary protein excretion (187.5 ± 142.0 vs 394.0 ± 326.4 mg/g). For almost all patients, proteinuria remained stable, but in two patients, it developed but responded to enalapril treatment. Dose decrement was required for four patients with hyperlipidemia (50%); one patient experienced new-onset hyperlipidemia that responded to treatment. One patient developed a urinary tract infection that responded to antibiotic treatment. None of the patients developed an acute rejection episode. CONCLUSION: Low-dose CNI combined with an mTOR inhibitor, as a replacement for mycophenolate mofetil or enteric-coated mycophenolate sodium, seemed to prevent renal dysfunction for at least 6 months among renal transplant patients without allograft nephropathy.

University students' suicidal thoughts and influencing factors.

This research was planned as a descriptive study for the purpose of examining the suicidal thoughts of first-year university students and the factors that might affect them. The research was conducted with the participation of first-year students (class of 1992) at Ege University between January 2003 and October 2004. The research data were collected on a form prepared by the researcher to determine the university students' socio-demographic characteristics and their suicidal thoughts, the trait anger, expression of anger inventory and the brief symptom inventory. It was determined that 2.4% of the students had suicidal thoughts, and 11.2% of the students had previously attempted suicide. The risk factors of the students' suicidal thoughts were determined to be issues of gender, school problems, family relationships, anger expression, somatization, hostility, psychotic symptoms, phobic anxiety, anxiety disorder and interpersonal sensitivity.

Pre-operative radiochemotherapy for rectal cancer. A prospective randomized trial comparing pre-operative vs. postoperative radiochemotherapy in rectal cancer patients.

PURPOSE: The aim of the study was to find out whether pre-operative radiochemotherapy had any survival advantage over postoperative radiochemotherapy for rectal carcinoma patients without distant metastasis or peritoneal carcinomatosis. MATERIAL AND METHODS: Between January 1998 and December 2003, 51 rectal carcinoma patients without distant metastasis or peritoneal carcinomatosis were randomly divided into pre-operative (PRE) and postoperative (POST) radiochemotherapy groups. Twenty-six were assigned to the PRE group and were operated on 5 to 8 weeks after the completion of radiotherapy. The other 25 patients were operated on immediately and received radiotherapy postoperatively 2 to 4 weeks after surgery. The patients were followed up for between 4 to 51 months. RESULTS: In the PRE group the rates of disease-free survival were 92%, 70%, 56% and 56% at the end of the 1t, 2d, 3"r and 4th years, respectively. In the POST group those percentages were 83%, 68%, 51% and 51% at the 1S", 2nd, 3r and 4th years, respectively (p = 0.707). One-year and 4-year overall survival rates in the PRE group were 100% and 86% respectively and 100% and 60% in the POST group (p = 0.520). CONCLUSION: No statistical difference was found between the survival rates of the rectal carcinoma patients receiving radiotherapy either pre-operatively or postoperatively. However, the disease-free survival rates of the PRE group were higher than the POST group's during each year and overall survival rates were higher after the third and fourth years. We conclude that pre-operative radiotherapy is at least as effective as postoperative radiotherapy.

Pre-operative radiochemotherapy for rectal cancer. A prospective randomized trial comparing pre-operative vs. postoperative radiochemotherapy in rectal cancer patients.

PURPOSE: The aim of the study was to find out whether pre-operative radiochemotherapy had any survival advantage over postoperative radiochemotherapy for rectal carcinoma patients without distant metastasis or peritoneal carcinomatosis. MATERIAL AND METHODS: Between January 1998 and December 2003, 51 rectal carcinoma patients without distant metastasis or peritoneal carcinomatosis were randomly divided into pre-operative (PRE) and postoperative (POST) radiochemotherapy groups. Twenty-six were assigned to the PRE group and were operated on 5 to 8 weeks after the completion of radiotherapy. The other 25 patients were operated on immediately and received radiotherapy postoperatively 2 to 4 weeks after surgery. The patients were followed up for between 4 to 51 months. RESULTS: In the PRE group the rates of disease-free survival were 92%, 70%, 56% and 56% at the end of the 1st, 2nd, 3rd and 4th years, respectively. In the POST group those percentages were 83%, 68%, 51% and 51% at the 1st, 2nd, 3rd and 4th years, respectively (p = 0.707). One-year and 4-year overall survival rates in the PRE group were 100% and 86% respectively and 100% and 60% in the POST group (p = 0.520). CONCLUSION: No statistical difference was found between the survival rates of the rectal carcinoma patients receiving radiotherapy either pre-operatively or postoperatively. However, the disease-free survival rates of the PRE group were higher than the POST group's during each year and overall survival rates were higher after the third and fourth years. We conclude that pre-operative radiotherapy is at least as effective as postoperative radiotherapy.