Comparison of clinical outcomes of robotic-assisted and video-assisted esophagectomy for esophageal cancer.

INTRODUCTION: Robotic-assisted minimally invasive esophagectomy (RAMIE) is a recently developed technique for the treatment of resectable esophageal cancer. The present study compares the outcomes of RAMIE and video-assisted thoracoscopic esophagectomy (VATE). METHOD: Patients undergoing minimally invasive esophageal surgery between December 2020 and September 2022 were included in the study, while those undergoing conventional surgery were excluded. The patients were divided into two groups, as those undergoing RAMIE (Group 1) and those undergoing VATE (Group 2). The demographic and clinical characteristics, intraoperative parameters, pathological data, and postoperative parameters of the groups were compared. RESULTS: A total of 28 patients were included in the study, with 13 patients in Group 1 and 15 patients in Group 2. The gender distribution was similar (P = 0.488), and the mean age was 64.7 and 59.0 years in Groups 1 and 2, respectively (P = 0.068). The majority of the sample was in the ASA2 category (46.2% vs. 66.7%, P = 0.341); Ca19.9 levels were higher in Group 1 than in Group 2 (25.7 vs. 13.7, P = 0.027); preoperative Hb was lower in Group 1 than in Group 2 (10.9 g/dL vs. 12.2 g/dL, P = 0.043); the most commonly performed surgery was the McKeown procedure (69.2% vs. 66.7%, P = 0.492); an intraoperative feeding jejunostomy was placed only in Group 2; the operation time was similar between the groups (338.5 min vs. 340 min, P = 0.916); and the distribution of tumor localizations was similar between the groups (P = 0.407). In terms of tumor histology, squamous cell carcinoma (SCC) was the most common tumor type in the two groups (84.6% vs. 80%, P = 0.636); the tumor diameter was similar between the groups (14.9 vs. 18.1, P = 0.652); the number of removed lymph nodes was similar between the groups (24.9 vs. 22.5, P = 0.419); and the number of metastatic lymph nodes was higher in Group 2 (0.08 vs. 1.07, P = 0.27). One patient in Group 2 underwent repeat surgery due to suspected ischemic anastomosis; the distribution of postoperative complications according to the Clavien-Dindo classification system was similar in the two groups (P = 0.650); there was no early mortality within the first 30 days in either group; one patient in Group 2 was re-admitted within 90 days of discharge with decreased oral intake; the length of hospital stay was shorter in Group 1 (9 days vs. 16.5 days, P = 0.006); and the patients in Group 2 more often received neoadjuvant therapy in proportion to the disease stage (15.4% vs. 60%, P = 0.016). CONCLUSION: Robotic procedures can be safely performed in esophageal cancers with complication rates and oncological radicality similar to those of other minimally invasive techniques.

Correlation of TIRADS scoring in thyroid nodules with preoperative fine needle aspiration biopsy and postoperative specimen pathology.

INTRODUCTION: The aim of our study is to determine the value of Thyroid Imaging Reporting and Data Systems (TIRADS) scoring in predicting malignancy in thyroid nodules by examining its relationship with fine needle aspiration biopsy and postoperative histopathological results. MATERIALS AND METHODS: In this study, patients who underwent surgery after ultrasonographic examination and fine needle aspiration biopsy for thyroid nodules at the General Surgery Clinic of Çukurova University Faculty of Medicine between January 2014 and November 2021 were retrospectively analyzed. The thyroid ultrasonography and fine needle aspiration biopsy of the included patients were performed by a clinician with 15 years of experience. The ultrasonographic features of the nodules were re-evaluated by the same clinician, and the American College of Radiology (ACR) TIRADS score was determined. Fine needle aspiration biopsy results were grouped according to Bethesda criteria. Postoperative histopathological examination results were divided into two groups: benign and malignant. The ACR TIRADS score was compared with fine needle aspiration biopsy and histopathological results. The performance of the ACR TIRADS score in predicting malignancy was determined. RESULTS: 79.8% of the 397 patients were female, and the mean age was 50.9 ± 12.8 years. The mean diameter of the nodules was 27.4 ± 15.8 mm. There was a significant, positive, but weak correlation between ACR TIRADS and Bethesda (p < 0.001) (r = 0.33). When the ACR TIRADS score was compared with histopathological results, it was found that the rate of malignancy increased as the TIRADS score increased (p < 0.001). The rates of malignancy diagnosis were 0% for TR1, 13.2% for TR2, 21.7% for TR3, 50.3% for TR4, and 72.4% for TR5. The area under the receiver operating characteristic curve for TIRADS in predicting malignancy was 0.747 (95% CI: 0.699-0.796, p < 0.001). TIRADS can distinguish malignancy with 75% accuracy. The optimal cutoff point was determined as TR4 with 80.3% sensitivity and 60.8% specificity. CONCLUSION: The ACR TIRADS scoring system is an effective risk classification system for thyroid nodules, providing 75% accuracy in predicting malignancy, with 80.3% sensitivity and 60.8% specificity values.

Short-term surgical outcomes of robotic gastrectomy. A single center/single surgeon experience.

AIM: Surgical resection is considered the optimum approach to the treatment of gastric cancer. The present study evaluates the efficacy of robotic surgery for the treatment of gastric cancer. METHOD: Included in the study were 30 patients who underwent robotic surgery for gastric cancer at the General Surgery Clinic between July 2021 and 2022. The demographic and clinical properties of the patients,intraoperative and postoperative results, tumor Characteristics, and early morbidity and mortality values were evaluated. RESULTS: The mean age of the 30 (F/M:8/22) patients was 63.9 (42-83) years, among which 20 (66.7%) had undergone neoadjuvant treatment. The mean surgery duration was 252.82 (110-380) minutes. A subtotal gastrectomy was performed in 10 patients (33%), while the remaining 20 patients (67%) underwent a total gastrectomy. The operation was converted to open surgery in four patients (13.2%). No intraoperative complications were seen, although one patient (3%) underwent re-anastomosis on postoperative day 3 due to an obstruction in the gastroenterostomy anastomosis. The mean largest diameter of the tumor was 4.6 (0-9) cm; the mean number of resected lymph nodes was 30.8 (11-58); and the mean duration of hospital stay was 5.9 (3-12) days. Early mortality within the first 30 days was seen in one patient with a cardiac cause. The rate of re-admission to hospital within the first 90 days was 11% (3 patients). CONCLUSION: Robotic surgery in patients with gastric cancer can be applied efficiently considering the successful clinicopathological results, short hospital stay, and low morbidity and mortality rates. KEY WORDS: Cancer, Morbidity, Mortality, Robotic Surgery, Stomach.

A Rare Tumor in Adulthood: Extrapancreatic Pancreatoblastoma.

Pancreatoblastoma is a rare malignant epithelial neoplasm of the pancreas. It primarily occurs in the pediatric population and is extremely uncommon in adults. A 64-year-old male patient with no known systemic disease presented to our clinic with abdominal pain and dyspeptic complaints. On physical examination, a tender epigastric mass was palpated. The patient was operated on with a preliminary diagnosis of gastrointestinal stromal tumor. Enbloc resection of the mass was performed. The transverse colon was segmentally resected with wedge resection of the gastric corpus. A stapled side-to-side anastomosis was performed. The macroscopic examination of the case revealed a tumoral lesion of approximately 16x13.5x10m, located in the submucosal area between the gastric corpus and the transverse colon. The microscopic examination showed acini, which have a highly cellular appearance, contain areas of necrosis, and form nested structures in places, stratification in places. The immunohistochemical examination demonstrated positive Trypsin expression, while focal positive expression of neuroendocrine markers such as Synaptophysin, Chromogranin, and Insulinomaassociated protein 1 (INSM-1) was observed. In betacatenin staining, aberrant nuclear and cytoplasmic positive expression was observed, and this staining pattern and morphology confirmed the diagnosis of pancreatoblastoma. Pathological Stage:pT3,N0,Mx the patient had an uneventful postoperative period and was referred to the oncology department for adjuvant chemotherapy. Pancreatoblastoma is an extremely rare type of pancreatic cancer and there are no established guidelines for the treatment of this aggressive disease. Surgical resection is recommended if anatomically possible. Pancreatoblastoma should be considered in the differential diagnosis of asymptomatic masses containing cystic-solid components and reaching very large sizes. Key words: Pancreas,Rare tumor, Pancreatoblastoma.

An early experience with the Da Vinci Xi surgical system in colorectal surgery. A single-center study.

AIM: Surgery is the optimum treatment approach in cases of colorectal cancer, with open or minimally invasive surgery options applied to patients in general surgery clinics. We present here an assessment of our use of robotic colorectal surgery for the treatment of colorectal cancer. METHOD: The outcomes of robotic colorectal surgeries performed in the General Surgery Clinic of Basaksehir Cam and Sakura City Hospital were evaluated. The demographic data, indications, type of surgery, complications, duration of postoperative stay and pathology results of the patients were recorded, and the surgical results were evaluated retrospectively. RESULTS: Of the 50 patients who underwent robotic colorectal surgery selected for the study, 19 were female and 31 were male, with a mean age of 60.9 years. Among the patients, 48% received neoadjuvant treatment and the most common tumor localization was the rectosigmoid region (40%), the most frequently performed operation was low anterior resection (44%). An ostomy was created in 50% of the patients, and two patients were converted. The mean duration of surgery was 191 minutes, the mean tumor diameter was 36 mm, the mean total number of lymph nodes dissected was 22.2 and the rate of complications of Clavien Dindo grade 3 or higher was 10%, namely anastomotic leak, anastomotic bleeding and chylous fistula. The mean length of hospital stay was 5 days, and one patient was reoperated due to the development of stomal necrosis. The rate of 90-day unplanned readmission was 10% and the most frequent cause was sub-ileus. One patient died in the postoperative period. CONCLUSION: Robotic surgery is a minimally invasive surgical approach that can be successfully applied in centers where perioperative and postoperative complications can be managed. KEY WORDS: Colorectal Cancer, Minimally Invasive Surgery, Robotic Surgery.

Analysis of appendiceal neoplasms in 1,423 appendectomy specimens: a 10-year retrospective cohort study from a single institution.

OBJECTIVE: This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms. METHODS: This is a retrospective cohort study from a single institution. Patients with a pathological diagnosis of malignancy who underwent appendectomy between January 2011 and 2021 were included in the study, and groups were formed according to pathological type. Clinical, pathological, and oncological results were compared in these groups. RESULTS: The incidence of neoplasia was 2.38% (n=34) in a cohort of 1,423 appendectomy cases. Of the cases, 56% (n=19) were female. The median age in the entire cohort was 55.5 (range: 13-106) years. In the cohort, the rate of neuroendocrine tumor mucinous cystadenoma adenocarcinoma, and low-grade appendiceal mucinous neoplasm, according to the American Joint Committee on Cancer classification of appendiceal neoplasms, was 32.3% (n=11), 26.4% (n=9), 26.4% (n=9), and 14.7% (n=5), respectively. Neuroendocrine tumor patients (median age: 35 years) were younger than the other groups (p=0.021). Secondary complementary surgery was performed in 66.7% (n=6) of adenocarcinoma patients and 27.3% (n=3) of neuroendocrine tumor patients. Right hemicolectomy was performed in all neuroendocrine tumor patients requiring secondary surgery, while right hemicolectomy was performed in three adenocarcinoma patients and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in three adenocarcinoma patients. After a median follow-up of 44.4 months (95% confidence interval: 18.6-70.1), the mean survival rate was 55% in appendiceal adenocarcinoma patients compared to 100% in neuroendocrine tumor patients. CONCLUSION: Appendiceal neoplasms are rare but remain an important cause of mortality. Appendiceal adenocarcinomas are associated with poorer oncological outcomes compared to other neoplasms.

"Comparison of Nissen Rossetti and Floppy Nissen techniques in laparoscopic reflux surgery".

OBJECTIVE: The present study makes a comparative assessment of the Floppy-Nissen (FN) and Nissen-Rossetti fundoplication (NRF) procedures. METHODS: Included in the study were 80 patients who presented to the General Surgery Department outpatient clinic of Balcali Hospital of the Cukurova University Faculty of Medicine with gastroesophageal reflux between March 2010 and March 2013 All patients were operated on by the same surgeon using the laparoscopic FN or NRF techniques in a randomized controlled manner. The preoperative and postoperative reflux-specific and nonspecific gastrointestinal symptoms of the patients were compared. RESULTS: The duration of symptoms had no effect on the level of satisfaction; regurgitation, bloating and heartburn were more common in those with a longer duration of symptoms Of the patients, 92.5% were satisfied with their resulting condition, and 92.5% were inclined toward the surgery. It was further found that there was no difference between the symptoms or satisfaction levels of the patient groups who underwent the FN procedure and those who underwent the NRF procedure, other than those related to the duration of surgery. laparoscopic NF and the NRF fundoplication treatments, aside from the duration of surgery. CONCLUSION: Our study revealed no significant difference between the laparoscopic NF and the NRF fundoplication treatments, aside from the duration of surgery.KEY MESSAGESThe Nissen-Rossetti technique can be used safely based on the similarity of its outcomes with those of the classical Nissen technique.Despite the documented success of laparoscopic anti-reflux surgery, the absence of studies comparing surgery and medical treatments prevents these discussions from being concluded.Comparison of Nissen Rossetti and Floppy Nissen Techniques in Laparoscopic Reflux Surgery.

The effect of D3 dissection on postoperative morbidity and early mortality in gastric cancer patients who underwent curative total gastrectomy.

AIM: The present study presents the factors associated with early complications and mortality in patients undergoing total gastrectomy. MATERIAL AND METHOD: The study included patients who underwent curative total gastrectomy for gastric adenocarcinoma between January 2001 and December 2016 in the General Surgery Department of the Çukurova University Medical Faculty Hospital. The patients were divided into D1, D2, and D3 groups depending on the lymph node dissection width, and the demographic and clinical data and mortality were compared. In addition, mortality-associated factors were analyzed. RESULTS: The study sample included 148 (62.7%) males and 88 (37.3%) females, with a mean age of 65.5±11.4 years. There were 87 patients in the D1 group, 117 in the D2 group, and 23 in the D3 group. As expected, the duration of the operation was longer in the D2 and D3 groups (179 vs. 224 vs. 252; p<0.001), and these groups had also higher numbers of lymph nodes dissected (8 vs. 20 vs. 32; p<0.001) and metastatic lymph nodes (2.6 vs. 7.5 vs. 9.2; p<0.001). The analysis of the operation type in terms of complications revealed a significant relationship only with stump blowout, which was significantly more common after D3 dissection than following D2 and D1 dissections (p:0.01). The male gender (87.5 vs 60.9 p:0.03) was more associated with mortality. CONCLUSION: D1, D2 and D3 Lymph node dissection in gastric cancer surgery can be safely performed with low mortality and morbidity rates by surgeons with sufficient technical knowledge, and in centers with sufficient hospital volume. KEY WORDS: Complications, Gastric Cancer, Mortality, Lymph Node Dissection.

Analysis of appendiceal neoplasms in 1,423 appendectomy specimens: a 10-year retrospective cohort study from a single institution

SUMMARY OBJECTIVE: This study aimed to reveal the incidence, clinicopathological, and oncological outcomes of appendiceal neoplasms. METHODS: This is a retrospective cohort study from a single institution. Patients with a pathological diagnosis of malignancy who underwent appendectomy between January 2011 and 2021 were included in the study, and groups were formed according to pathological type. Clinical, pathological, and oncological results were compared in these groups. RESULTS: The incidence of neoplasia was 2.38% (n=34) in a cohort of 1,423 appendectomy cases. Of the cases, 56% (n=19) were female. The median age in the entire cohort was 55.5 (range: 13-106) years. In the cohort, the rate of neuroendocrine tumor mucinous cystadenoma adenocarcinoma, and low-grade appendiceal mucinous neoplasm, according to the American Joint Committee on Cancer classification of appendiceal neoplasms, was 32.3% (n=11), 26.4% (n=9), 26.4% (n=9), and 14.7% (n=5), respectively. Neuroendocrine tumor patients (median age: 35 years) were younger than the other groups (p=0.021). Secondary complementary surgery was performed in 66.7% (n=6) of adenocarcinoma patients and 27.3% (n=3) of neuroendocrine tumor patients. Right hemicolectomy was performed in all neuroendocrine tumor patients requiring secondary surgery, while right hemicolectomy was performed in three adenocarcinoma patients and cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in three adenocarcinoma patients. After a median follow-up of 44.4 months (95% confidence interval: 18.6-70.1), the mean survival rate was 55% in appendiceal adenocarcinoma patients compared to 100% in neuroendocrine tumor patients. CONCLUSION: Appendiceal neoplasms are rare but remain an important cause of mortality. Appendiceal adenocarcinomas are associated with poorer oncological outcomes compared to other neoplasms.

The relationship of patients, giving or not giving a pathological full response, with YAP (Yes Associated Protein) in breast cancer cases to which neo-adjuvant chemotherapy is applied.

AIM: We aimed to evaluate (immunohistochemically) the YAP expression in breast cancer patients undergoing neoadjuvant chemotherapy and to clarify the relationship between the molecular characteristics, treatment response and survival data and the YAP expression, and hence, to clarify the prognostic significance. MATERIAL AND METHODS: One hundred and four patients who were diagnosed with Breast Cancer between 2015-2020 and underwent Neo Adjuvant Chemotherapy were included in the study. Estrogen Receptor(ER), Progesterone Receptor(PR), Human Epidermal Growth Receptor-2(HER2) and Ki-67. Expression are routinely stained immunohistochemically. In this study, existing immunohistochemical markers were reviewed and also, the relationship of YAP with these biological markers was evaluated by using immunohistochemistry and its effect on prognosis has been investigated. RESULTS: The average age of the patients was 52.37. While YAP was positive in 78 patients (75%), it was negative in 26 patients (25%). In the evaluation after neoadjuvant therapy, pathological complete response (MillerPayne Grade5 response) in 28 patients (26.9%), relapse in 6 patients (5.8%), and exitus in 6 patients (5.8%) were detected. In the pathological evaluation, invasive Ductal Carcinoma was the most common one observed in 88 patients (84.6%). As a result of the statistical evaluation, no significant result was obtained between the parameters and YAP negative/positive. CONCLUSION: As a result of staining with additional YAP in patients who were diagnosed with breast cancer and routinely stained with ER, PR, Cerb B2 and Ki-67 in pathology samples, we could not reach a result that would contribute positively to survival. Longer studies to be conducted prospectively will be meaningful. KEY WORDS: Breast Cancer, Chemotherapy, Neoadjuvant, Yes Associated Protein.

Importance of HALP Score in Breast Cancer and its Diagnostic Value in Predicting Axillary Lymph Node Status.

OBJECTIVE: To determine the diagnostic value of the haemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting axillary lymph node (ALN) involvement. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: Department of General Surgery, Balikesir University and Mersin City Hospital, Turkey from January 2016-December 2021. METHODOLOGY: Included in the study were 307 patients who underwent surgical treatment for breast cancer. HALP values were calculated by multiplying the haemoglobin, albumin, and lymphocyte values and dividing the resulting value by the platelet number. The patients were divided in two groups, being those with low HALP (Group 1) and high HALP (Group 2) scores. We examined the potential of the HALP score for the prediction of ALN involvement. RESULT: Group 1 had 65 patients and the Group 2 had 242 patients. At the cut-off point, a HALP score of <29.01 predicted the presence of axillary involvement with a sensitivity of 84.33% and a specificity of 26.1%. The sentinel lymph node sampling rate was similar in both groups (12.3% vs. 16.9% p=0.365). The presence of positive lymph nodes in the axilla was higher in group 1 (67.7% vs. 53.3% p=0.038). There was no correlation between HALP score, and the metastatic lymph node and total lymph node count. CONCLUSION: The use of HALP score alone for the prediction of axillary lymph node positivity in patients with breast cancer is not advised. In the present study, a low HALP score was associated with aggressive tumour activity, such as advanced tumour and axillary lymph node positivity. KEY WORDS: Breast cancer, Axillary lymph node involvement, Immunity, Nutrition.

Diagnostic Value of Preoperative Haemoglobin, Albumin, Lymphocyte and Platelet (HALP) Score in Predicting Tumour Budding in Colorectal Cancer.

OBJECTIVE: To investigate the value of preoperative haemoglobin, albumin, lymphocyte, and platelet (HALP) score in predicting tumour budding in colorectal carcinoma. STUDY DESIGN: Observational study. PLACE AND DURATION OF STUDY: University of Health Sciences, Basaksehir Çam and Sakura City Hospital Istanbul/Turkey, between May 2020 and May 2021. METHODOLOGY: The colorectal cancer patients who underwent surgery were divided into two groups according to the presence or absence of tumour budding. A total of 110 patients were included in the study, and there were 31 patients in group 1 and 79 patients in group 2. The predictive value of the HALP score in predicting tumour budding at the determined cut-off point was evaluated. RESULTS: The mean HALP score was similar in both groups (p=0.459). The rate of lymphovascular invasion was higher in group 2 (p=0.002), and T3 and T4 tumours were more common in group 2 (p<0.001). The number of metastatic lymph nodes was higher in group 2 (p=0.049). When the patients in group 2 were divided into subgroups according to the degree of tumour budding, the HALP score differed between intermediate and high budding groups (p=0.032). A HALP value of >31.6 predicted the presence of tumour budding with a sensitivity of 70.89% and a specificity of 48.39%. CONCLUSION: The presence of tumour budding is associated with aggressive phenotypic features in colorectal carcinoma. The preoperative prediction of tumour budding can serve as a guide in the development of individualised therapy plans. The HALP score was associated with the presence of intermediate or high degree of tumour budding. KEY WORDS: Colorectal cancer, Tumor, Pathology, Hemoglobin, Albumin.

Migration of Tenckhoff Catheter to Sigmoid Colon: A Rare Delayed Complication.

Bowel perforation associated with inserted peritoneal dialysis (PD) catheter mainly occurs during the perioperative period. Delayed bowel perforation is difficult to diagnose because of its different clinical signs and rarity. A 53-year-old woman developed acute abdomen after her PD catheter was changed. It was found that the changed catheter perforated the sigmoid colon. Primary repair of the perforated area of the sigmoid colon was performed, and the last inserted PD catheter was removed. The postoperative period and recovery were uneventful. Perforations due to the PD catheter may remain silent until the catheter is replaced. In patients with frequent episodes of peritonitis, a perforation area due to PD catheter which limited itself should be considered as the etiology.

Clinicopathologic characteristics and surgical management of schwannomas of the upper digestive tract.

AIM: Schwannoma is a peripheral nervous system tumor arising from Schwann cells of the neural sheath, and they are very rarely seen in the upper digestive tract. In this study, we aimed to present the clinicopathologic characteristics and surgical management of patients who underwent surgical treatment for esophageal or gastric schwannoma. MATERIAL AND METHODS: Patients who were diagnosed with esophageal or gastric schwannoma between January 2013 and January 2020 were included in the study. Demographic, clinicopathological and immunohistochemical parameters of the patients were analyzed along with the follow-up results. RESULTS: There were 13 patients in our study. Nine patients had gastric schwannoma and 4 patients had esophageal schwannoma. Female gender was dominant (61.5%). The mean age was 56 years. Esophageal tumors were all enucleated. Minimal invasive approach was preferred in 3 patients. Gastric tumors were most commonly localized in the lesser curvature. Three patients underwent laparoscopic wedge resection, 3 patients open wedge resection, 2 patients subtotal gastrectomy, and one patient proximal gastrectomy. Intraoperative or postoperative complications did not develop in any patient. No patient required reoperation, and there were no deaths within 90 days postoperatively. In the postoperative 90-day period, there was no unplanned re-admission to the hospital. The mean follow-up period was 53.4 months (range: 23-93 months). No recurrence was detected in any patients. CONCLUSIONS: Definitive diagnosis of schwannomas is made only by histopathologic examination postoperatively. S-100 expression has diagnostic significance. The preferred treatment is complete surgical excision with negative margins, and the long-term outcome is excellent as these lesions are mostly benign. KEY WORDS: Esophagus, Enucleation, Schwannoma, Stomach, Wedge resection.

Long-term Results of Low Grade Appendiceal Mucinous Neoplasm (LAMN): A Retrospective Analysis of 24 Patients.

BACKGROUND: Appendix tumors are rare tumors found in the gastrointestinal tract, observed at a rate of about 0.2%-0.3%. Our aim in this study was to present the clinicopathological classification, treatment and long-term prognosis of patients with low grade appendiceal mucinous neoplasm (LAMN). METHODS: Patients who underwent surgery in the Erciyes University Department of (Kayseri, Turkey), Department of General Surgery between December 2010 and December 2018, and who had LAMN as a result of pathology were included in our study. Demographic data, clinical and pathological features of the disease, their treatment and follow-up results after treatment were reviewed retrospectively. RESULTS: We included 24 patients in the study. Of these patients, 10 (41.6%) were male. The mean age distribution was 56.4 ± 20.3 (21-91) years. Appendectomy was performed in 14 patients, and additional organ resections were performed in 8 patients. The most common symptom at the time of presentation was abdominal pain (79.1%; 95% CI, 58.3-91.7). The most common preliminary diagnosis in the preoperative period was acute appendicitis (50%; 95% CI, 29.2-70.8). Mean postoperative hospitalization time was 7.4 ± 7.96 (2-31) days. On pathological examination, appendectomy resection margins were positive in two patients. The mean (median) postoperative follow-up was 31.25 ± 23.9 (27) (1-90) months. One-year survival was 91.6%, and 5-year survival was 83.3%. Recurrence was detected in three patients during the follow-up period. CONCLUSION: If appendix mucinous neoplasia (AMN) is suspected in patients undergoing surgery with an initial diagnosis of acute or plastron appendicitis, care should be taken to remove the lesion without perforation. Pseudomyxomaperitonei, which may develop as a result of perforation, is associated with recurrence and decreased survival.

Prognostic significance of preoperative hemoglobin and albumin levels and lymphocyte and platelet counts (HALP) in patients undergoing curative resection for colorectal cancer.

BACKGROUND/OBJECTIVE: In this study, we aimed to determine the relationship between HALP score and postoperative complications (According to Clavien-Dindo classification 3 and above), in patients with colo-rectal cancer who underwent curative surgical resection and to determine its clinical value in predicting prognosis. METHODS: 279 patients who underwent curative surgery for colorectal cancer between 2015-2018 were included in the study. The HALP value was calculated by dividing the product of hemoglobin (g/L), albumin (g/L), lymphocytes (/ L) by the number of platelets (/ L). In order to generate a cut off value for the HALP value, ROC analysis and ROC curve were created. The patients were divided into two groups according to survival, and cut off value was found by ROC analysis: Group 1 (Low HALP) and Group 2 (High HALP). Demographic, clinical characteristics, intraoperative , postoperative results and mean survival were compared between the groups. RESULTS: The patients were divided into two groups according to cut off value of 15.73. Group 1 consisted of 113 patients; Group 2 consisted of 166 patients. Average age was similar in the groups (62vs61, p:0.480). Patients in Group 1 received more neoadjuvant therapy (31%vs21%, p:0.064). CEA levels were higher in Group 1 (7.6vs4.3 p:0.034). Mucinous adenocarcinoma histological type was more common in Group 1 (24%vs13% ,p:0.040). Pathological grade poorly differentiated was more common in Group 1 (27%vs13%). Postoperative outcomes was similar to groups We found the HALP score as a risk factor for survival in multivariate analysis (HR=0.8552 95% (CI:0.6575-1.1125, p:0.007). If the HALP value is below 15.73, it is assumed that the average survival is 28 months with 45.4% sensitivity and 66.938% specificity. CONCLUSION: Our results showed that the HALP score is closely related to clinic pathological features and is an independent prognostic factor for survival. Its value in estimating mean survival is limited. KEY WORDS: Colorectal cancer, HALP score, Immunity, Nutrition.

Surgical myotomy and anterior fundoplication for achalasia disease. Short-term outcomes.

AIM: Achalasia is a well-known disease among esophageal motility disorders, and all treatments for this disease are aimed at relaxing the lower esophageal sphincter (LES). Recently, endoscopic and surgical myotomy techniques are used more frequently because they give better results than other conservative techniques. In this study, we aimed to present the early results of surgical myotomy and anterior fundoplication techniques in the treatment of achalasia-related dysphagia. METHODS: Our study enrolled patients who operated with laparoscopic myotomy and anterior fundoplication for achalasia between 2014 and 2019. Patients' demographic and clinical properties, operative details, and postoperative shortterm outcomes were retrospectively analyzed. RESULTS: A total of 25 patients (11 women, 14 men) were enrolled. The mean age was 40.72±13.6 (range 18-66) years. The mean LES pressure was 26.6±11.2 (range 16-50) mmHg. The mean esophageal myotomy length was 7.83±1.88 (range 7-12 cm). Esophagus perforation developed in one patient during myotomy. The mean time to start oral feeding was 2.56±0.76 (range 2-4) days, and the mean length of hospital stay was 4.96±1.17 (range 3-8) days. During the follow-up, symptom regression was observed in 92 % of patients at the end of a 1-year. CONCLUSION: According to our results and available literature, myotomy with Dor fundoplication is an effective technique that can be used to treat achalasia disease. KEY WORDS: Achalasia, Dor fundoplication, Heller myotomy.

Should tall cell thyroid cancers be evaluated differently from well-differentiated thyroid cancers?

OBJECTIVE: In this study, we aimed to investigate the clinical features of Papillary thyroid carcinoma(PTC) Tall cell variant(TCV), long-term outcomes and surgical experience in papillary thyroid carcinoma. MATERIAL-METHOD: 33 patients who were operated in our clinic between August 2012 and March 2018 and diagnosed as TCV in their pathology evaluation were included in the study. The demographic and clinical features of the patients, pathological features of the tumor and long-term results were examined. RESULTS: A total of 33 patients were included in our study. The mean age was 55.2(18-85) years. The female sex was more dominant (75.8%). The most common presenting complaint was swelling in the neck (75.7%).Total thyroidectomy was performed in 84.8% and completion thyroidectomy after lobectomy was performed in 15.2%. Neck dissection was performed in 33% of the patients. The mean tumor diameter was 3.6 (1-10) cm. The tumor was multifocal in 36.3% of the patients. The capsule invasion rate of the tumors was present in 69.7% of the patients, extrathyroidal rate was 39.4%, Metastatic lymph nodes were detected in 30.3% of the cases. The mean follow-up duration was 39.3+22.4(5.25-78.63) months. 39.4% of patients had distant metastasis during follow-up. Disease free survival rate was 57.6%, total survival was 42.4 + 3.8 (34.7-50.0) months. CONCLUSION: TCV is closely associated with larger tumor diameter, multifocal location, extrathyroidal spread and lymph node involvement, We believe that more aggressive surgery should be performed in the treatment of TCV cases and it is important to follow up the patients more closely. KEY WORD: Esophagus cancer, Neutrophil/lymphocyte ratio, Preoperative lymphocyte /neutrophil ratio, Prognosis.

Intraabdominal Schwannomas Single-center experience.

OBJECTIVE: Intraabdominal schwannomas are rare benign tumors. In this study, we aimed to present our clinical experience in patients with intrabdominally located Schwannoma. MATERIAL-METHOD: Patients who received the diagnosis of intrabdominal schwannoma between 2011-2019 were retrospectively examined. Demographic and clinical characteristics, treatment methods, short- and long-term results and immunohistochemical characteristics of the patients were analyzed. RESULTS: A total of 7 patients were included in the study. Four patients were female and three were male. The mean age was 51.5 (31-63) years. The most common clinical presentation was abdominal pain (57.1%). Tumor location was stomach (n=2), pelvic region (n=2), rectum (n=1), retropancreas (n=1), and left juxtadrenal space (n=1). Postoperative wound infection developed in one patient and pancreatic fistula complication was seen in one patient. Re-admissions to the hospital were due to anemia and pleural effusion in two patients. The mean tumor diameter was 6 cm (0.3-13 cm). All patients were S 100 strongly positive Mitoses / 50 HPFs (high power field), <2 Ki67 <3%. The mean follow- up period was 60 months. Currently, 5 patients are being followed without disease, 1 patient survives despite recurrence and 1 patient has died due to non-cancer reasons. CONCLUSION: Intrabdominal schwannomas are rare tumors which most commonly exhibit gastrointestinal involvement. Since these tumors are mostly benign, the long-term prognosis of patients is good. Schwannoma should be kept in mind in the differential diagnosis of intrabdominal masses. Radical resections with high morbidity and mortality should be avoided if preoperative diagnosis is made. KEY WORDS: Abdominal tumor, Mesenchymal tumor, Nerve sheath tumor, Schwannoma.

Microgravity, Stem Cells, and Cancer: A New Hope for Cancer Treatment.

Humans are integrated with the environment where they live. Gravitational force plays an important role in shaping the universe, lives, and even cellular biological processes. Research in the last 40 years has shown how exposure to microgravity changes biological processes. Microgravity has been shown to have significant effects on cellular proliferation, invasion, apoptosis, migration, and gene expression, specifically in tumor cells, and these effects may also exist in stem and cancer stem cells. It has also been shown that microgravity changes the effects of chemotherapeutic drugs. Although studies have been carried out in a simulated microgravity environment in cell culture lines, there are few animal experiments or true microgravity studies. Cancer remains one of the most significant problems worldwide. Despite advances in medical science, no definitive strategies have been found for the prevention of cancer formation or to inform treatment. Thus, the microgravity environment is a potential new therapeutic strategy for future cancer treatment. This review will focus on current knowledge on the impact of the microgravity environment on cancer cells, stem cells, and the biological behavior of cancer stem cells.