Clinical outcomes of crystallized phenol as a first treatment option in patients with recurrent pilonidal sinus.

AIM: This study aimed to observe the clinical outcomes of phenol treatment in patients with recurrent pilonidal sinus disease. MATERIAL AND METHODS: This study retrospectively collected data from 107 patients with recurrent the pilonidal disease who received phenol treatment in a single institute. Patients were divided into two groups as successful treatment (ST) and unsuccessful treatment (UST) after phenol application. A comparison was held between groups to define factors associated with failure treatment. RESULTS: There were 89 patients in ST and 18 patients in UST group. The treatment success rate after phenol treatment was 83.2%. We observed no difference between ST and UST in terms of age, gender, family history, surgical technique at the first operation, time to recurrence, procedure time, follow-up time, time to return to work, walk without pain or sit on the toilet without pain (p>0.05). However, smoking rate, presence of comorbidity, and mean BMI were statistically significantly higher in the UST group compared to the ST group (p<0.05). In addition, being obese (OR: 2.45, 95% CI: 1.07 - 5.60), having a comorbid disease (OR: 3.11, 95% CI: 1.29 - 7.47), and smoking (OR: 1.97, 95% CI: 0.85 - 4.53) were significantly associated with treatment failure. CONCLUSION: Phenol treatment is an effective and simple procedure that could be easily applied even in rural hospitals in an outpatient fashion. Therefore, it should be considered for patients suffering from recurrence without the need for an aggressive surgical excision. KEY WORDS: Crystallized phenol, Pilonidal sinus, Recurrence.

Gastric cancer surgery in elderly patients: promising results from a mid-western population.

BACKGROUNDS: Extended resection for gastric cancer in elderly patients is still challenging for surgeons. This study aimed to evaluate the prognosis and the postoperative outcomes of elderly patients underwent gastric cancer surgery in a high-volume center. METHODS: The medical records of patients with gastric cancer surgery at Marmara University Hospital's General Surgery Department were examined retrospectively. Patients were divided into two groups: Age ≤ 70 and Age > 70. The clinicopathological data of the patients were compared. The prognostic factors regarding gastric cancer surgery were analyzed with Cox proportional regression models. Kaplan Meier analysis and log-rank test were used to compare Overall Survival (OS) and Cancer-Specific Survival (CSS) among the groups. Competing risk regression analysis was used to examine cause-specific hazards among elderly patients. RESULTS: The number of eligible patients was 250. Age > 70 group was 68 patients, and Age ≤ 70 group was 182 patients. There is no significant difference between the patient's demographics or pathological outcomes. Neoadjuvant therapies performed less in elderly patients [40 (22%) vs. 7 (10%), p: 0.03, respectively]. There was no significant difference in severe complication (≥ Grade III) rates in both groups. Multivariate analysis showed that advanced T stage and adjacent organ invasion were the independent risk factors for OS. No significant difference was observed between the groups regarding OS (Log Rank (Mantel-Cox): 0.102). Younger patients have worse CSS than those who are older. Cause-specific hazard model demonstrated a not increased hazard ratio [HR: 1.04(0.78-1.38)] for elderly patients for OS and CSS. CONCLUSION: Gastric resections can be safely performed for elderly patients diagnosed with gastric cancer. This study showed that growing age is no longer a factor that will affect the clinician's decision in performing surgery in gastric cancer patients.

Evaluation of Colonoscopic Results of Patients with Incidental Colonic FDG Uptake in PET/CT Imaging.

BACKGROUND: Colorectal cancer is a significant global health concern, ranking as the second most deadly and third most common cancer worldwide. Early detection and removal of precancerous lesions play a crucial role in preventing cancer development and reducing mortality. Since FDG uptake is not specific for malignancy, incidental increased FDG uptake in the gastrointestinal tract may be challenging to interpret and may require further colonoscopic examination. This study aimed to investigate the features associated with malignant and premalignant pathology in patients with incidental colonic FDG uptake and determine the necessity of colonoscopy for each FDG uptake. METHODS: Retrospective analysis was performed on data from patients who underwent colonoscopies between January 2016 and December 2021. Patients with FDG uptake in known colorectal malignancy regions were excluded. The study included 56 patients with incidental colonic FDG uptake. PET/CT images were visually and quantitatively analyzed, and the corresponding colonoscopy and histopathological results were recorded. Statistical analyses were conducted to evaluate the relationship between FDG uptake patterns, SUVmax values, and histopathological diagnoses. Colonoscopic findings were categorized as malignancy, polyps, and non-neoplastic lesions. RESULTS: Among the 56 patients with incidental colonic FDG uptake, 36 lesions were identified, and histopathology revealed malignancy in 10 (17.9%) patients and premalignant polyps in the 26 (46.4%) cases. Focal FDG uptake with corresponding wall thickening or soft tissue density on CT was associated with a higher likelihood of premalignant or malignant lesions. The SUVmax values demonstrated a significant difference between negative findings and polyps/malignancies. However, no significant difference was observed between malignant and premalignant lesions. A ROC curve analysis was made and assesed a cut-off value of 11.1 SUVmax (sensitivity: 83.3% and specificity: 90%) to distinguish premalignant or malignant lesions from non-malignant lesions. CONCLUSION: Incidental colonic FDG uptake with a focal pattern and corresponding CT findings were more likely to indicate premalignant or malignant lesions. SUVmax values were helpful in predicting the presence of pathological findings, but histopathological verification remains necessary for a definitive diagnosis. These findings contribute to our understanding of the clinical implications of incidental colonic FDG uptake and highlight the importance of follow-up colonoscopy for further evaluation.

Is it Possible to Diagnose "Non-Invasive Follicular Thyroid Neoplasm with Papillary-Like Nuclear Features" Preoperatively?

There is no accepted consensus or algorithm for the preoperative diagnosis of non-invasive follicular thyroid neoplasm with papillary-like nuclear features (NIFTP) in patients with thyroid nodules. In this study, we evaluated the importance of preoperative neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in the differential diagnosis of NIFTP. Pathology preparations of 209 patients with a follicular variant of papillary thyroid carcinoma (FVPTC) diagnosed after thyroid surgery in a tertiary health center between January 2010 and January 2020 were re-evaluated. Patients were divided into NIFTP and encapsulated follicular variant papillary thyroid carcinoma (EFVPTC) to compare. Of the patients, 58 (27.7%) were NIFTP, and 151 (72.3%) were EFVPTC. There was no statistically significant difference in terms of age (p = 0.46), tumor size (p = 0.51), gender (p = 0.48), and surgical technique (p = 0.78) between the groups. The probability of the neutrophil-to-lymphocyte ratio (NLR) > 2 is more common in the EFVPTC group. It was statistically significant that the NIFTP group was 1.96 times more likely to have NLR > 2 (OR: 1.96, 95% CI: 1.06-3.63) (p < 0.05). However, there was no risk difference between the groups in terms of the platelet-to-lymphocyte ratio (PLR) (OR: 0.76, 95% CI: 0.41-1.43) (p > 0.05). The diagnosis of NIFTP should be kept in mind in the evaluation of patients whose thyroid fine-needle aspiration (FNA) biopsy results are in the intermediate group. NIFTP exhibits better prognostic findings than classic thyroid papillary cancer and EFVPTC. Therefore, preoperative diagnosis of NIFTP in line with laboratory, ultrasonography, and FNA findings will save the patient from unnecessary overtreatment.

Pseudoangiomatous stromal hyperplasia of the breast: Clinical evaluation.

BACKGROUND: Pseudoangiomatous stromal hyperplasia is a rare benign breast stromal proliferative lesion of the breast. Clinical presentation ranges from rapidly growing mass to incidental identification in routine screening. This difference in manifestation and its rarity makes it difficult to be a standard treatment protocol. Therefore, we aimed to share our clinical experience in Pseudoangiomatous stromal hyperplasia. METHODS: The files of patients who underwent core biopsy or surgical excision due to a breast mass and resulted in pseudoangiomatous stromal hyperplasia between January 2013 and December 2021 were included in the study. RESULTS: 17 patients with a median age of 37 (22-68) were found Pseudoangiomatous stromal hyperplasia confirmed by surgical excision or core biopsy. Chosen treatment option was observation in 8 patients (47.1%), while surgical excision was used in 9 (52.9%) patients. The mean follow-up period was 55.24 ± 26.72 (13-102) months. None of the patients observed the Malignant transformation during the follow-up period. CONCLUSION: For Pseudoangiomatous Stromal Hyperplasia of the breast, surgical excision with clean margins or close follow-up after diagnosis confirmation by tissue biopsy is sufficient. Pseudoangiomatous Stromal Hyperplasia is not a risk factor for developing breast cancer.

Effect of Sarcopenia on Mortality and Morbidity in Patients With Fournier's Gangrene.

BACKGROUND: Preoperative sarcopenia is an essential factor that negatively affects postoperative results. The effect of preoperative sarcopenia on postoperative complications and prognosis in patients treated for Fournier's gangrene (FG) is controversial. This retrospective cohort study analyzed the effect of FG to evaluate the effect of preoperative sarcopenia on postoperative complications and prognosis in patients who were operated on. METHOD: The data of patients who were operated on with FG diagnosis in our clinic between 2008 and 2020 were reviewed retrospectively. Demographic data (age and gender), anthropometric measurements, preoperative laboratory values, abdominopelvic CT, location of FG, number of debridements, ostomy, microbiological culture result, wound closure method, length of hospital stay, and overall survival were recorded. In addition, the presence of sarcopenia was determined according to psoas muscular index (PMI) and Hounsfield unit average calculation (HUAC). RESULTS: Of the patients, 57 (30.8%) were female and 128 (69.2%) were male. According to the PMI, sarcopenia was detected in 67 (36.2%) patients and 70 (37.8%), according to the HUAC. At the end of one postoperative year, the mortality rate was higher in the sarcopenia group than in the non-sarcopenia group (P = .002, P = .01). According to the PMI, patients with sarcopenia have an 8.17 times greater risk of exitus than non-sarcopenic patients. According to the HUAC, patients with sarcopenia have a 4.21 times greater risk of exitus than non-sarcopenic patients. CONCLUSION: Based on this large retrospective study, sarcopenia is a strong and independent predictor of postoperative mortality after Fournier's treatment for gangrene.

Clinical, Radiological and Histopathological Evaluation of Primary Colon Lymphoma.

BACKGROUND: In this study, we aimed to examine the clinical, radiological, histopathological, immunohistochemical, and prognostic features of a case series undergoing surgery for non-Hodgkin's primary colon lymphoma (NHL). METHODS: The data of six patients diagnosed with NHL who were operated on in our clinic between January 2010 and January 2020 were retrospectively analyzed. NHL was detected in six of the patients operated on for colon tumors. B (n=5) and T (n=1) cell lymphomas were detected based on their cellular subtypes. RESULTS: The median age at diagnosis was 66 (52-70). The most common complaints were abdominal pain, weight loss, nausea, and vomiting. One patient underwent emergency surgery, and five underwent elective surgery due to obstruction. While CT was used in all patients, Positron emission tomography-computed tomography (PET/CT) was taken only in patients who underwent elective surgery. The masses were localized in the cecum in two patients, in the right colon in two patients, and in the transverse colon and sigmoid colon in one patient each. All patients underwent mesocolic resection. The mean tumor size was 7.51±2.20 (4.5-11) cm. The median number of total lymph nodes was 33 (18-44), and the median number of metastatic lymph nodes was 15 (4-39). CONCLUSION: The overall and disease-free survival of the patient with T-cell lymphoma was shorter than that of patients with B-cell colon lymphoma. NHL is a rare disease. The cellular subtype effectively determines the survival time and prognosis of NHL.

Can minimally invasive surgical techniques reduce the incidence of postoperative adhesions?

<br><b>Introduction:</b> Postoperative intra-abdominal adhesions are a clinical condition that may develop after any abdominal surgery and constitute the leading cause of mechanical small bowel obstructions.</br> <br><b>Aim:</b> This study investigates factors which influence the formation of postoperative adhesion and evaluates the efficiency of applying minimally invasive surgical techniques in reducing adhesion.</br> <br><b>Material and methods:</b> Patients who underwent surgery to diagnose obstructive ileus in our clinic between January 2015 and January 2020 were analyzed retrospectively. Demographic data of the patients, operation details time between the operations and history of hospitalizations, postoperative mortality and morbidity, as well as the severity of complications were recorded. The patients included in the study were divided into groups according to the surgical technique applied in the first operation (laparoscopy/ laparotomy), the abdominal incision line (upper/lower/total), and the etiology of the primarily operated lesion (benign/malignant).</br> <br><b>Results:</b> One hundred eighteen (118) patients were included in the study. The mean age of patients was 61.2 ± 10.8 (39-82) years. Age, ileus history, time to the onset of ileus, length of hospital stay and the number of complications were shorter in the laparoscopy group as compared to the laparotomy group and the difference was found to be statistically significant. In addition, when patients were categorized according to the abdominal incision line, fewer hospitalizations and more frequent postoperative complications due to ileus were observed in the sub-umbilical incision group (p < 0.05).</br> <br><b>Conclusions:</b> Postoperative adhesion formation is currently one of the clinical conditions which pose a challenge to both the patient and the clinician due to its incidence and recurrence. However, adhesion formation can be reduced by applying minimally invasive surgical methods, especially laparoscopic surgery and precise maneuvers during surgery.</br>.

Did the COVID-19 Pandemic Affect the Management of Patients With Acute Appendicitis?

Background The coronavirus disease 2019 (COVID-19) pandemic has changed the lives and habits of people all over the world. In this study, it was planned to investigate the effect of the COVID-19 pandemic on the diagnosis and treatment duration of acute appendicitis (AA), morbidity and mortality. Methods The data of patients who were operated on with the diagnosis of AA in our clinic between March 2019 and March 2021, divided into pre-COVID and post-COVID periods, were analyzed. Patients diagnosed with AA, who had the only appendectomy perioperatively, and who had complete preoperative blood analysis and radiological imaging data were included in the study. Results The time from the onset of symptoms to the time of admission to the hospital was statistically significantly longer than in the post-COVID group (p=0.04). During the COVID-19 pandemic period, the use of ultrasonography was statistically significantly reduced (p<0.01); computed tomography use increased (p<0.001). Laparoscopic appendectomy as a surgical technique decreased statistically significantly during the pandemic period (p=0.02). Postoperative complications and the postoperative complication severity degrees were not statistically significant between periods (p=0.24, p=0.68). The risk for the occurrence of postoperative complications in COVID-19 positive patients was statistically higher (p=0.01) (OR: 9.38 95% CI: 1.96 - 44.88). Conclusion The COVID-19 pandemic had caused delays in the admission and diagnosis of patients who might need surgery due to AA. Postoperative complication frequency and complication severity classification were not affected. COVID-19 positivity was a risk factor for complex AA presenting with periappendicular abscess, gangrenous and perforated appendix.

Fecal Occult Blood Test, Is it still worth for Colorectal Cancer Screening?

INTRODUCTION: One of the most critical factors determining survival in terms of colorectal cancers is diagnosis and treatment at an early stage. Diagnosis at an early stage is possible with screening programs carried out within preventive health services. In this study, we aimed to compare the results of patients who underwent colonoscopy due to fecal occult blood test (FOBT) positivity with those over 50 years of age who underwent colonoscopy with other complaints and to reveal whether FOBT test is still essential for screening programs. METHODS: This study included patients who underwent colonoscopy between January 2016 and December 2021. Patients were analyzed in two groups according to colonoscopy reasons: group I (FOBT-positive) and group II (other reasons). RESULTS: A total of 3393 patients were included in the study. The patients were divided into two groups for evaluation. Patients who underwent colonoscopy for FOBT positivity (Group I) and patients over 50 years of age who underwent colonoscopy for other reasons (Group II). When the colonoscopy findings were compared between the groups' inflammatory bowel diseases (p=0,03) were higher in group I, while normal colonoscopy (p=0,03) was found to be more common in group II. Polyps, malignancy, diverticulosis, and perianal diseases seem similar between the groups statistically. CONCLUSION: FOBT can still be used in colorectal screening because it is inexpensive, widely available, has more participation due to non-invasiveness, and can be applied outside of clinical settings.

Gastric Cancer Surgery During the Pandemic: What It Costs?

BACKGROUND: From the early days of 2020, the COVID-19 pandemic continues to change whole life all around the world. Oncological patients are the most affected populations since these days. Because of decreasing numbers in surgery and endoscopy, gastric cancer patients had difficulties in treatment and diagnoses. Therefore, the early and long-term results may be affected during the pandemic. In this study, we aimed to evaluate pandemia effects on gastric cancer surgery in a single center. PATIENTS-METHODS: Patients were categorized as the COVID group and the Pre-COVID group. Patients who received neoadjuvant chemotherapy were excluded from the study. In the COVID period, 50 patients underwent gastric cancer surgery, while 64 were operated on in the pre-COVID period. Patients' demographics and clinical and pathological outcomes were evaluated. RESULTS: There was no statistically significant difference in both periods among patient characteristics such as age, gender, and body mass index. Pre-operative laboratory results were similar between two groups. Although there was no difference in operation types, an increase was detected in Clavien-Dindo grade 3 and higher complications during the COVID period. During the pandemic, there was a significant difference in the pathological outcomes. Peritoneal cytology-positive patients were higher in the COVID group. More lymphovascular invasions were also detected in the COVID period. Finally, it resulted stage differences between two groups. CONCLUSION: Because of COVID-19's heavy burden on healthcare system, delays in the diagnosis and treatment of oncological patients may occur. Therefore, this may be affected pathological and survival outcomes of cancer patients. Finally, further investigations are needed.

Current status of laparoscopic surgery usage in Türkiye: A middle-income country.

Objectives: This study aimed to determine the usage status of laparoscopic procedures in general surgical practice in Türkiye, which is a sample of middle-income countries. Material and Methods: The questionnaire was sent to general surgeons, gastrointestinal surgeons, and surgical oncologists who have completed their residency training and are actively working in university, public or private hospitals. Demographic data, laparoscopy training and the period of education, the rate of laparoscopy use, the type and volume of laparoscopic surgical procedures, their views on the advantages and disadvantages of laparoscopic surgery, and the reasons for preferring laparoscopy were determined with a 30-item questionnaire. Results: Two hundred and forty-four questionnaires from 55 different cities of Türkiye were evaluated. The responders were mainly males, younger surgeons (F/M= 11.1/88.9 % and 30-39 y/o), and graduated from the university hospital residence program (56.6%). Laparoscopic training was frequently taken during residency (77.5%) in the younger age group, while the elderly participants mostly received additional training after specialization (91.7%). Laparoscopic surgery was mostly not available in public hospitals for advanced procedures (p <0.0001) but was available for cholecystectomy and appendectomy operations (p= NS). However, participants working in university hospitals mostly stated that the laparoscopic approach was the first choice for advanced procedures. Conclusion: The results of this study showed that the surgeons working in MICs spent strong effort to use laparoscopy in daily practice, especially in university and high-volume hospitals. However, inappropriate education, cost of laparoscopic equipment, healthcare policies, and some cultural and social barriers might have negatively impacted the widespread use of laparoscopic surgery and its usage in daily practice in MICs such as Türkiye.