The importance of the scoring system in Fournier's gangrene.

BACKGROUND: The objective of the study was to investigate risk factors affecting mortality rates in patients with Fournier's gangrene (FG) and develop methods to increase the survival rate. METHODS: We collected data of 73 patients treated for FG between February 2012 and June 2021 at Istanbul Professor Doctor Cemil Tasçioglu City Hospital General Surgery Clinic. The data of living patients (Group 1, n=56) and deceased patients (Group 2, n=17) were analyzed separately. Demographic data of patients were sex, age, infection rate, Uludag FG severity index (UFGSI) scores and FG severity index (FGSI) scores, urea serum levels, the source of infection, the presence of diabetes, obesity, the presence of diversion stoma, duration of vacuum-assisted closure treatment in days, hospitalization time in days, intensive care period in days, and isolated bacterial species. RESULTS: The mortality rate was 23%. A significant difference in age and dissemination score of the infection was found between the two groups. According to UFGSI and FGSI scores, the scores of the two groups of patients were significantly higher. The UFGSI had 100% sensitivity and 68% sensitivity. FGSI had 82% sensitivity and 58% specificity. The cutoff values for UFGSI and FGSI were 8 and 6, respectively. CONCLUSION: Age and dissemination scores of diseases were important factors that cause mortality in patients with FG. However, an accurate scoring system is important in predicting patients to be treated in the intensive care unit (ICU). Patients with a UFGSI score above 8 face a higher risk of death and should be treated in the ICU.

The value of potassium, pH and D-dimer levels in early diagnosis of acute mesenteric ischemia: an experimental study on rats.

INTRODUCTION: The aim of this randomized controlled experimental study was to evaluate the efficacy of potassium, pH and D-dimer levels in blood, as well as potassium and pH levels in peritoneal lavage fluid, in the early diagnosis of acute mesenteric ischemia. MATERIAL AND METHODS: This study was conducted at the Istanbul University Center of Experimental Medicine after having received approval from the Istanbul University animal testing ethics committee. Male albino Wistar rats (n = 24; 250 to 350 g) were divided into two control groups and two ischemic groups. Levels of potassium, pH, and D-dimer in blood and levels of potassium and pH in peritoneal lavage fluid were analyzed for 1 h and 2 h after the induced acute mesenteric ischemia procedure. The degree of ischemic injury was determined using the histopathological damage score in tissue samples taken from the terminal ileum. RESULTS: Ischemic groups had statistically significant differences in potassium and pH in blood and peritoneal lavage fluid compared to non-ischemic groups (p < 0.05). There was no significant difference between control and ischemic groups in terms of D-dimer and histologic grading results after 1 h (p = 0.132, p = 0.475 respectively), while there was a significant difference between control and ischemic groups after 2 h (p < 0.05). CONCLUSIONS: The levels of potassium, pH, and D-dimer could be useful in daily practice for the early diagnosis of acute mesenteric ischemia.

Comparison of Mortality in Fournier's Gangrene with the Two Scoring Systems.

OBJECTIVE: To determine the factors associated with mortality in Fournier's gangrene (FG) toward informing the development of effective treatment strategies. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Department of Surgery, University of Health Sciences, Okmeydani Education and Research Hospital, Istanbul, Turkey, from February 2012 to September 2017. METHODOLOGY: Informations of 30 patients treated for FG were examined retrospectively. The deceased patients (Group 1, n = 8) were analysed separately from the living ones (Group 2, n = 22). Informations in this analysis contained gender, age score, dissemination score, Uludag Fournier's Gangrene Severity Index (UFGSI) and Fournier's Gangrene Severity Index (FGSI) scores, serum levels of urea, infection source, the presence of diabetes, obesity, and other comorbidities, the presence of stoma for diversion, duration of the vacuum-assisted closure treatment, hospitalisation time, intensive care period, and species of bacteria isolated. RESULTS: The overall mortality rate was detected as 26%. A significant difference between the two groups concerning age score of UFGSI parameters was found. The dissemination score of the infection, which is one of the UFGSI parameters, was significantly higher in Group 1 than in Group 2. According to UFGSI and FGSI scores, the scores of group 1 patients were significantly higher. To determine the incidence of mortality, the UFGSI and FGSI had 87.5% sensitivity and had 96% and 91% specificity, respectively. The cut-off values for UFGSI and FGSI were 10 and seven, respectively. CONCLUSION: Based on the findings described in this study, age and dissemination scores from the UFGSI can be used to predict patient outcome. Patients with a UFGSI score greater than 10 have a higher mortality rate.

A Comparison of the Clinicopathological Features, Metastasis Sites and Survival Outcomes of Invasive Lobular, Invasive Ductal and Mixed Invasive Ductal and Lobular Breast Carcinoma.

OBJECTIVE: We compared the breast cancer patients with invasive lobular carcinoma (ILC), invasive ductal carcinoma (IDC) and mixed invasive ductal and lobular carcinoma (IDLC) in terms of clinicopathological and treatment features, metastatic patterns and long-term survival. MATERIALS AND METHODS: In a 10 years patient cohort, 3412 patients with unilateral breast carcinoma were enrolled in the study. Tumors were classified histologically according to criteria described by World Health Organization classification. RESULTS: The highest rate of T3 tumors were found in IDLC patients, the lowest in IDC patients, and the difference between groups was significant only in comparison of IDC vs IDLC. Axillary positivity rate was highest in IDLC, lowest in ILC; differences were significant in comparisons of IDLC vs ILC and IDLC vs IDC. There was no significant difference between the patient groups in terms of surgical treatment, mastectomy and breast conserving surgery. Rate of bone metastasis was highest in IDLC, lowest in IDC, with significant difference between IDLC and IDC. Locoregional recurrence-free survival (LRFS) rate was 90.9% in ILC patients, 92.5% in IDC patients, 92.9% in IDLC patients, with no significant difference between the groups; in multivariate Cox analysis, histological type had no prognostic significance (p=0.599). Distant metastasis-free survival (DMFS) rate was 66.2% in ILC patients, 66.7% in IDC patients, 57.1% in IDLC patients; in multivariate Cox analysis, histological type had no prognostic significance (p=0.392). CONCLUSION: Although these results suggest that IDLC may have a worse prognosis than IDC and ILC, in multivariate analysis LRFS and DMFS were not significantly different among the histological type groups.

Improvement of Esophageal Anastomotic Leak by Vacuum-assisted Closure in Three Cases with Gastric Cancer.

This case report presents three consecutive patients who developed esophageal anastomotic leak after gastric cancer surgery and were treated by the two-way vacuum-assisted closure with open abdomen technique in addition to endoscopic stent application (ESA). Esophageal anastomotic leak follow-up was performed by fluoroscopic fistulography. Total parenteral nutrition was given until cessation of leak. All applications of the two-way vacuum-assisted closure were carried out with a vacuum-assisted closure management system. In case of the improvement of the esophageal anastomotic leak detected by fluoroscopy, the two-way vacuum-assisted closure application was terminated. The subcutaneous layer was bilaterally dissected from the fascial layer of the anterior wall of the abdomen, and the abdominal skin was closed without tension. The combination of ESA and the two-way vacuum-assisted closure technique should be suggested in case of severe abdominal sepsis in patients with an esophageal anastomotic leak.

Acute biliary pancreatitis during pregnancy and in the post-delivery period.

BACKGROUND: Acute pancreatitis has an incidence of approximately 1 in 1000 to 5000 pregnancies, and is most often seen in the third trimester or the postpartum period. The most common cause of pregnancy-related acute pancreatitis is cholelithiasis, which accounts for more than 65% of cases. The aim of this study was to present a detailed analysis of 4 years of experience with cases of acute biliary pancreatitis related to pregnancy from a single center. METHODS: The medical records of 55 consecutive patients who were hospitalized in the emergency surgery clinic for acute biliary pancreatitis related to pregnancy between January 1, 2014 and January 1, 2018 were examined in this single-center, retrospective study. RESULTS: Fifty-five patients with acute biliary pancreatitis related to pregnancy were included in the study. Of the 55 women, 13 (24%) were in the pregnant group, 28 (51%) in the postpartum (6 weeks) group, and 14 (25%) were in the 1-year (6 weeks-1 year) group. There was no statistically significant difference between the 3 groups. The most appropriate treatment for each patient was targeted. Six (10%) patients had recurrent acute pancreatitis. There was no maternal or fetal mortality or morbidity. CONCLUSION: Acute biliary pancreatitis related to pregnancy is not limited to pregnant women, and the incidence of these cases was greater than expected. Acute biliary pancreatitis related to pregnancy can be successfully managed with conservative treatment because it usually has a mild to moderate clinical course. However, the surgeon should keep an early cholecystectomy in mind for patients other than those in the first trimester.

Etiology, management, and survival of acute mechanical bowel obstruction: Five-year results of a training and research hospital in Turkey.

BACKGROUND: Acute mechanical bowel obstruction (AMBO) is still a major surgical problem for emergency departments. The aim of this study was to evaluate AMBO in terms of etiology, management, and survival. METHODS: Data of the age, sex, etiology, management, and survival of patients who were hospitalized for bowel obstruction between January 2014 and December 2018 were evaluated retrospectively. Adhesions, tumors, hernias and peritoneal carcinomatosis were evaluated in detail. RESULTS: A total of 735 patients were included in the study. The obstruction was located in the small bowel (AMSBO) in 60% and in the large bowel (AMLBO) in 40%. The mean patient age was 59.9+-16.02 years and 52.9% of the patients were male. Adhesion, tumor, and hernia were the most common etiologies of the overall AMBO group (43.3%, 26.2%, and 6%, respectively). The most common etiology for AMSBO was an adhesion (69.3%), while it was a tumor for AMLBO cases (61.6%). The most common management of AMBO patients was a conservative approach (53.2%; adhesions: 76.7%). Surgical palliation was performed in 24.9% (peritoneal carcinomatosis: 65.7%), and resection was performed in 21.9% (volvulus: 61.9%). The mortality rate in the group was 8.6%. The most common etiology was colorectal surgery (51.4%) for adhesions, colorectal cancer (93.8%) for tumors, and incisional hernia (47.7%) in cases of hernia-related AMBO. CONCLUSION: Adhesions, tumors, and hernias are the most common etiologies of AMBO. The incidence of femoral/inguinal hernia have decreased while that of incisional hernia has increased, and it was further observed that peritoneal carcinomatosis has now become as common as hernia as a cause.

Neuroendocrine tumor of the appendix: Twelve years of results from a single institution.

BACKGROUND: The aim of this study was to investigate the incidence of appendiceal neuroendocrine tumors (NET) in an acute appendicitis cohort, as well as to investigate the behavioral form of the tumor. Our secondary aim was to investigate survival in patients with appendiceal NET. METHODS: Between February 2006 and June 2018, 6518 appendectomies were performed for acute appendicitis in the department of surgery, University of Health Sciences, Okmeydani Education and Research Hospital, Istanbul, Turkey. The medical records of these consecutive 6518 appendectomy patients were evaluated retrospectively. After the histopathological analysis, a total of 22 patients were identified as cases of appendiceal NET. These patients were included in the study. A retrospective analysis of data including gender, age, intraoperative surgical findings, duration of postoperative follow-up and survival, tumor localization, the diameter of the tumor, tumor grade, invasion, surgical margin, and stage of the tumor was performed. RESULTS: The incidence of appendiceal NET was 0.33%. Eleven patients were diagnosed as primary pathological stage pT1aN0M0 according to the European Neuroendocrine Tumor Society guidelines. One patient was diagnosed as primary pathological stage pT1bN0M0, and 10 patients were diagnosed as primary pathological stage pT2N0M0. The median tumor diameter was 7.6 mm. There was no patient with a tumor diameter greater than 20 mm. CONCLUSION: The incidence of appendiceal NET in our study is consistent with that stated in the literature. The results of our research suggest that further surgical procedures for NETs that occur coincidentally in patients of the AA cohort are often unnecessary. In addition, the study revealed that disease-free survival (100%) was good over a mean follow-up of 59.2 months.

Improvement of a duodenal leak: Two-way vacuum-assisted closure.

A 55-year-old male patient developed a duodenal re-leak, which caused severe peritonitis, on the second postoperative day after surgery to treat an acutely perforated duodenal ulcer. Relaparotomy was performed 2 days after surgery for the re-leak after omentoplasty. The necrotic omentum was dissociated from the bulbus duodeni. Viable omentum for reinsertion of the omental patch was not found. The turned-outward duodenal mucosa was excised and the duodenal perforation was sutured. Two-way vacuum-assisted closure (VAC) was carried out by taking a liquid culture of the abdomen and washing the abdomen. The two-way VAC exchange procedures were continued every 3 days until the re-leak was terminated. The whole treatment process occurred in the intensive care unit. The duodenal leak was completely stopped by 41 days after surgery. The subcutaneous layer was dissected from the fascial layer of the anterior wall of the abdomen; thus, the abdominal skin was closed without tension and the patient was subsequently discharged. In conclusion, since primary source control is often difficult when treating duodenal leaks, the two-way VAC system is a convenient solution for localizing the source of the peritonitis and removing toxic peritoneal material.

Can Alvarado and Appendicitis Inflammatory Response scores evaluate the severity of acute appendicitis?

BACKGROUND: The Alvarado score (AS) and the Appendicitis Inflammatory Response score (AIRS) were developed to diagnose acute appendicitis (AA). The aim of this study was to evaluate the severity of AA using the AS and the AIRS tools. METHODS: Patients who presented between January 2016 and December 2017 and underwent surgery for AA and who had a preoperative AS and AIRS value were evaluated retrospectively. The details of age, sex, pathological severity, the presence of local peritonitis or fecaloid, drainage, appendix diameter, and operation type were evaluated according to the AS and the AIRS. RESULTS: A total of 578 patients were included in the study. Appendicitis was the most common pathological severity classification (44.4%). The most common appendix diameter group was 7-10 mm (59.2%). The difference observed in the AS and AIRS results for all of the pathological severity categories was statistically significant (p<0.05). The AIRS revealed a statistically significant difference (p<0.05) in the detection of uncomplicated and complicated appendicitis. The AIRS difference was statistically significant for appendix diameter (p<0.05). The AS and the AIRS results were both statistically significant for drainage (p<0.05). The AS was correlated with pathological severity, local peritonitis, and drainage, while the AIRS was correlated with pathological severity, uncomplicated/complicated determination, appendix diameter, and drainage (p<0.05). CONCLUSION: Both the AS and the AIRS can evaluate pathological severity, but only the AIRS can evaluate complicated or uncomplicated appendicitis and the diameter of the appendix. These tools can be used to reduce the number of unnecessary radiological or surgical interventions.

Drain amylase monitoring for early diagnosis of anastomotic leakage in sleeve gastrectomy An animal study.

BACKGROUND: Sleeve gastrectomy(SG) is a popular bariatric surgery procedure with rare but dreaded complications. Although drain amylase levels are a reliable early predictor of anastomosis leakage in oesophagectomy and pancreaticoduodenectomy, for SG have not yet been studied. We aimed to monitor drain amylase levels to ascertain their applicability for early diagnosis of gastric leakage in SG. METHODS: Twenty-four rats were randomly divided into three groups: Group A: only laparotomy and abdominal drain; Group B: laparotomy, SG, and drain; Group C: laparotomy, SG with fistula,and drain. On postoperative days 0,1,2,3, and 4, drain lavage samples were collected to measure amylase. RESULTS: Groups were compared in pairs. Preoperative weights were not significantly different in any comparison. On postoperative days 0,1,2,3, and 4, drain amylase levels were found to be significantly lower in Group A than in Group B as well as in Group A than in Group C but were significantly higher in Group C than in Group B. For postoperative day 1, a receiver operating characteristic curve was done. Drain amylase levels over 1514 IU were statistically significant for leakage. CONCLUSIONS: Drain amylase levels were significantly high in sleeve gastrectomy with fistula. This indicates that drain amylase level monitoring might be an easy and cheap alternative for determining staple-line leakage for high risk patients with Body Mass Index(BMI)>50kg/m2 in whom we cannot use radiological imaging. KEY WORDS: Animal Experimental Study, Bariatric Surgery, Drain amylase, Sleeve gastrectomy, Staple-line leakage.

The breast lesion excision system procedure: An optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety.

OBJECTIVES: To evaluate the efficacy of the Breast lesion excision system (BLES) procedure as a primary excisional biopsy for the management of breast imaging-reporting and data system (BI-RADS) category 3, small, and solid breast lesions in women having severe breast cancer anxiety. METHODS: A retospective study was conducted on 68 patients who underwent a BLES procedure. The study protocol was approved by the local ethical committee of Yeni Yuzyil University in Istanbul, Turkey. The study was carried out according to the principles of the Helsinki Declaration. Small breast lesions removed using a (12, 15 or 20 mm) wand from September 2011 to November 2014. These were category 3 lesions as determined by ultrasound (US) imaging according to BI-RADS. The radiological and pathological sizes of these lesions, the complete excision rates, the procedure durations, the pathological diagnosis, the complications, and the imaging findings before and after the procedure were all recorded. RESULTS: All the patients had a benign pathology. The mean duration of procedure was 12 (range=8-22) minutes. There was no major complication during the procedure and in the following period. Only some small hematomas were determined in 3 (4.2%) patients, and no additional surgical intervention was performed. Conclusion: The BLES procedure is an optimal solution for the management of indeterminate BI-RADS category 3 breast lesions in women with severe anxiety.

Protective effects of pentoxifylline in small intestine after ischemia-reperfusion.

Objective This study was performed to determine the healing effects of pentoxifylline on molecular responses and protection against severe ischemic damage in the small intestine. Methods Thirty-six Wistar albino rats were divided into six groups. The superior mesenteric artery was clamped for 120 minutes, and reperfusion was performed for 60 minutes. Saline (0.4 mL), pentoxifylline (1 mg/kg), and pentoxifylline (10 mg/kg) were intraperitoneally administered to the rats in the C1, P1, and P3 groups, respectively, 60 minutes before ischemia and to the rats in the C2, P2, and P4 groups, respectively, during reperfusion onset. Malondialdehyde, myeloperoxidase, tumor necrosis factor alpha, interleukin-1 beta, and interleukin-6 in serum and tissue were measured by enzyme-linked immunosorbent assay. Intestinal ischemic injury was histopathologically evaluated by the Chiu score and immunohistochemical staining. Results All serum and tissue molecular responses were significantly blunted in the pentoxifylline-treated groups compared with the controls. Significant improvement in ischemic damage was demonstrated in the pentoxifylline-treated groups by histological grading and immunohistochemical scoring. Conclusions The protective effects of pentoxifylline were confirmed by molecular responses and histopathological examination.

Drain amylase monitoring for early diagnosis of anastomotic leakage in sleeve gastrectomy An animal study.

BACKGROUND: Sleeve gastrectomy(SG) is a popular bariatric surgery procedure with rare but dreaded complications. Although drain amylase levels are a reliable early predictor of anastomosis leakage in oesophagectomy and pancreaticoduodenectomy, for SG have not yet been studied. We aimed to monitor drain amylase levels to ascertain their applicability for early diagnosis of gastric leakage in SG. METHODS: Twenty-four rats were randomly divided into three groups: Group A: only laparotomy and abdominal drain; Group B: laparotomy, SG, and drain; Group C: laparotomy, SG with fistula,and drain. On postoperative days 0,1,2,3, and 4, drain lavage samples were collected to measure amylase. RESULTS: Groups were compared in pairs. Preoperative weights were not significantly different in any comparison. On postoperative days 0,1,2,3, and 4, drain amylase levels were found to be significantly lower in Group A than in Group B as well as in Group A than in Group C but were significantly higher in Group C than in Group B. For postoperative day 1, a receiver operating characteristic curve was done. Drain amylase levels over 1514 IU were statistically significant for leakage. CONCLUSIONS: Drain amylase levels were significantly high in sleeve gastrectomy with fistula. This indicates that drain amylase level monitoring might be an easy and cheap alternative for determining staple-line leakage for high risk patients with Body Mass Index(BMI)>50kg/m2 in whom we cannot use radiological imaging. KEY WORDS: Animal Experimental Study, Bariatric Surgery, Drain amylase, Sleeve gastrectomy, Staple-line leakage.

Primary umbilical endometriosis: A painful swelling in the umbilicus concomitantly with menstruation.

BACKGROUND: Primary umblikal endometriosis is a rare illness. In this report we aimed to discuss the management of this rare condition. CASE SUMMARY: A 28-year-old nulliparous woman was present at our clinic who was suffering from painful swelling in the umbilicus during her menstruation for the last 3 months. Her examination showed a dark-color sensitive nodule of 20×15mm in size in the umbilicus. A lower abdominal tomography was performed to exclude the presence of a concomitant pelvic endometriosis, and it showed increased density consistent with subcutaneous inflammation in the umbilicus. Her medical history and physical examination suggested primary umbilical endometriosis. A total resection including umbilicus was performed. DISCUSSION: Primary umbilical endometriosis is a rare benign disease and clinically difficult to differentiate from other diseases that cause umbilical nodule. Imaging modalities have no pathognomonic findings for diagnosis. Surgical exploration and excision are the definitive and safe treatment of primary umbilical endometriosis. CONCLUSION: Total umbilical resection should be preferred to avoid local recurrent.

Massive and life-threatening upper gastrointestinal bleeding due to invasive hepatocellular carcinoma: A case report.

BACKGROUND: The mean survival is less than 6 months in hepatocellular carcinoma (HCC) patients with extrahepatic metastasis. Gastrointestinal(GI) bleeding frequency due to HCC invasion is 0.05% to 2.0%, and may be fatal. CASE PRESENTATION: We encountered a case of HCC with direct invasion to the gastrium that caused a life-threatening upper GI bleeding. Our patient was a 62 year old male who was a heavy smoker and drinker for almost 30 years. He had several upper GI bleeding episodes during the previous 6 months. Computed tomography (CT) revealed a 13cm liver tumour directly invading the gastrium. Partial hepatic resection and subtotal gastrectomy were performed. Unfortunately, the patient died at the intensive care unit postoperatively due to hepatic failure. DISCUSSION: Although the prognosis of HCC that has invaded the gastrium is very poor due to the advanced stage of the disease, surgical resection may be a favourable treatment option for patients with a massive upper GI bleeding. CONCLUSIONS: The incidence of patients with massive bleeding due to gastric invasion of HCC is low, and only a few cases have been reported in the literature. Our purpose while presenting this rare case is to increase the awareness about the issue.

Solitary caecum diverticulitis mimicking acute appendicitis.

Solitary cecum diverticulum is a benign formation, but it can be complicated with inflammation, perforation and bleeding. Cecum diverticulitis (CD) is the most common complication of caecal diverticulum and it has the highest incidence among Asians, but it is a rare condition in the western world. The incidence of colonic diverticular disease can vary according to national origin, cultural structure and nutritional habits. CD is not common in our country, but it is an important situation because of its clinical similarity with the commonly seen acute right side abdominal diseases like acute appendicitis. Preoperative diagnosis is difficult, and hence, the actual frequency is not known. The treatment of CD can vary from medical therapy to right hemi colectomy. In this study, we presented ten CD cases on whom surgical resection was performed in our surgery unit during the last 8 years. Our purpose was to increase the awareness of surgeons about this situation, and so, make them pay attention for not having their first experience in the operating room.

Short- and long-term results of harmonic scalpel hemorrhoidectomy versus stapler hemorrhoidopexy in treatment of hemorrhoidal disease.

PURPOSE: In this prospective randomized study, our aim is to compare the short- and long-term results of harmonic scalpel hemorrhoidectomy (HSH) and stapler hemorrhoidopexy (SH) methods in the surgical treatment of Grade III and Grade IV hemorrhoidal disease. METHODS: Ninety-nine consecutive patients diagnosed with Grade III or Grade IV internal hemorrhoidal disease were included in the study. Patients were randomized to HSH (n = 48) or SH (n = 51) treatments. Data on patient demographic and clinical characteristics, operative details, postoperative pain score on a visual analog scale, additional analgesic requirement, postoperative short- and long-term complications, and recurrence of hemorrhoidal disease were also recorded. Patients were regularly followed for a total period of 24 (6-36) months. RESULTS: The patient demographic and clinical characteristics were similar in the two groups. The operative time was significantly shorter in the HSH group compared with the SH group. Overall pain scores were not significantly different between the groups, although severe pain was significantly more common in the HSH group. Recurrence was significantly lower in the HSH group compared with the SH group. CONCLUSION: HSH and SH are both safe and effective methods for surgical treatment of Grade III and Grade IV hemorrhoidal disease. In our study, the HSH method was determined to be safer, easier, and faster to perform, and associated with fewer long-term recurrences than the SH method.

The prognostic value of the number of lymph nodes removed in patients with node-negative colorectal cancer.

BACKGROUND: To investigate the prognostic significance of the number of lymph nodes removed in colorectal cancer (CRC) patients with no metastatic lymph node. PATIENTS AND METHODS: The clinicopathological data of 461 CRC patients was analyzed. In order to compare the survival of patients who had fewer lymph nodes removed versus the survival of patients who had 1-3 metastatic lymph node(s), a separate group of 74 N1 disease patients were also included in the study. All patient data were collected prospectively. Kaplan-Meier method was used for calculation and plotting of the survival curves of the patient groups, and log-rank test was used for the comparison of the survival curves. RESULTS: Cancer-specific survival (CSS) rates of patients who had 1-7 lymph node(s) and 8-11 lymph nodes removed were significantly worse than those who had 12 or more lymph nodes removed (p = 0.006 and p = 0.037, respectively), while CSS was not significantly different between those who had 1-7 versus 8-11 lymph node(s) removed (p = 0.647); this grouping had independent prognostic significance in Cox analysis (p = 0.006). CSS of patients with N1 disease was not significantly different from those who had 1-7 and 8-11 lymph node(s) removed (p = 0.312 and p = 0.165, respectively), while it was significantly worse than CSS of patients who had 12 or more lymph nodes removed (p = 0.001). CONCLUSION: In colorectal cancer patients whose removed lymph nodes are non-metastatic, removal of at least 12 lymph nodes will determine the lymph node status reliably.

The impact of primary tumor resection on overall survival in patients with colorectal carcinoma and unresectable distant metastases: a prospective cohort study.

BACKGROUND: To compare the patients with primary colorectal carcinoma (CRC) and non-resectable distant metastases with or without primary colorectal tumor resection as a primary treatment in terms of postoperative mortality and overall survival (OS). PATIENTS AND METHODS: The clinicopathological data of 188 CRC patients with non-resectable distant metastases was analyzed. All patient data were collected prospectively. Colorectal tumor was resected in 121 patients (64.3%). Kaplan-Meier method was used for calculation and plotting of the OS curves of the patient groups, and log-rank test was used for the comparison of the survival curves. The relative importance of the prognostic features was investigated using the Cox proportional hazards model. RESULTS: In the whole series and in the patient group undergoing emergency surgical intervention, mortality rate was lower in patients having colorectal tumor resection compared with non-resected patients, with differences approaching the significance level (p = 0.072 and p = 0.076, respectively). Median OS time was significantly longer in resection group (11.0 months), compared with non-resection group (5.5 months) (p < 0.001); in the multivariate Cox analysis colorectal tumor resection had independent prognostic significance (p < 0.001). CONCLUSION: Resection of colorectal tumor in primary CRC patients with non-resectable distant metastasis gives significant survival advantage without increasing postoperative mortality compared with non-resection.