Laparoscopic versus Open Surgery in Colorectal Cancer: Is Laparoscopy Safe Enough?

OBJECTIVE: To compare the early and long-term outcomes of laparoscopic and open surgery in colorectal cancer stages 1-3. STUDY DESIGN: Comparative study. PLACE AND DURATION OF STUDY: Department of Gastroenterological Surgery, Health Sciences University, Gulhane Training and Research Hospital, Ankara, Turkey, from January 1, 2017 to January 1, 2021. METHODOLOGY: A total of 142 patients, who underwent surgery for colorectal cancer with a follow-up period of at least 3 years, were included in the study. The groups of the patients; (Group A) treated with laparoscopic surgery, and (Group B) treated with open surgery, were compared in respect of general characteristics, short and long-term morbidity, mortality, and oncological outcomes. RESULTS: Body Mass Index (BMI) values were higher, and the duration of surgery was shorter in Group A patients compared to Group B (p<0.05). The re-operation rate (12.2%) was observed to be statistically and significantly high in Group B (p=0.040). In comparison of the oncological outcomes, a significantly greater number of metastatic lymph nodes were removed in Group B (p=0.004). Stage 2A (31.1%) was observed at a higher frequency in Group A, and Stage 3C was significantly higher in Group B (25.7%) (p=0.037). There was no statistically significant difference between the groups in terms of the number of lymph nodes removed, insufficient lymph nodes dissection (<12), surgical margin negativity, local recurrence, and distant metastasis. CONCLUSION: For the selected patient group with early-stage colorectal tumours, laparoscopic surgery has short-term oncological outcomes similar to those of open surgery and relatively lower morbidity and mortality rates. KEY WORDS: Laparoscopic surgery, Colorectal cancer, Open surgery, oncological Outcomes.

Timing of Percutaneous Cholecystostomy.

OBJECTIVE: To investigate the effect of the timing of Percutaneous Cholecystostomy (PC) on morbidity and mortality. STUDY DESIGN: Comparative cross-sectional study. PLACE AND DURATION OF STUDY: Deparmant of Gastroenterological Surgery, University of Health Sciences, Gulhane Training and Research Hospital, Ankara, Turkey from 2017 to 2020. METHODOLOGY: The study included 61 patients with ASA 3-4 score, who were underwent PC during the study period. The patients were separated into two groups as Group 1 (n = 23); who underwent PC in the first 24 hours; and Group 2 (n = 38), who underwent PC at 24-96 hours. Morbidity and mortality rates were compared between the groups. RESULTS: Morbidity was observed in 2 (8.7%) patients in Group 1 and 6 (15.8%) in Group 2 (p = 0.698) with 30-day mortality in 3 (13.04%) patients in Group 1 and 8 (21.1%) in Group 2 (p = 0.730). In the cholangiographic studies, more choledochus stones were determined in Group 2 (p = 0.041). Length of stay in hospital was calculated as mean 10.35 ± 9.50 days in Group 1 and 20.03 ± 45.28 days in Group 2 (p = 0.003). CONCLUSION: No statistically significant difference was found in the morbidity and mortality rates when PC was performed later. The length of stay in hospital was found to be shorter in patients applied with early PC. Key Words: Percutaneous cholecystostomy, Acute cholecystitis, Cholecystectomy, Morbidity, Mortality, Calculous cholecystitis, Acalculous cholecystitis.

Single-Center Results of Choledochal Cysts in Turkish Population.

BACKGROUND: Choledochal cysts are seen commonly in Asian populations, but rarely in Western populations. The pathogenesis of these premalignant lesions is not fully understood yet and the risk of malignant transformation increases with age. The overall malignancy risk is 10%-15% in East Asian countries. In this study, we aimed to present our surgical experience as a hepatobiliary center to the literature. METHODS: We retrospectively analyzed the data from the medical records of 70 patients operated for choledochal cyst between 2008-2019. RESULTS: Sixty-two of the 70 (89%) patients were female and 8 (11%) were male, the mean age was 45.89 ± 15.32 years. Overall, 44 (63%) patients had type I (a+b+c), 20 (28%) type V (Caroli), 2 (3%) type II, 2 (3%) type III and 2 (3%) type IVb cysts. The most common operation was cyst excision combined with hepaticojejunostomy (n: 26, 37%). The median diameter of the resected cysts was 3 cm (min- max: 1-11 cm). Malignancy was observed only in three (4%) patients with type III, type Ib, and type V cyts, who were 19, 38, and 72 years old, respectively. Mortality was not observed, morbidity was determined totally in 30 (43%) cases during early and late postoperative periods. CONCLUSION: Type of surgery in choledochal cysts differs according to the type of the cyst. Malignancy was observed at a rate of 4% in all age groups. Although the frequency of malignancy varies, the main treatment of choice should be surgery because malignancy can be seen at a young age.

Relationship of Preoperative Serum Uric Acid Level with Survival in Colorectal Cancer.

OBJECTIVE: To investigate the prognostic significance of uric acid level in colorectal cancer in addition to conventional factors in terms of  survival. STUDY DESIGN: Observational Study. PLACE AND DURATION OF STUDY: At the University of Health Sciences, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey, between January 2012 and December 2019.   Methodology: A total of selected 332 patients, who underwent surgery for colorectal cancer between 2012 and 2019, were retrospectively reviewed. Patients with a history of neoadjuvant therapy due to rectal cancer, GUT disease, renal failure, stage 4 disease, emergency surgery and severe preoperative infection, were excluded from the study. Peripheral blood samples were collected about a week before the operation. Serum uric acid (SUA) values were measured and recorded.   Results: The patients comprised 198 males and 134 females with a mean age  62.2 ±11.7 years (14-91) years in total. Conventional surgery was performed in 228 patients, and laparoscopy in 104 patients. Uric acid level, number of pathological lymph nodes, number of pathological lymph nodes/total number of lymph nodes (LNO), perineural invasion, type of surgery and disease stage were found to be factors affecting the prognosis (p <0.05). Uric acid cut off value of 5.3 or higher was found to be statistically significant in terms of survival. CONCLUSION: Serum uric acid (SUA) value measured preoperatively was found to be a prognostic factor for colorectal cancer. Key Words: Serum uric acid (SUA), Colon cancer, Rectal cancer, Prognostic factor.

Assessment of computed tomography indications and computed tomography reports for usefulness in clinical presentation at postoperative follow-up of gunshot wound cases.

BACKGROUND: The present study aimed to evaluate the results of lower thoracic tomography (LTT) and upper abdominal tomography (UAT) of the patients who were treated and followed at our tertiary center due to gunshot wounds (GSWs). METHODS: The present research was designed as a retrospective descriptive study. All patients, who were admitted to our clinic due to GSW between January 2016 and April 2020, were retrospectively analyzed. This study included 44 patients who had postoperative lower thoracic and upper abdominal tomography scans. RESULTS: Among the patients, 43 (97.72%) were male, and one (2.27%) patient was female, with a mean age of 27.45 (range: 20-53) years. The mean length of hospital stay was 14.93 (range: 5-38) days. The mean number of tomography scans per patient was 1.65 (1-4), and the mean Injury Severity Score (ISS) was 24.38 (12-43). Among the patients, 31 (70.45%) had a direct GSW from a pistol or a rifle, while 13 (29.5%) sustained secondary injuries from shrapnel emanating from a bomb explosion. Furthermore, 23 (52.27%) patients who were initially operated at another center were clinically observed, while 15 (34.09%) patients were operated for the first time, and six (13.63%) patients had their second operation. LTT scans were obtained due to dyspnea, direct thoracic trauma and in addition to abdominal tomography for follow-up in 25 (56.81%), 13 (29.54%) and six (13.63%) patients, respectively. UAT scans were obtained for postoperative follow-up in 29 (65.90%), preoperative assessment in 12 (27.27%) and assessment of blast trauma in the absence of,direct abdominal trauma in three (6.81%) patients. The most common finding on LTT was effusion (47.7%). No pathology was observed in 61.36% of the UAT scans, while liver laceration was noted in 20.45%. The total cost of LTT and UAT was almost half that of a total thoracic tomography and a whole abdominal tomography. CONCLUSION: Selective lower thoracic and upper abdominal tomography obtained following a gunshot injury may be used not only to detect pathology but also as an efficacious, fast, reliable and cost-effective imaging method.

How much Reliable Is Alvarado Scoring System in Reducing Negative Appendectomy?

There is still an ongoing debate, especially regarding early diagnosis of acute appendicitis. Early surgery leads to inadequate evaluation of acute abdominal pain and negative appendectomy, whereas delayed surgery leads to appendicitis perforation complications. The diagnosis of this condition is considerably difficult, especially due to subtle early symptoms and clinical condition. The aim of the present study was to identify whether the Alvarado scoring system could reduce the incidence of negative appendectomy in patients who will undergo surgery for acute appendicitis. Patients who underwent surgery with acute appendicitis prediagnosis were retrospectively classified as negative appendectomies (group A) and positive appendectomies (group B) according to histological diagnosis. All groups were evaluated for age, gender, Alvarado scores, and parameters. Two hundred eighty-one patients were included in the study. Group A contained 71 (25.3 %) patients, and group B contained 210 (74.7 %) patients. There was a significant difference in WBC, left shift, rebound, and change of pain localization between the groups (p = 0.002, p < 0.001, p < 0.001, and p = 0.023, respectively). Alvarado scores were significantly different between the groups (p < 0.001). In logistic model examination, the major factor was the Alvarado score (7 or above) and the minor factor was spreading pain. The Alvarado scoring system can be used to reduce negative appendectomy in patients who will undergo surgery with acute appendicitis.

Could Mean Platelet Volume Be a Reliable Indicator for Acute Mesenteric Ischemia Diagnosis? A Case-Control Study.

Objective. Acute mesenteric ischemia (AMI) is a disease, usually seen in elderly people and accompanied by comorbid diseases. Mean platelet volume (MPV), the significant indicator of platelet activation and function, is associated with AMI. In this study, we considered that we can use MPV as a reliable indicator in the diagnosis of AMI. Methods. This study was conducted among AMI patients with two control groups. Age, gender, MPV, platelet count, concomitant diseases, abdominal computed tomography, and patient outcomes were recorded for evaluation. Control group I contained 41 healthy patients whose ages-genders were matched. Control group II contained 41 patients with no AMI, whose ages-genders-concomitant diseases were matched. Results. Of the total 41 AMI patients, 22 were female and 19 were male. The average age of them was 72.12 ± 13.2 (44-91) years. MPV was significantly increased in the AMI (p = 0.001) and control group II (p < 0.001) in comparison with healthy control groups. In the comparison of the AMI patients with their matched controls for concomitant diseases, no statistical difference was found in the MPV values. Conclusion. MPV may be used as an indicator of AMI only if the patient has no concomitant diseases. The existence of a concomitant disease brings into question the reliability of high MPV values as a suitable indicator.

Do intestinal parasitic infestations in patients with clinically acute appendicitis increase the rate of negative laparotomy? Analysis of 3863 cases from Turkey.

INTRODUCTION: Acute appendicitis is the most frequently observed disease requiring emergency surgery. The role of parasites in its pathogenesis has long been discussed. The signs of the parasitic infestations can mimic the signs of acute appendicitis. Therefore, it can cause a negative laparotomy. AIM: To evaluate the parasitic infestations of the appendix vermiformis whether increas the rate of negative laparotomy. MATERIAL AND METHODS: The histopathology results of a total of 3863 patients who underwent appendectomy with clinically acute appendicitis were evaluated retrospectively. All appendectomy materials in which parasites were observed were evaluated with respect to the nature of the parasites and the findings of inflammation. Cases in which parasite tissue fragments and/or eggs as well as findings of inflammation were histopathologically observed in the appendix lumen were diagnosed with parasitic appendicitis. RESULTS: Evidence of parasites was observed in 19 (0.49%) of the evaluated appendectomy materials. In 9 (47.3%) of these specimens that had evidence for parasites, findings for acute appendicitis and localized peritonitis were identified. Findings of acute appendicitis had not been identified in the other ten (52.7%) of the specimens. Enterobius vermicularis was the most frequently identified parasite. CONCLUSIONS: In parasitic acute appendicitis, appendectomy in itself is not sufficient for treatment. Pharmacological treatment should also be administered after surgery. Patients should be evaluated prior to surgery for parasites, and diagnosis of acute appendicitis should be considered more cautiously in order to avoid negative laparotomies.

A Rare Cause of Jaundice Following Cholecystectomy: Compression by the Silicon Drain.

Jaundice that develops following laparoscopic cholecystectomy is a troublesome experience for the surgeon which requires invasive management after a challenging diagnosis period. Jaundice is. We aimed to present our experience with a rare complication of jaundice in a patient that occurred due to the compression of an isolated drain without choledoc canal injury. A 63-year-old female patient underwent laparoscopic cholecystectomy due to symptomatic gallstone. The patient developed post-operative jaundice which was detected by upper abdominal magnetic resonance (MR) and magnetic resonance cholangiopancreatography (MRCP) to result from compression by the silicon drain on main hepatic canal. The patient was discharged upon removal of the silicon drain with recovery in biochemical and radiological parameters. To the best of our knowledge, our study is the first to report jaundice developing due to extrahepatic bile duct obstruction caused by isolated drain compression. Although this rare complication can be diagnosed by radiological workup and managed by simple surgical intervention, we believe that it requires consideration among other possible complications during laparoscopic cholecystectomy.