Impact of positive-to-total lymph node ratio on prognosis in stage 3 colorectal cancer. A multicenter study.

BACKGROUND: Colorectal cancer remains a health problem despite advances in diagnostic and treatment methods. This study aimed to determine the impact of positive-to-total lymph node ratio on survival in colorectal cancer. METHODS: Patients with stage 3 colorectal cancer were included. Patients age; sex; operation type (emergency or elective); tumor size, grade, and location; TNM stage; vascular and perineural invasions; numbers of lymph nodes examined and negative lymph nodes, positive-to-total lymph node ratio, and administration of postoperative chemotherapy were examined. RESULTS: Median follow-up period was 34.7 months. Most patients were in stage 3b (67.9%), and the median number of dissected lymph nodes was 15. The number of metastatic lymph nodes, positive lymph node ratio, and negativeto- positive lymph node ratio were 3, 16.7, 11, and 5, respectively. The overall survival rate was 48.6%. Mean life expectancy was 51.5 months. Multivariate Cox regression analysis revealed positive-to-total lymph node ratio >23.3%, age, and absence of postoperative chemotherapy as risk factors for overall survival (p<0.05). Positive-to-total lymph node ratio >23.3% was associated with poor overall survival and 3.726-fold poorer survival. DISCUSSION: Positive-to-total lymph node ratio >23.3% is a risk factor affecting overall survival in stage 3 colorectal cancer. Increased positive-to-total lymph node ratio (>23.3%) is associated with poor overall survival. KEY WORDS: Colorectal Cancer, Overall Survival, Positive Lymph Node Ratio, Stage 3 Cancer.

Effect of tumor size on prognosis in colorectal cancer.

AIM: This study aimed to reveal the effect of tumor size on overall survival and disease-free survival. MATERIAL AND METHODS: This study retrospectively evaluated the data of 593 patients who underwent colorectal surgery for colorectal cancer (CRC) between May 2012 and December 2018. The patients were divided into two groups based on their tumor size; those with a tumor size <5 cm were grouped as group 1 and those with a tumor size ≥ 5 cm were grouped as group 2. RESULTS: The present study included 222 patients with colorectal adenocarcinoma. The median follow-up period of the patients was 36.0 (1.4-107.4) months, mean tumor size was 5.1±2.3 cm, and number of patients with a tumor size of ≥5 cm was 117 (52.7%). There were statistically significant differences between the groups in terms of overall survival (Log-Rank = 12.559, p<0.001). DISCUSSION: According to the American Joint Committee on Cancer's Cancer Staging Manual (8th edition), the CRC staging system considers the tumor's depth of invasion of the intestinal wall but not the tumor's size. Moreover, it considers the size of the tumors developing in the parenchymal organs (breasts and lungs) but not tumors developing in luminal organs (stomach, colon, etc.). CONCLUSIONS: Tumor size ≥5 cm was found to be a risk factor for poor prognosis. To a certain extent, we believe that this study will aid in elucidating the link between tumor size in and prognosis of patients with CRC. KEY WORDS: Colorectal cancer, Prognosis, Tumor size.

Impact of COVID-19 pandemic on colonoscopy results - an overview.

<b>Aim:</b> Colorectal cancers are common cancers. Colonoscopy procedure, which is applied in the early diagnosis and treatment of this disease, has a very important role. In this study, we aimed to examine the effect of the COVID-19 pandemic period on our colonoscopic procedures. </br></br> <b> Material and methods:</b> In this observational study, the data of the patients who underwent colonoscopy in our General Surgery Endoscopy Unit, between March 11, 2019 and March 12, 2021 were scanned retrospectively. Patients under 18 years of age were excluded. The patients were divided into 2 groups. 1. Group patients between 11 March 2019-11 March 2020; patients in the pre-COVID-19 period, Group 2, on March 12, 2020-March 12, 2021; Grouped as the COVID-19 era. </br></br> <b>Results:</b> Data of 8285 patients were analyzed. A total of 4889 patients in Group 1 and 3396 patients in Group 2 were included in the study. The detection of precancerous polyps between the groups was found to be significantly higher in group 1 (p < 0.05) (4.3% vs 2.1). Similarly, the presence of precancerous polyps over the age of 65 was found to be significantly higher in the pre-covid group. In group 1, no significant difference was found in the evaluation of cancer patients according to gender (p > 0.05) (F/M: 1.2%/1.6%). In group 2, cancer patients were found to be significantly higher in males. </br></br> <b>Conclusions:</b> The COVID-19 pandemic has had negative effects in many areas, as well as on our colonoscopic procedures. Experienced centers continue to work to minimize these negative effects.

Analysis of upper gastrointestinal endoscopy results during the Covid-19 pandemic. A high-volume single-Center experience.

PURPOSE: The histopathological effects of the COVID-19 period on the upper gastrointestinal system are not clearly known. This study is the first in the literature to compare the results of upper endoscopic biopsy before and during the COVID- 19 period. METHODS: Data of 10510 patients who underwent upper endoscopy with a given biopsy sample during the procedure between March 2019 and March 2021 were retrospectively scanned. Patients are divided into two groups as the prepandemic period patients and the COVID-19 pandemic period patients. The pathological data of these patients were statistically analyzed according to the Sydney classification. RESULTS: Group 1 comprised of 6,787 patients with 3,915 females and 2872 males (F:M=1.3:1), while Group 2 with 1,734 females and 1,455 males (F:M=1.2:1), and this gender difference between the two groups was statistically significant (p=0.002). A comparison of the patient groups in terms of the inflammation, activation, intestinal metaplasia, and presence of H. pylori revealed a significant difference, with higher rates recorded in the COVID-19 period than in the pre-pandemic period (p < 0.05). CONCLUSION: In the pandemic period, the results of the upper endoscopic biopsy are adversely affected by various factors compared to the pre-pandemic period. KEY WORDS: Biopsy, COVID-19, Sydney classification, Upper endoscopy.

Frequency of Celiac Disease and Spontaneous Normalization Rate of Celiac Serology in Children and Adolescent Patients with Type 1 Diabetes

Objective: The prevalence of celiac disease (CD) varies between 1% and 10% in patients with type 1 diabetes mellitus (T1DM). This study aimed to determine the frequency of spontaneous recovery of celiac serology and the biopsy-proven CD (BPCD) frequency in patients with T1DM. Methods: The data of 668 patients with available celiac serology tests from a total of 779 patients who were followed for the last 10 years with the diagnosis of T1DM were retrospectively evaluated. Results: Positive serology was detected in 103 out of 668 (15.4%) patients. There was spontaneous normalization in 24 (23.3%), fluctuation in 11 (10.7%) and permanently positive serology in 68 (66%). In 46 out of 53 (86.8%) patients with positive serology and biopsy, CD diagnosis was confirmed by biopsy (BPCD). The frequency of BPCD was 6.9%, and the serology in 76.1% was positive at the time of diagnosis of T1DM. The weight, height and body mass index-standard deviation score at diagnosis were lower in patients with BPCD compared to the group without CD. An anti-tissue transglutaminase-IgA (anti-TTG-IgA) level of 11.8 times the upper limit of normal was the most sensitive (93%) and specific (90%) cut-off for BPCD (area under the curve: 0.95; 95% confidence interval: 0.912-1; p<0.001). Conclusion: In our cohort, the frequency of positive serology for CD was 15.4%, while the rate of BPCD was 6.9%. The majority (97.8%) of cases were diagnosed within the first five years of T1DM. In 23.3% of cases, positive anti-TTG-IgA spontaneously resolved without a gluten-free diet (GFD). Therefore, serological follow-up instead of immediate duodenal biopsy or GFD therapy, particularly for patients with asymptomatic and mild anti-TTG IgA level, is warranted.

A Rare Tumor in Childhood Desmoplastic Infantile Astrocytoma: Two Case Reports.

Desmoplastic infantile astrocytomas (DIAs), are rare supratentorial tumors, usually observed in the first 24 months of life. Despite their aggressive appearance, they tend to follow a favorable clinical course. Total or near total resection of tumor is usually the treatment option. Desmoplastic Infantile Ganglioglioma (DIG) and DIA are WHO grade I tumors that have similar clinical and morphological findings. The only criterion in differential diagnosis is the neural component of DIG. These tumors both have dense fibroblastic stroma and positive staining with glial fibrillar acidic protein (GFAP) and CD34. A rare case of desmoplastic infantile astrocytoma presenting with right side partial seizures presented in a 1-year-old child. A rare case of desmoplastic infantile astrocytoma presenting with focal onset generalized seizures presented in a 1-year-old child. Despite their radiological and histological properties, these tumors have a benign course. After 3-year follow-up for the first case and 1-year follow-up for the second case, there was no recurrence.