Factors affecting survival in stage 2-3 colorectal cancer: a single-center retrospective study.

OBJECTIVE: The principal aim of this research is to investigate the variables that exert a discernible impact on the overall survival (OS) of individuals afflicted with colorectal cancer (CRC) harboring pathologic stages 2-3, as delineated within the TNM staging schema tailored to CRC, an established framework governed by the American Joint Committee on Cancer (AJCC). PATIENTS AND METHODS: Patients with preoperative stages 1 and 4, patients with a history of other organ malignancy, patients who could not undergo curative resection, patients with systemic malignant diseases (leukemia, lymphoma, etc.), patients with synchronous tumors, and patients with positive surgical margins were excluded from the study. Notable pathological parameters, including tumor grade, perforation status, lymphovascular invasion, perineural invasion, the presence of mucinous components, and tumor size, were ascertained through pathological examination of resected specimens. RESULTS: Curative resection was performed on 241 patients. The mean age of all patients was calculated to be 65.67±16.04. The average tumor size was measured as 5.03±2.22 cm. The 1-year survival rate of the patients was found to be 84.3%, 3-year survival rate was 69.0%, and 5-year survival rate was 52.9%. According to the COX regression analysis, the categorical variables that were found to be significantly associated with OS were grade (p=0.046), emergency surgery (p<0.001), and tumor localization (p=0.015). CONCLUSIONS: The initial patient and tumor characteristics at baseline have demonstrated substantial predictive capacity regarding patient outcomes following disease recurrence. Survival analyses showed that undergoing emergency surgery, having the tumor located in the rectum, and having a "poor" tumor grade adversely affected survival.

Postoperative pancreatic fistula after pancreaticoduodenectomy: if you lack knowledge of what to search for, you will be unable to locate what you desire.

OBJECTIVE: Postoperative pancreatic fistula (POPF) is the most common and critical complication of pancreatoduodenectomy (PD). In this study, we aimed to define preoperative, perioperative, and postoperative conditions that may cause POPF and examine the predictive value of drain fluid amylase (DFA) values in showing the clinical severity of POPF. PATIENTS AND METHODS: Between December 2018 and December 2019, 49 patients who underwent PD for malignant reasons by a single team were retrospectively analyzed. Patients with benign indications, vascular reconstruction, preoperative biliary drainage catheterization, resectable liver metastases, POPF that occurred after reoperation, and patients undergoing neoadjuvant oncological treatment were excluded from the study. The patients were divided into two groups developing (FP) and non-developing (FN) POPF. RESULTS: There was no difference between the groups in terms of gender (p=0.781), age (p=0.219), American Society of Anesthesiologists (ASA) score (p=0.338), and comorbidity status (p=0.219). The mean body mass index (BMI) kg/m2 values of the patients in the FN and FP groups were 25.2±4.0 kg/m2 and 27.4±2.6 kg/m2, respectively (p=0.042). An increased BMI increases the risk of POPF. Preoperative prognostic nutritional index (PNI) score (p=0.588), preoperative total bilirubin level (p=0.707), pancreatic duct diameter (p=0.334), pancreatic texture (p=0.334), operation time (p=0.659) do not pose a risk for POPF. Increased perioperative bleeding amounted to a risk for POPF (123.8±46.7 ml, 244.7±66.3 ml in FN and FP groups, respectively, p=0.024). Drain fluid amylase (DFA) values (p<0.001, p=0.043, p=0.019, respectively) were found to be high in patients with POPF on postoperative days 1, 4, and 7. CONCLUSIONS: Increased BMI and excess perioperative blood loss increase the risk of POPF. DFA level is an easily applicable method that provides early diagnosis for POPF.

Confusing effect of concurrent endoscopy and colonoscopy on histopathologic findings in dyspeptic patients: a nested case-control study.

OBJECTIVE: Esophagogastroduodenoscopy (EGD) is recommended for patients over 60 years old with dyspeptic complaints, treatment-resistant dyspepsia, and alarming symptoms such as vomiting, weight loss, and dysphagia. However, colonoscopy is recommended for patients with abnormal colonic loops in their imaging, lower gastrointestinal bleeding-iron deficiency anemia, or patients with symptoms related to the lower gastrointestinal tract. This study aimed to analyze the possibility of performing concurrent colonoscopy when it is indicated and whether this may affect endoscopic and histological findings. PATIENTS AND METHODS: One hundred and two patients who underwent EGD and colonoscopy (Group CC) at the same time due to dyspeptic symptoms and 146 patients who underwent EGD alone (Group EA) at SBU Kartal City Hospital between December 2020 and December 2021 were included in the study. All gastric biopsies were taken by the Sydney system. The specimens were assessed in terms of helicobacter pylori positivity, inflammation, neutrophilic activity, intestinal metaplasia, and lymphoid aggregate. RESULTS: Helicobacter pylori positivity was 46.5% and 50.7% (p=0.521), inflammation was 93.1% and 98.6% (p=0.023), neutrophilic activity was 50.0% and 65.8% (p=0.013), intestinal metaplasia was 20.6% and 24.0% (p=0.531), and the presence of lymphoid aggregate was 46.1% and 58.9% (p=0.046) in Group CC and Group EA, respectively. CONCLUSIONS: The present study comparatively evaluated the histopathological findings of patients who underwent EGD due to dyspeptic symptoms and those who underwent bidirectional endoscopy. Notably, no false positive results were observed that would necessitate a change in the treatment applied to the patients.

Effect of COVID-19 pandemic on general surgery trauma surgeries: a single-center, retrospective cross-sectional study.

OBJECTIVE: This study aims to assess the impact of trauma surgeries performed in our clinic before and during the COVID-19 pandemic on surgical indications, procedure types, perioperative course, and final outcomes. PATIENTS AND METHODS: We conducted a retrospective single-center clinical study. The study group (n=88) comprised trauma patients who presented to the emergency department during the COVID-19 pandemic and underwent emergency surgeries. The control group (n=115) consisted of trauma patients who sought emergency care and underwent surgeries in the same period of the previous year, before the pandemic. We compared the number of patients, demographic data, clinical findings, diagnoses, and surgical interventions. RESULTS: The study group exhibited a 13.3% decrease in the number of patients compared to the control group during the COVID-19 pandemic. The study group and control group had similar age and gender distributions. The study group had a lower rate of surgical intervention. Among the study group, liver laceration was the most common diagnosis in 19 patients (7.4%), compared to 30 patients (11.7%) in the control group. Mortality rates were 1.0% in the study group and 2.0% in the control group. There were no significant differences in mortality (p=0.632) or patient diagnoses (p=0.357) between the COVID-19 pandemic and control periods. CONCLUSIONS: This study demonstrates a decline in the number of trauma patients admitted to the hospital and undergoing surgery during the COVID-19 pandemic. The pandemic has affected the management of patients requiring urgent surgical intervention, resulting in a lower rate of surgical procedures in the study group. However, despite the preference for medical treatment in trauma patients, surgical interventions remain necessary for appropriate indications.

Does laparoscopic-guided transversus abdominis plane block have an effect on postoperative pain and recovery after sleeve gastrectomy?

OBJECTIVE: Postoperative pain management is thought to have an effect on patient comfort, morbidity, and mortality after bariatric surgery. Local anesthetic agents are frequently used for this purpose. Local anesthetics can be used in many different ways. In this study, we aimed to investigate the effect of transversus abdominis plane (TAP) block on postoperative pain by laparoscopic method. PATIENTS AND METHODS: A prospective randomized clinical trial was performed. While TAP block was applied to one group with bupivacaine, no action was taken for the other group. Postoperative analgesia was given to both patient groups with the "patient-controlled analgesia (PCA)" device. Demographic, operational, and postoperative clinical and pain data of the patients were recorded. RESULTS: TAP block and non-TAP block groups consisted of 30 patients each. Visual analog scale (VAS) scores of the patients at 6, 12, and 24 hours were lower in the TAP group compared to the non-TAP group (p=0.015, 0.018, 0.04, respectively). According to the PCA device data, the analgesic requirement was lower in the TAP group at 6, 12, and 24 hours (p <0.001). Rescue analgesia was required more in the non-TAP group (p=0.04). There was no statistically significant difference between the two groups in terms of gas discharge time (p=0.102), stool discharge occurred earlier in the TAP group (p=0.02). Oral intake times (p=0.554) and length of stay hospital (p=0.551) were similar. CONCLUSIONS: Laparoscopic TAP block using bupivacaine can be safely administered in morbidly obese patients and reduces postoperative analgesic requirements. Thus, side effects that may develop secondary to the use of analgesics are avoided.

The magnetic resonance imaging assessment of optic nerve sheath diameter in pediatric acute liver failure patients.

OBJECTIVE: To evaluate the diagnostic value of optic nerve sheath diameter (ONSD) using brain MRI in the pretransplantation period in the pediatric acute liver failure patients, and correlate the ONSD with clinical grade of hepatic encephalopathy (HE) and MRI findings. PATIENTS AND METHODS: Forty acute liver failure patients and 40 control group patients were retrospectively analyzed. The high signal intensities in T2W (T2-weighted image), FLAIR (Fluid Attenuated Inversion Recovery) and DWI (diffusion-weighted imaging) sequences were evaluated and ONSD was measured. The patients were grouped first into 5 according to their West Haven score, and HE grade 0 and grade 1 were accepted as low grade HE, HE grade 2, 3 and 4 were accepted as high grade HE. The patients were grouped to 2 according to the MRI findings as low grade and high grade MRI group. RESULTS: The mean value of ONSD was 6.0 ± 1.80 and 4.94 ± 1.27 in the all patients and in the control group, respectively. There was statistically significant difference between both the ONSD and the low grade-high grade HE groups (p=0.01), and between the ONSD and the low grade-high grade MRI groups (p<0.001). CONCLUSIONS: Although high ONSD values do not make the diagnosis of cerebral edema, it may cause suspicion in the early period. MRI can be helpful in the diagnoses of increased intracranial pressure like ultrasound. Our study is the first study to compare ONSD and MRI findings in addition to HE grades. The widespread use of MRI in children in recent years may help determine the normal range of ONSD values.

Should Interventional Radiology or Open Surgery Be the First Choice for the Management of Ureteric Stenosis After Transplantation? Dual-Center Study.

BACKGROUND: Ureteric stenosis (US) is the most common urologic complication after kidney transplantation. In this dual-center retrospective study we compared the efficacy and safety of open surgery versus interventional radiology for the management of US. METHODS: From 2009 to January 2016, US was treated by surgical revision in 22 (7.8%) out of 281 recipients at one center (group 1) and managed by percutaneous nephrostomy with antegrade nephroureteral stenting (PNAS) in 22 (14.2%) out of 155 recipients at the other center (group 2). RESULTS: Three patients in group 1 required reintervention and again were treated with open surgery. With a mean follow-up of 42.1 ± 38.7 months, graft function improved in all but one patients (95%). Three patients in group 2 were admitted with relapse of US not amenable to 2nd PNAS, and 2 of them were managed with surgery. These 3 and 2 other cases with improved graft function after PNAS lost their grafts and returned to hemodialysis. The remaining 17 patients (77%) still have functioning grafts. There was no statistically significant difference between the efficacy of PNAS and open surgery for the management of post-transplantation US. However; a benefit in favor of open surgery existed for type 2 urinary tract obstruction in terms of decreased reintervention rate and much better protection of the graft function and survival. CONCLUSIONS: Both interventional radiology and open surgery have acceptable efficacy rates in the management of ureteric complications after renal transplantation. Open surgery is a better treatment option for type 2 obstruction.