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.

What is the effect of percutaneous cholesistostomy in patients with acute cholecystitis? when is the right time for the procedure?

BACKGROUND: Acute cholecystitis (AC) is one of the most common emergency diseases in surgical practice. Although the gold standard treatment is laparoscopic cholecystectomy, percutaneous cholecystostomy (PC) is performed in some patients due to age, comorbidity, and delays in admission. We aimed to investigate the effect of timing on the clinical process of patients undergoing PC. METHODS: Patients who underwent PC between February 2017 and December 2021 were included in the study. Those who un-derwent PC in the first 72 h were determined as the early PC group, and those who underwent PC after 72 h were determined as the late PC group. Demographic information of the patients, clinical information before drainage, biochemical values of the first 3 days, length of hospital stay, morbidity and mortality in the early and late period after drainage, and elective cholecystectomy information were recorded. These data were compared between the two groups. RESULTS: One hundred and twenty-two patients were included in the study. Early PC was performed in 98 patients (80.3%) and late PC was performed in 24 patients (19.7%). The median follow-up period was 26.6 months (min: 0.25-max: 67) in the early PC group and 26.4 months (min: 0.6-max: 66) in the late PC group (P=0.408). There was no statistically significant difference in mean age, distribu-tion of males and women, concomitant disease, Charlson Comorbidity Index, hepatopancreatobiliary pathology (HPBP), endoscopic retrograde cholangiopancreatography in history and grade (TG18) compared to Tokyo classification (P>0.05). There was no difference between the biochemical parameters (P>0.05). In our study, the median length of hospital stay was 6 (min: 2-max: 36) days in the early PC group, and the median was 9 days (min: 5-max: 20) in the late PC group (P<0.001). A total of 25 patients developed HPBP after PC, 16 of which were AC. There was no statistically significant difference between the early and late PC groups in terms of HPBP develop-ment after PC (P=0.576). There was no statistically significant difference between the early and late PC group in terms of the rate of surgery and type of operation (emergency/elective, open/laparoscopic/conversion, total/subtotal, duration) (P>0.05). CONCLUSION: Discussions about the right timing are ongoing. In our study, we found that patients who underwent early PC had shorter hospital stays. There was no difference between the early and late groups in terms of patient characteristics and severity of AC. PC procedure in AC should be based on algorithms determined by objective data instead of patient-based indications with ran-domized controlled trials.

Analysis of factors related to the decision of Hartmann's procedure and its reversal: a single-center experience.

BACKGROUND: Hartmann's procedure (HP) is commonly applied to resolve acute clinical conditions in most cases with colonic obstruction or perforation. HP and the closure of the end colostomy are associated with high morbidity-mortality rates. In our study, we aimed to report our clinical experience in HP. METHODS: Demographic data and outcomes of Hartmann procedures performed between 2015 and 2023 were retrospectively reviewed. RESULTS: The median age of our study was 63 (18-94) years; 65 of the patients were female, and 97 were male. Colorectal malig-nancies were the primary etiology in 50% of patients who underwent HP, with 70% presenting with obstruction and 30% with perfora-tion. Two-thirds of the patients were American Society of Anesthesiologists-2 or higher. Postoperative complications did not develop in 74.7% of patients. Our mortality rate was 33.3%. The colostomy was closed in 59 patients during an average 2-year follow-up. The median closure time was 311 (57-1319) days. A stapler was used in 89.8% of patients during the closure. A diverting ileostomy was created in only two patients. The median hospital stay was 8 (5-70) days. Post-operative complications did not develop in 25.4% of patients, while four patients died. CONCLUSION: In our population, HP was more commonly performed for colorectal cancer. The procedure and closure of the ostomy result in low stoma closure rates, high morbidity, and mortality rates, as well as surgical difficulties.

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.

Barriers to Coronavirus Disease 19 vaccination in patients with obesity.

BACKGROUND: Patients with obesity are at a high risk of severe disease and death from Coronavirus Disease 2019 (COVID-19). Vaccination offers a safe and effective means of reducing this risk. The rate of COVID-19 vaccine refusal in patients with obesity is unknown. METHODS: Patients with obesity were administered validated questionnaires assessing COVID-19 fear, general vaccine hesitancy, and COVID-19-specific vaccine hesitancy. RESULTS: 507 participants completed the study. COVID-19 vaccine hesitancy was high: Fifteen percent of patients refused COVID-19 vaccine. Hesitancy related to other vaccines was also high: Eight percent of patients refused a vaccine in the past, and 15% delayed a vaccine. Fear of side effects and doubts regarding effectiveness were the most common reasons for vaccine refusal. CONCLUSIONS: Despite high risk for complications, vaccine hesitancy is high among patients with obesity. Targeted public health interventions are critical to reduce vaccine hesitancy and improve vaccination rates.

Breast cancer awareness among Afghan refugee women in Turkey.

Background Refugees and asylum-seekers have lower levels of cancer awareness and this contributes to low rates of screening and more advanced cancers at diagnosis, compared to non-refugee populations, due largely to reduced access to medical information and care. The global Afghan refugee population is rapidly increasing with the ongoing Afghan political crisis. The present study investigates breast cancer (BC) awareness among Afghan refugee women. Methods: A cross-sectional survey of Afghan refugee women residing in Turkey was performed in September 2021. A validated BC patient awareness assessment, the Breast Cancer Awareness Measure (BCAM), was used to assess participants' knowledge of seven domains of BC: symptoms, self-examination, ability to notice breast changes, age-related risk of BC, urgency of addressing changes in the breast, BC risk factors, and BC screening. BCAM was translated into patients' native language and administered verbally by a physician with the assistance of an official interpreter. Routine statistical methods were employed for data analysis. Findings: A total of 430 patients were recruited to the study. The response rate was 97·7% (420 patients). The median participant age was 35 years (range: 18 to 68 years). The majority of participants (84%) had no formal education. Most participants (96%) were married, and most (95%) were not employed. Awareness of warning signs of BC was low: only seven to 18% of participants recognized 11 common warning signs of BC. Participant use of breast self-exam (BSE) was low, with 82% of participants stating they rarely or never complete BSE. Zero of 420 patients reported ever seeing a physician for a change in their breasts. Awareness of risk factors for BC was also low: only 15% of participants recognized increasing age as a risk factor for BC, and other risk factors were only recognized by four to 39% of participants. Interpretation: BC awareness among Afghan refugee women is critically low. There is an urgent need to target this population for practical interventions to increase BC awareness, in addition to screening and earlier diagnosis. Evidence-based interventions include educational sessions in patients' native language and use of BSE and clinical breast examination for screening. Funding: American Society for Radiation Oncology (ASTRO) - Association of Residents in Radiation Oncology (ARRO) Global Health Scholar Grant, Dana-Farber Cancer Institute Jay Harris Junior Faculty Research Grant.

A Rare Cause of Colonic Obstruction: Inflammatory Fibroid Polyp.

Only 5% of all cases of intussusceptions occur in adults. Although it is known to occur frequently due to inflammatory bowel disease, postoperative adhesions, or neoplastic masses, inflammatory fibroid polyps (IFP), which are rare lesions of the gastrointestinal tract, may present this clinical picture. In rare cases of intussusception due to IFP, clinical suspicion should be kept in the foreground and mind in the differential diagnosis. In this article, the purpose was to present the clinical, radiological, and pathological findings and the treatment of obstruction caused by this rare lesion.

Different approaches in diagnosis, follow-up and treatment of acute biliary pancreatitis: Results of attitude survey.

BACKGROUND: Acute biliary pancreatitis is one of the most frequently encountered diseases among general surgeons in emergency surgical diseases. Differences in diagnosis and treatment management of these patients, varying from physician to physician, are common in clinical practice. We aimed to present these differences and discuss the results in the light of current guidelines in the literature. METHODS: In this study, 21 questions were prepared regarding the physicians' approach in the diagnosis, follow-up and treatment of acute biliary pancreatitis (Appendix).The questionnaires were completed by face to face interviews with 94 general surgery specialists at the 20th National Surgery Congress. RESULTS: In this study, 38 (40%) of the physicians who answered the questionnaire were working in the Training and Research Hospital, 27 (29%) in the State Hospital, 19 (20%) in the University Hospital and nine in private health care was working in the establishment. 85% of the physicians were general surgery specialists with 10 years of experience. 53% (50) of the surgeons reported that they had less than five cases of acute biliary pancreatitis each month, and 35% (34) stated that they wanted amylase value daily for follow-up. Ultrasonography and computed tomography were the most commonly used imaging modalities and 15% of the respondents indicated that each patient underwent magnetic resonance cholangiopancreatography. 45% of surgeons stated that antibiotics were started at the time of diagnosis of pancreatitis. The percentage of surgeons who did not undergo cholecystectomy early in patients with mild to moderate pancreatitis was 60%. The reason for not preferring surgery in the early period was the most frequent operation difficulty with 40% and not supporting the operation in the early period. CONCLUSION: According to the attitude survey results, there are differences between general surgery specialists in the diagnosis, follow-up and treatment of acute biliary pancreatitis.