Comparison of transanal and transvaginal specimen extraction in laparoscopic colorectal surgery.

AIM: This study aimed to compare the outcomes of transanal and transvaginal NOSES in patients undergoing laparoscopic colorectal surgery. MATERIAL AND METHODS: This study included 45 patients who were scheduled for NOSES after undergoing laparoscopic colorectal resection in our clinic between January 2019 and March 2020. To ensure homogeneity between the groups, the data of 22 female patients were analyzed in this study. Patients were divided into two groups according to the specimen extraction technique used. Demographic data, preoperative and postoperative findings, as well as the pathology and sizes of the specimens were examined in both the groups. RESULTS: The demographic characteristics and preoperative and early postoperative outcomes were similar in both the groups. The size of the lesion was larger in the transvaginal group than that in the transanal group [4.58 ± 1.28 and 2.71 ± 1.55, respectively (P = 0.039)]. Two complications associated with extraction were observed (%9.09). A patient who underwent transanal extraction developed transient anal incontinence, which spontaneously resolved, and a patient who underwent transvaginal extraction developed anastomotic leakage and rectovaginal fistula associated with anastomotic leakage; a colonic stent was inserted for the management of this condition following which the patient recovered. CONCLUSION: Only the lesion size was statistically significantly different between the transanal and transvaginal routes. Further, avoiding secondary organ injury is essential; therefore, the transanal route is primarily preferred. However, if the diameter of the lesion is large and the patient is female, the transvaginal route can be a useful alternative. KEY WORDS: Natural orifice specimen extraction surgery, Laparoscopic colorectal surgery, Minimally invasive surgery.

Does systemic immune inflammation index have predictive value in gastric cancer prognosis?

OBJECTIVE: Some studies have reported that the systemic immune inflammatory index (SII) and neutrophil/lymphocyte ratio (NLR) provide predictive data on prognosis in gastric cancer patients. In the present study, it was aimed to examine the diagnostic and prognostic values of SII and NLR in gastric cancer. METHODS: A total of 152 patients, operated with the diagnosis of gastric cancer and followed up in the General Surgery Department of our hospital between January 2012 and April 2018, and 152 healthy controls were included in the study. RESULTS: The mean SII (989±685) and the mean NLR (3.9±5.2) were significantly higher in gastric cancer patients than the healthy control group (433±203 and 1.9±0.8, respectively) (p<0.001 for both). In the receiver operating characteristic analyzes, a threshold value of 892 for SII had a sensitivity of 66.7% and a specificity of 62.7% in terms of predicting 5-year survival (AUC: 0.637; p=0.076; LB: 0.475; UB: 0.799; CI 95%). The 5-year survival rate was found to be significantly higher in those with a SII of above 892 than those with a SII of 892 and below (p=0.026). The 5-year mortality risk was 0.67-fold lower in those with SII above 892 (p=0.111; 95% CI 0.4-1.1). CONCLUSION: The present study findings show that SII and NLR are far from providing reliable data on gastric cancer prognosis.

Use of the Systemic Immune Inflammation Index, TNM classification, and CEA in pre- and post- prognostic evaluation of sporadic colorectal cancer.

AIM: The aim of this study was to investigate the correlation between preoperative systemic immune inflammatory index (SII) and carcinoembryonic antigen (CEA) and postoperative lympho-vascular invasion and TNM stage in patients with colorectal carcinoma. MATERIAL AND METHODS: A total of 153 patients with colorectal cancer admitted to our tertiary hospital between 2014 and 2018 were included in the study. RESULTS: While 71.2% of the patients had low preoperative CEA values, 28.8% had high preoperative CEA values. Lymphovascular invasion rate was found to be significantly higher in patients with high CEA levels than those in low levels (70.4% vs. 39.4%, p=0.002). The percentage of patients with lymphovascular invasion with a high SII (60.0%) was significantly higher than those without lymphovascular invasion (p=0.015). CONCLUSION: In our study, serum CEA and SII index values were found to provide critical information in terms of showing lympho-vascular invasion, which is considered as an independent "bad" prognostic factor in patients with colorectal carcinoma. In conclusion, we consider that CEA and SII index values can be used to determine the prognosis of patients with colorectal cancer. KEY WORDS: Carcinoembryonic antigen, Colorectal carcinoma, Microsatellite, lymphovascular invasion, TNM.

Primary extra gastrointestinal stromal tumors of the abdomen.

OBJECTIVE: In the present study, we aimed to evaluate the clinicopathological features and prognostic factors in extra-gastrointestinal stromal tumor (EGIST) cases, which are observed very rare, by examining the data the cases obtained in a single center. METHODS: Data of 14 EGIST cases who were operated by a general surgeon between January 2007 and May 2020 were obtained and analyzed. RESULTS: The median age was 47.5 (range: 34-87) years. A total of 135 patients were operated for GIST, and 14 (10.4%) of these patients were EGIST. The mean tumor diameter was 16.8±10.5 (range: 2.8-40) cm. The mitotic index was 5/50 high power field and below in seven (50%) cases. Twelve (85.7%) of the patients were in the high-risk group. The overall survival (OS) rate was 80%, and the 5-year survival rate was 88.9%. Mean OS was 78.5±50.7 months, 5-year OS and disease-free survival (DFS) were both 53.3±20.0 months, and overall DFS was 58.0±59.8 months. The mean OS and DFS durations were found to be significantly lower in women than men (p=0.006 for both comparisons). The mean OS was found to be significantly lower in patients over 60 years of age compared to those aged 60 and under (p=0.013). CONCLUSION: In the present study, it has been determined that the rare EGISTs are large in size and that the mitotic index is often low. In addition, it has been observed that the prognosis may be similar to other GISTs, however, may be worse in elderly patients and in women.

Gastrointestinal Stromal Tumours of the Small Intestine.

OBJECTIVES: To describe the spectrum of small intestine gastrointestinal stromal tumour (GIST) cases; and to analyse prognostic factors. STUDY DESIGN: Descriptive study. PLACE AND DURATION OF STUDY: Kartal Dr. Lütfi Kirdar City Hospital, Istanbul, Turkey, from 2010 to 2020. METHODOLOGY: Forty patients with small intestine GIST followed up between 2010-2020 were included in this study. The demographic information and clinical laboratory, histopathology, and radiology findings of all patients were analysed and compared. Five-year overall survival (OS) rate and five-year disease-free survival (DFS)were calculated. RESULTS: The mean patient age at diagnosis was 58.9 ± 12.6 years (34-79 years). Thirty-seven (92.5%) tumours were in the jejunum and ileum, and three (7.5%) were in the duodenum. The most common symptoms were bleeding (50%) and pain (37.5%). A total of 5% of the patients were asymptomatic, and 67.5% were in the high-risk group. Two patients (5%) died within a 30-day postoperative period, and 13 (32.5%) died during the follow-up period. The five-year overall survival (OS) rate was 54.2%. The mean five-year OS and five-year disease-free survival (DFS) were 47.5 ± 16.8 months and 40.9 ± 25.0 months, respectively. The mortality risk was calculated as 4.5-fold increased in the patients aged over 60 years and as 3.556-fold increased in those with recurrence/metastasis detected in their follow-ups. CONCLUSION: The OS ratio and OS duration were not as high as expected for small intestine GIST cases. Tumour diameter, mitotic index, and risk classification may not provide sufficient information for prognosis prediction in some cases. The frequency of recurrence and/or metastasis was higher than expected - although complete resection was achieved. Key Words: Gastrointestinal stromal tumours, Small intestine, Tumour diameter, Mitotic index.

Short-term Prognostic Value of Tumor Diameter in Stage 2 and 3 Gastric Cancer.

OBJECTIVE: To investigate the prognostic value of tumor diameter in the short term of 3 and 5 years in patients operated for gastric cancer. STUDY DESIGN: A descriptive study. PLACE AND DURATION OF STUDY: Kartal Dr Lütfi Kirdar City Hospital, Istanbul, Turkey, from January 2014 to December 2018 Methodology: A total of 125 patients with stage 2 or 3 gastric cancer, followed up in the Department of General Surgery, were included. Demographic information, clinical, laboratory, and pathology reports were analysed in terms of postoperative 30-day mortality. RESULTS: The mean age of the patients was 63.9±11.9 (31-88) years. Forty-four (35.2%) were in stage 2, and 81 (64.8%) were in stage 3 cancers. The mean tumor diameter was 6.5±3.1 cm, and the mean metastatic lymph node rate was 35.6±29.8%. The mean follow-up period was 31.8±21 months. The 3-year and 5-year survival rates were 39.8% and 17.6%, respectively. Tumor diameter was not directly related to survival, differentiation, number of resected lymph nodes, number of metastatic lymph nodes, and metastatic lymph node rate in stage 2 and 3 cases (p>0.05 for each). The 5-year mortality risk was 1.2-fold higher in those with tumor diameter over 6.5 cm (95% CI 0.7-2.0; p=536). CONCLUSION: The tumor size did not have a direct effect on prognosis. It did not provide reliable data about short-term prognosis such as 3 and 5 years in stage 2 and 3 gastric cancer cases. Key Words: Gastric cancer, Stage 2, Stage 3, Tumor size, Prognosis.

Gastric medullary carcinoma. A case report and review of the literature.

Medullary gastric carcinoma (MGC) is a rare gastric neoplasm characterized by histological appearance of dense lymphocytic infiltration of the stroma. The prevalence of MGC among all gastric neoplasms is about 1%. Although it is classified within the poorly differentiated carcinomas, the biological activity of MGC is similar to that of the well differentiated carcinomas. Hereby, we present a case of a 64-year-old male patient who underwent upper gastrointestinal (GI) endoscopy for abdominal pain over the last 2 months. The pathological findings of the GI endoscopy specimen revealed adenocarcinoma of the stomach. Subsequently, the patient underwent total gastrectomy and D2 lymph node dissection. Pathological evaluation of the excised specimens samples were compatible with MGC (gastric carcinoma with lymphoid stroma) which was staged as T2N0M0. This paper purposed to describe the clinical and pathological findings of MGC. KEY WORDS: Gastrectomy, Gastric carcinoma, Medullary.

Effect of Genetic Factors on the Etiopathogenesis of Thrombosed Hemorrhoidal Disease.

OBJECTIVE: The aim of this study is to investigate whether genetic factors known to increase thrombosis risk play a role in the etiopathogenesis of thrombosed hemorrhoidal disease. Methods: Genomic DNA from patients with thrombosed hemorrhoidal disease was analyzed for the presence of factor V Leiden, prothrombin G20210A, methylenetetrahydrofolate reductase C677T, and methylenetetrahydrofolate reductase A1298C mutations. Results: No significant differences were found in the allele frequencies of factor V Leiden, prothrombin G20210A, methylenetetrahydrofolate reductase C677T, and methylenetetrahydrofolate reductase A1298C mutations between patients with thrombosed hemorrhoidal disease and controls (p 0.05). Moreover, there were no significant differences in the genotype (heterozygous and homozygous mutations) of factor V Leiden, prothrombin G20210A, methylenetetrahydrofolate reductase C677T and A1298C mutations between patients with thrombosed hemorrhoidal disease and controls (p 0.05). Conclusions: Our findings indicate that mutations associated with venous thromboembolism do not play a role in the etiopathogenesis of thrombosed hemorrhoidal disease; however, several environmental, mechanical, and hemodynamic factors may contribute to the etiopathogenesis of hemorrhoidal disease.

Association of the nibrin gene (NBN) variants with breast cancer.

Nibrin, encoded by the NBN gene, participates in DNA repair. Mutations in the NBN gene lead to Nijemen breakage syndrome, which may result in several types of diseases, particularly susceptibility to cancer, including breast cancer. Polymorphic variants and defective mutations occurring in the NBN gene increase the risk of breast cancer through the double-stranded break repair mechanism. The aim of the present study was to investigate a possible association between breast cancer and NBN genetic variants, NBN 924 T>C, 8360 G>C and 30537 G>C, in women with breast cancer. Locus-specific primers were designed to study 3 genetic variants in DNA samples isolated from peripheral blood samples of 101 women with breast cancer and 115 healthy controls. Subsequently, 3 polymerase chain reaction-restriction fragment length polymorphism methods were performed and the obtained results were statistically analysed. The NBN gene 924 T>C variant was found to be significantly associated with breast cancer (χ2=5.722, P=0.017). There were no statistically significant differences between cases and controls in the NBN gene 8360 G>C variant (χ2=1,125, P=0.570) or the NBN gene 30537 G>C variant (χ2=4.301, P=0.116). In conclusion, the NBN gene 924 T>C variant may be a genetic risk factor for breast cancer development in women with breast cancer.