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Öğe Characteristics of multifocality/multicentricity in breast cancer and its effect on axillary lymph node metastasis(2024) Karabacak, Ufuk; Karadayı, KursatMultifocal (MF) and multicentric (MC) breast cancers are seen with increasing frequency with advances in imaging methods. However, there is no consensus on the behavior and management of these tumors. In this study, we aimed to investigate the characteristics of MF/MC breast cancers and their relationship with axillary lymph node metastasis (ALNM). Patients who underwent surgery for breast cancer between January 2015 and January 2023 were retrospectively scanned. Exclusion criteria were as follows; male breast cancer, second primary cancer diagnosis, previous breast cancer history, previous excisional/incisional breast biopsy, neoadjuvant chemotherapy, and occult breast cancer. Multiple tumors that were closer than 5 cm to each other were defined as MF, and the others were defined as MC. T stage was determined in two different ways, using the largest tumor diameter (Tmax) and the aggregate tumor diameter (Tsum), and two different multivariate analysis models were applied. A total of 156 patients were enrolled in the study, including 130 unifocal (UF), 17 MF and 9 MC. Lymphovascular invasion (LVI) (p=0.43), ALNM (p=0.23), younger age (<50) (p=0.41) and invasive lobular carcinoma (ILC) (p<0.001) were higher in MF/MC tumors than in UFs. When comparing MF and MC, no difference was seen except progesterone receptor positivity (p=0.017). In both multivariate analyses, LVI and ILC had an effect on ALNM, while no effect of MF/MC was seen. In addition, while T stage had a significant effect on ALNM in the model using Tsum, it did not have a significant effect in the Tmax model. Our retrospective data supports that MF/MC is not a direct risk factor for ALNM and that the main factor affecting ALNM is the total tumor burden.Öğe Comparision of Hem-o-lok polymeric clip and tri-staple in laparoscopic splenectomy(Edizioni Luigi Pozzi, 2021) Derebey, Murat; Ozbalci, Gokhan Selcuk; Yuruker, Savas; Tarim, Ismail Alper; Karabacak, Ufuk; Akgun, Can; Mutlu, VahitAIM: This study aimed to compare the hem-o-lok polymeric clip (HC) and tri-staple (TS) methods used in dividing the splenic hilum in terms of results, and to reveal their superiority to each other. MATERIAL AND METHODS: Medical records of patients undergoing elective laparoscopic splenectomy at the Ondokuz Mayis University Faculty of Medicine General Surgery Clinic between March 2011 and March 2020 were retrospectively analyzed. Forty-two laparoscopic splenectomy cases performed using hem-o-lok polymeric clip (HC) or tri-staple (TS) were included in this study. Demographic features, primary diagnoses, splenic size, intraoperative data and postoperative complications, as well as the clip and stapler prices used in the surgery were analyzed. RESULTS: The mean operative time was significantly longer for HC group than TS group (1167 min vs. 87.6 min, p<0.05). The mean cost of surgical instruments used to divide the splenic hilum was significantly lower for HC group than TS group (34.1 usd vs. 165.4 usd, p<0.05). There was no postoperative mortality, with a morbidity rate 6 (261%) for TS group and 4 (21.1%) for HC group (p>0.05). No significant difference existed in the complication rates. CONCLUSIONS: In the HC group, the operation time was longer, but the surgical cost was significantly lower. There was no significant difference when comparing other perioperative results. Although both techniques can be applied safely, we would like to emphasize that hemostasis is the most important factor for good results.Öğe Cytoreductive Surgery and Perioperative Intraperitoneal Chemotherapy Experience in Peritoneal Carcinomatosis: Single-Center Analysis of 180 Cases(Hindawi Ltd, 2021) Karadayi, Kursat; Bostanci, Meric Emre; Mollaoglu, Murat Can; Karabacak, UfukBackground. In peritoneal carcinomatosis (PC), increased life span and disease-free survival times are shown in patients with hyperthermic intraperitoneal chemotherapy (HIPEC) and early postoperative intraperitoneal chemotherapy (EPIC) following cytoreductive surgery (SRC). In this study, our main objective was to present our experience of performing SRC and perioperative intraperitoneal chemotherapy (HIPEC and EPIC) on patients with PC, in light of the literature. Methods. Demographic data, follow-up results, peritoneal carcinomatosis index (PCI), completeness of cytoreduction (CCR) score, and morbidity and mortality rates of 180 patients treated with SRC + HIPEC + EPIC for PC at the Department of Surgical Oncology at Sivas Cumhuriyet University between January 2008 and July 2020 were analyzed retrospectively. Results. Distribution of 180 PC cases according to primary organs included 53 ovarian, 39 colorectal, 33 stomach, 25 primary peritoneum, 10 uterus, 10 tuba, five soft tissue, and five appendix originated carcinoma. The average PCI of the cases detected preoperatively was 21 (5-30). Completeness of cytoreduction scores of CCR-0 in 102 cases, CCR-1 in 67 cases, CCR-2 in eight cases, and CCR-3 in three cases was obtained. Median operation time was 300 (200-540) minutes. Perioperative morbidity rate was 47.0%, and perioperative mortality rate was 13.5%. Conclusion. The peritonectomy procedure is a difficult, long-lasting, troublesome intervention, but it is the most important treatment option with acceptable morbidity and mortality rates in patients selected for PC treatment in experienced centers.Öğe Effects of COVID-19 pandemic on management of acute cholecystitis: A single tertiary center's experience(Ondokuz Mayis Universitesi, 2022) Derebey, Murat; Yüksek, Mahmut Arif; Karabacak, Ufuk; Mutlu, Vahit; Mizan, Salih Raşit; Tarim, Ismail Alper; Özbalci, Aysu BaşakFollowing the spread of novel coronavirus (COVID-19) pandemic, surgical associations have issued their different recommendations for managing the acute cholecystitis (AC) clinic during the pandemic. We aimed to examine the effects of the COVID-19 pandemic period on our clinical approach in patients who presented to the emergency department with abdominal pain and were diagnosed with AC. Medical records of patients diagnosed with AC in the emergency room between 11 March 2020 and 10 March 2021 and in the same period of one year before the pandemic were retrospectively reviewed. Patients were divided into 2 groups as COVID-19 period (Group 1) and non-COVID period (Group 2). Demographics and clinical characteristics, treatment modalities, and outcomes of these two groups were compared. The number of patients diagnosed with AC in the emergency department decreased during the ongoing COVID-19 pandemic. When the time between the onset of the complaints and the admission to the emergency service was evaluated, no statistically significant difference was found between the groups (p>0.05). The distribution of cholecystitis type and TG18 severity grading for AC were similar in both groups (p>0.05). While percutaneous cholecystostomy (PC) is more preferred in the treatment of AC during the pandemic period and the number of delayed interval laparoscopic cholecystectomy decreased, AC management was similar in both periods with no significant statistical difference (P>0.05). In conclusion, our clinical approach and management in the treatment of AC did not differ when compared to the pre-pandemic period. © 2022 Ondokuz Mayis Universitesi. All rights reserved.Öğe Effects of COVID-19 pandemic on management of acute cholecystitis: A single tertiary center's experience(Ondokuz Mayıs Üniversitesi, 2022) Derebey, Murat; Yüksek, Mahmut Arif; Karabacak, Ufuk; Mutlu, Vahit; Mızan, Salih Rasit; Tarım, Ismail Alper; Ozbalcı, Aysu BasakFollowing the spread of novel coronavirus (COVID-19) pandemic, surgical associations have issued their different recommendations for managing the acute cholecystitis (AC) clinic during the pandemic. We aimed to examine the effects of the COVID-19 pandemic period on our clinical approach in patients who presented to the emergency department with abdominal pain and were diagnosed with AC. Medical records of patients diagnosed with AC in the emergency room between 11 March 2020 and 10 March 2021 and in the same period of one year before the pandemic were retrospectively reviewed. Patients were divided into 2 groups as COVID-19 period (Group 1) and non-COVID period (Group 2). Demographics and clinical characteristics, treatment modalities, and outcomes of these two groups were compared. The number of patients diagnosed with AC in the emergency department decreased during the ongoing COVID-19 pandemic. When the time between the onset of the complaints and the admission to the emergency service was evaluated, no statistically significant difference was found between the groups (p>0.05). The distribution of cholecystitis type and TG18 severity grading for AC were similar in both groups (p>0.05). While percutaneous cholecystostomy (PC) is more preferred in the treatment of AC during the pandemic period and the number of delayed interval laparoscopic cholecystectomy decreased, AC management was similar in both periods with no significant statistical difference (P>0.05). In conclusion, our clinical approach and management in the treatment of AC did not differ when compared to the pre-pandemic period.Öğe Fournier's gangrene: etiology, treatment outcomes and factors affecting mortality in 38patients(2021) Derebey, Murat; Tarım, İsmail Alper; Karabacak, Ufuk; Şeker, Kadir; Özbalcı, Gökhan SelçukAim: Fournier's gangrene (FG) is a rare, rapidly progressing and life-threatening disease of the genital, perianal and perineal regions. We aimed to evaluate etiological parameters, accompanying diseases, current treatment methods and factors affecting mortality in patients with FG. Method: The medical records of 38 patients who were operated by the same team with a diagnosis of FG from December 2015 to January 2021 were retrospectively reviewed. Those patients were divided into two groups: survivors (Group 1), and non-survivors (Group 2). Comparisons were made regarding clinical and demographic features; comorbid diseases; leukocyte count at first presentation; etiological factors; treatment outcomes; and mortality rates. Results: Thirty-eight patients (24 males, 14 females) were evaluated; mean age was 60.2 ± 13.2 years. While 76.3% (n = 29) of these patients recovered with treatment, the total mortality rate was 23.7% (n = 9). The most common cause of the FG and comorbidity were anorectal diseases (n = 22; 57.9%) and type 2 diabetes mellitus (n = 21; 55.3%), respectively. Female gender, septic shock, necrosis, abdominal wall and lumbar region involvement, chronic renal failure, FG development secondary to postoperative complications and ostomy rates were higher in non-survivors. There were no significant differences between the two groups regarding leukocyte count at first presentation, number of debridement, dressing methods, reconstruction methods, and length of hospital stay. Conclusions: Female gender, presence of septic shock and necrosis on physical examination, involvement of the abdominal wall and lumbar region in addition to the perianal region, chronic renal failure, disease secondary to postoperative complications and the necessity of ostomy play an important role in mortality.Öğe Gastric pouch cancer after mini gastric bypass surgery: The first case report(Wolters Kluwer Medknow Publications, 2024) Karabacak, Ufuk; Mollaoglu, Murat Can; Seven, Turan Eray; Karadayi, KursatDevelopment of gastric cancer following bariatric surgery is very rare. Nearly all patients with cancer after mini gastric bypass/one anastomosis gastric bypass have carcinoma in their remnant stomach. This is the first case with the development of gastric cancer in the gastric pouch following mini gastric bypass surgery. Our case was a 32-year-old woman who was admitted to our department with oral intolerance 5 years after mini gastric bypass. In her endoscopic examination, an ulcerovegetan mass in the gastric pouch (Siewert type III) was detected. The pathological examination of the biopsies was reported as low differentiated adenocarcinoma. Clinical staging was performed using Positron emission tomographycomputed tomography (PET-CT) and endoscopic ultrasonography (T3N1M0). Following four cycles of neoadjuvant chemotherapy, en-bloc total gastrectomy, D2 lymph node dissection, and partial small intestine resection were performed. In pathological evaluation, no tumors were detected in the specimen and a total of 38 lymph nodes were dissected. This finding was accepted as a pathologic complete response. Signs and symptoms such as anemia, oral intolerance, and vomiting that develop after bariatric surgery can often be attributed to the surgical procedure performed, but it should be kept in mind that similar symptoms may also be associated with malignancy. In case of clinical suspicion, endoscopic examination and cross-sectional imaging should be performed.Öğe Is complete mesocolic excision or total mesorectal excision necessary during cytoreductive surgery in ovarian peritoneal carcinomatosis with colonic involvement?(Taylor & Francis Ltd, 2023) Karadayi, Kursat; Karabacak, UfukIntroduction Cytoreductive surgery (CRS) and intraperitoneal chemotherapy are effective in the treatment of ovarian peritoneal carcinomatosis (OPC). Colon resection is often required to achieve maximal cytoreduction during CRS. The success of complete mesocolic excision (CME) and total mesorectal excision (TME) in the surgical treatment of primary colorectal tumors is well-known. Our study aimed to investigate the factors affecting mesocolic lymph node metastasis (MLNM) and the contribution of CME/TME techniques to maximal cytoreduction in patients diagnosed with ovarian peritoneal carcinomatosis (OPC) with colon metastasis. Patients and methods Between 2004-2020, 30 patients who underwent colorectal resection with CME/TME techniques due to OPC-related colon metastasis were retrospectively analyzed. Results The median age of patients was 61 (33-86). Six (20%) patients underwent total colectomy, 7 (23%) subtotal colectomy, 6 (20%) right hemicolectomy, 4 (13%) left hemicolectomy, and 7 (23%) rectosigmoid resection. Histopathological diagnosis was high-grade serous carcinoma in 29 (97%) patients, and malignant mixed Mullerian tumor in 1 (3%) patient. MLNM was detected in 17 (56%) of 30 patients. There was a significant relationship between MLNM and pelvic and para-aortic lymph node metastasis (PALNM) (p = 0.009) and lymphovascular invasion in primary ovarian tumors (p = 0.017). There was no significant relationship between MLNM and depth of colonic invasion (p = 0.463), histological grade (p = 0.711), and primary/secondary surgery (p = 0.638). MLNM was seen in 8 (47%) of 17 patients with only serosal invasion. Conclusion A high rate of MLNM can be seen in OPC-induced colon metastasis regardless of the degree of colon wall invasion. In patients with PALNM, the frequency of MLNM increases. We believe that if colon resection is to be performed in OPC, a colectomy should be performed by CME/TME principles to achieve maximal cytoreduction.Öğe Is diabetes onset at advanced age a sign of pancreatic cancer?(Edizioni Luigi Pozzi, 2022) Ozsay, Oguzhan; Karabacak, Ufuk; Cetin, Sirin; Majidova, NargizAIM: Pancreatic cancer is the 11th most common cancer in the world. The importance of early diagnosis and treatment for curative treatment is very high. Many studies have shown a relationship between diabetes mellitus (DM), smoking, genetic factors, obesity, nutritional habits and sedentary lift and pancreatic ductal adenocarcinoma (PDAC). In this study, we aimed to investigate the relationship between DM onset age and PDAC. MATERIALS AND METHODS: 158 patients with PDAC and DM were compared with 244 patients with DM in the control group. We retrospectively analyzed PDAC risk factors with a focus on DM onset age. RESULTS: It was calculated that the risk of PDAC increased 8.5 times in patients diagnosed with DM after 60 years of age compared to those diagnosed with DM before 60 years of age (HR = 8.54, 95% CI 5.66-12.90, p<0.0001). The interval between the diagnosis of DM and the diagnosis of PDAC peaked at 32 months (95% CI 27.90-35.56). When the age of DM onset was evaluated, it was observed that peaks were around 50 years in the group without PDAC and 60 years in the group with PDAC. CONCLUSION: In patients with DM onset after the age of 60, we recommend keeping in mind the increased risk of PDAC and evaluating these patients for PDAC, even if they are asymptomatic.Öğe Is extereme cytoreductive surgery beneficial to survival ın malignant peritoneal mesothelioma?(Taylor & Francis Ltd, 2024) Mollaoglu, Murat Can; Karabacak, Ufuk; Bostanci, Meric Emre; Seven, Turan Eray; Karadayi, KursatIntroduction: Malign peritoneal mesothelioma (MPM) is an uncommon disease that is difficult to treat. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) are the gold standards for treating MPM. Sometimes extreme cytoreductive surgery (eCRS) is required to achieve complete cytoreduction, which is one of the most important prognostic factors. There is limited information in the literature about the contribution of eCRS in patients with MPM. In this study, we aimed to investigate the impact of eCRS on survival and perioperative outcomes. Methods: The Department of Surgical Oncology at Cumhuriyet University database was retrospectively reviewed for MPM patients who underwent CRS-HIPEC between January 2004 and December 2018. Patients who underwent CRS-HIPEC were divided into eCRS and less extensive CRS (leCRS) groups. A resection of >= 5 organs or >= 3 small bowel anastomoses were defined as eCRS. Both groups were compared regarding survival, demographic information, and perioperative outcomes. Results: A total of 31 patients were included. eCRS-HIPEC was used in 15 patients. Complete cytoreduction (CC score 0/1) was achieved in all 31 patients. Compared to leCRS, the eCRS group had a longer median length of stay, longer intensive care unit stay, a higher median peritoneal cancer index (PCI), higher intraoperative blood loss, more frequent occurrence of any complication, and a longer operative time (all p values < 0.001). Clavien Dindo 3-4 complications, ASA, and gender were similar in both groups of patients (p > 0.05). It was found that there was no significant difference between the OS of the eCRS and leCRS groups (37.5 vs. 42.8 months, p = 0.895). Conclusions: Rates of serious complications and morbidity are similar in patients undergoing eCRS compared to leCRS. In patients with high PCI and multiorgan involvement, complete cytoreduction can be achieved by performing eCRS, and survival results equivalent to those with low PCI can be achieved.Öğe The Role of Axillary SUVmax in 18F-FDG PET/CT in Predicting the Number of Axillary Metastases of Breast Cancer(Coll Physicians & Surgeons Pakistan, 2023) Karabacak, Ufuk; Turkan, Halil; Coskun, Gokhan; Mollaoglu, Murat Can; Hasbek, Zekiye; Karadayi, KursatObjective: To investigate the role of positron emission tomography/computed tomography (PET-CT) in determining the maximum number of axillary lymph node metastasis (ALNM) detectable in sentinel lymph node biopsy (SLNB).Study Design: Observational study.Place and Duration of the Study: Sivas Cumhuriyet University Faculty of Medicine, Turkiye, from January 2015 to August 2021.Methodology: A total of 104 breast cancer patients who underwent surgery after a PET-CT scan were examined. A receiver operating characteristic (ROC) analysis was utilised to determine optimal cut-off values for the standardised uptake values of the primary tumour (pSUVmax) and axillary lymph nodes (nSUVmax) in the presence of ALNM and the presence of more than two ALNMs.Results: The presence of more than two ALNMs was associated with pSUVmax, nSUVmax, LVI, and the number of LNs detected on PET-CT. In the ROC analysis, for the ability to predict more than two ALNMs in SLNB/axillary lymph node dissection (ALND), cut-offvalues were calculated as 4.65 for pSUVmax (AUC=0.669, sensitivity=66.7%, specificity=62%, PPV=0.482, NPV=0.800, p=0.006) and 1.75 for nSUVmax (AUC=0.838, sensitivity=81.8%, specificity=88.7%, PPV= 0.676, NPV=0.913, p<0.001).Conclusion: Low sensitivity, NPV, and accuracy values that limit the use of PET-CT in preoperative axillary evaluation can be increased by targeting the criterion of more than two ALNMs. Thus, PET-CT can be used more effectively in axilla management.
