The Relatıonshıp Between Serum Mırna Levels And Prognostıc Factors In Gastrıc Cancer

Giriş: Gastrik kanserler dünya çapında önemli bir kanser türü olarak yerini korumaktadır. Gastrik kanserli hastalarda günümüzde kullanılan noninvaziv serolojik belirteçlerin (ör. CEA, CA 19-9 gibi) tanı ve prognoz belirlemede düşük sensivite ve spesifiteye sahip olması nedeniyle tanı, tedavi takibi, nüks saptama amaçları için kullanılabilecek biyobelirteçlere hala ihtiyaç duyulmaktadır. Son yıllarda mikroRNA’ların (miRNA) farklı vücut sıvılarındaki düzeyleri ile kanserin patolojik özellikleri arasında anlamlı bir ilişki olduğu kanıtlanmıştır. Ancak miRNA’ların cerrahi yönetimi etkileyebilecek parametreler ile ilişkisi konusunda oldukça sınırlı veri vardır. Sonuç olarak, bu çalışmamızda serum miRNA ekspresyon düzeylerinin gastrik kanserlerde tanı, cerrahi yönetimi ve prognozu etkileyen patolojik özellikleri ile ilişkisinin değerlendirilmesi amaçlandı. Materyal - Metod: Eylül 2015 – Aralık 2018 tarihleri arasında Gazi Üniversitesi Tıp Fakültesi Genel Cerrahi Kliniğinde gastrik adenokarsinom nedeniyle total gastrektomi ve D2 lenf nodu diseksiyonu yapılan 35 hasta ve 33 kontrolün serum miRNA ekspresyon düzeyleri (miR-101-3p, miR-146a-5p, miR-148a-3p, miR-200a-3p, miR-21-5p, miR-106b-5p, miR-203a-3p, miR-27a-3p, miR-17-5p) karşılaştırıldı. Ardından serum miRNA ekspresyon düzeyleri ile operasyon sonucu elde edilen patolojik prognostik faktörler arasındaki ilişki değerlendirildi. Bulgular: Serum miR-17-5p, miR-21-5p, miR-27a-3p, miR-146a-5p, miR-148a-3p, miR-203a-3p ekspresyon düzeyleri gastrik kanser hastalarında anlamlı şekilde yüksekti. Serum miR-21-5p, miR-27a-3p, miR-106b-5p, miR-146a-5p, miR-148a-3p ekspresyon düzeyleri erken gastrik kanser hastalarında anlamlı şekilde yüksekti. Serum miR-106b-5p ve miR-146a-5p düzeylerinin tümör lokalizasyonu (AUC: 0,773; 0,797; p: 0,049; 0,036); serum miR-27a-3p ve miR-148a-5p düzeylerinin de tümörün T evresi ile ilişkili olduğu görüldü (AUC: 0,748; 0, 729; p: 0,036; 0,049). Sonuç: Bu çalışmada serum miR-17-5p, miR-21-5p, miR-27a-3p ve miR-203a-3p ekspresyon düzeylerinin gastrik kanserlerde tanısal biyobelirteçler olduğunu; serum miR-106b-5p, miR-146a-5p, miR-27a-3p, miR-148a-5p ekspresyon düzeylerinin de tanısal olmakla birlikte cerrahi yönetimi etkileyebilecek prognostik biyobelirteçler olduğunu gösterdik.Introduction: Gastric cancers are a major cancer in the world. Because of the low sensitivity and sensitivity of the noninvasive serological markers (eg CEA, CA 19-9) used in patients with gastric cancer, there is still a need for biomarkers that can be used for diagnosis, treatment follow-up, and relapse detection purposes. In recent years, it has been shown that there is a significant relationship between the levels of microRNAs and the pathological features of cancer. However, there is very limited data on the relationship between serum miRNA expression levels and pathological prognostic parameters that may affect surgical management. In conclusion, the aim of this study was to evaluate the relationship between serum miRNA levels and the pathological properties of gastric cancers in diagnosis, surgical management and prognosis. Material and Method: Serum miRNA expression levels of 35 patients who underwent total gastrectomy and D2 lymph node dissection for gastric adenocarcinoma at Gazi University Faculty of Medicine Department of General Surgery between September 2015 and December 2018 and 33 controls were compared. After, the relationship between serum miRNA expression levels and pathological prognostic factors were evaluated. Results: Serum miR-17-5p, miR-21-5p, miR-27a-3p, miR-146a-5p, miR-148a-3p, miR-203a-3p expression levels were significantly higher in gastric cancer patients. Serum miR-21-5p, miR-27a-3p, miR-106b-5p, miR-146a-5p, miR-148a-3p expression levels were significantly higher in early gastric cancer patients. Serum miR-106b-5p and miR-146a-5p levels were associated with tumor localization (AUC: 0,773; 0,797; p: 0,049; 0,036); serum miR-27a-3p and miR-148a-5p levels were associated with T stage of the tumor (AUC: 0,748; 0, 729; p: 0,036; 0,049). Conclusion: In this study, we showed that serum miR-17-5p, miR-21-5p, miR-27a-3p and miR-203a-3p levels were diagnostic biomarkers in gastric cancers. However, we have shown that serum miR-106b-5p, miR-146a-5p, miR-27a-3p, miR-148a-5p levels are prognostic biomarkers that may affect surgical management, although they are diagnosti

30-Day Morbidity and Mortality of Bariatric Surgery During the COVID-19 Pandemic: a Multinational Cohort Study of 7704 Patients from 42 Countries.

BACKGROUND There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. METHODS We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. RESULTS Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. CONCLUSIONS BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak

Effect of BMI on safety of bariatric surgery during the COVID-19 pandemic, procedure choice, and safety protocols - An analysis from the GENEVA Study

Background: It has been suggested that patients with a Body Mass Index (BMI) of > 60 kg/m2 should be offered expedited Bariatric Surgery (BS) during the Coronavirus Disease-2019 (COVID-19) pandemic. The main objective of this study was to assess the safety of this approach. Methods: We conducted a global study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into three groups according to their preoperative BMI -Group I (BMI < 50 kg/m2), Group II (BMI 50-60 kg/m2), and Group III (BMI > 60 kg/m2). The effect of preoperative BMI on 30-day morbidity and mortality, procedure choice, COVID-19 specific safety protocols, and comorbidities was assessed. Results: This study included 7084 patients (5197;73.4 % females). The mean preoperative weight and BMI were 119.49 & PLUSMN; 24.4 Kgs and 43.03 & PLUSMN; 6.9 Kg/m2, respectively. Group I included 6024 (85 %) patients, whereas Groups II and III included 905 (13 %) and 155 (2 %) patients, respectively.The 30-day mortality rate was higher in Group III (p = 0.001). The complication rate and COVID-19 infection were not different. Comorbidities were significantly more likely in Group III (p = < 0.001). A significantly higher proportion of patients in group III received Sleeve Gastrectomy or One Anastomosis Gastric Bypass compared to other groups. Patients with a BMI of > 70 kg/m2 had a 30-day mortality of 7.7 % (2/26). None of these patients underwent a Roux-en-Y Gastric Bypass. Conclusion: The 30-day mortality rate was significantly higher in patients with BMI > 60 kg/m2. There was, however, no significant difference in complications rates in different BMI groups, probably due to differences in procedure selection

Safety of Bariatric Surgery in ≥ 65-Year-Old Patients During the COVID-19 Pandemic

Background Age >= 65 years is regarded as a relative contraindication for bariatric surgery. Advanced age is also a recognised risk factor for adverse outcomes with Coronavirus Disease-2019 (COVID-19) which continues to wreak havoc on global populations. This study aimed to assess the safety of bariatric surgery (BS) in this particular age group during the COVID-19 pandemic in comparison with the younger cohort.Methods We conducted a prospective international study of patients who underwent BS between 1/05/2020 and 31/10/2020. Patients were divided into two groups - patients >= 65-years-old (Group I) and patients < 65-years-old (Group II). The two groups were compared for 30-day morbidity and mortality.Results There were 149 patients in Group 1 and 6923 patients in Group II. The mean age, preoperative weight, and BMI were 67.6 +/- 2.5 years, 119.5 +/- 24.5 kg, and 43 +/- 7 in Group I and 39.8 +/- 11.3 years, 117.7 +/- 20.4 kg, and 43.7 +/- 7 in Group II, respectively. Approximately, 95% of patients in Group 1 had at least one co-morbidity compared to 68% of patients in Group 2 (p = < 0.001). The 30-day morbidity was significantly higher in Group I ( 11.4%) compared to Group II (6.6%) (p = 0.022). However, the 30-day mortality and COVID-19 infection rates were not significantly different between the two groups.Conclusions Bariatric surgery during the COVID-19 pandemic is associated with a higher complication rate in those >= 65 years of age compared to those < 65 years old. However, the mortality and postoperative COVID-19 infection rates are not significantly different between the two groups

30-Day morbidity and mortality of bariatric metabolic surgery in adolescence during the COVID-19 pandemic – The GENEVA study

Background: Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives: This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in-hospital and 30-day COVID-19 and surgery-specific morbidity/mortality. Results: One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre-operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre-operative testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self-isolate pre-operatively. Two patients developed symptomatic SARS-CoV-2 infection post-operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions: MBS in adolescents with obesity is safe during the COVID-19 pandemic when performed within the context of local precautionary procedures (such as pre-operative testing). The 30-day morbidity rates were similar to those reported pre-pandemic. These data will help facilitate the safe re-introduction of MBS services for this group of patients