The 33-year Retrospective Analysis of Esophageal Carcinomas: Cerrahpaşa Experience

Aim:Esophageal cancer is a fatal disease where the majority of patients are diagnosed at an advanced stage. In this study, we aimed to present the demographic and clinicopathological characteristics of patients who were operated for esophageal cancer.Materials and Methods:A total of 847 patients who underwent surgery, chemoradiotherapy, or palliative procedures for esophageal pathology between the years of 1985 and 2018 were retrospectively analyzed. Age, gender, tumor location, histopathology, surgical technique, and chemoradiotherapy history of patients were analyzed.Results:In the study, 488 patients were male (60.5%) and 319 were female (39.5%). The ratio of males and females was 1.52. The average age was 58.6 years, and 80.1% were older than 50 years. The most common pathological material obtained was squamous cell carcinoma (67.5%), followed by adenocarcinoma (27.7%). Total esophagectomy was performed in 435 patients; distal esophagectomy was performed in 38 patients. Transhiatal esophagectomy (n=271, 62.2%) was the most common procedure that was performed.Conclusion:Esophagectomy is the primary treatment modality for esophageal cancers. When determining the optimal treatment, appropriate patient selection, staging, and risk assessment should be made. Patient-specific treatment should be planned with a multidisciplinary approach

Did the ERAS Protocol Improve Our Results in Locally Advanced Gastric Cancer Surgery?

ERAS is a protocol consisting of multidisciplinary approaches, including patient education, fluid resuscitation, keeping patients’ innormothermic state, early feeding, and mobilization. We aimed to present and compare the postoperative results of patients operated on due to locally advanced gastric cancer who received neoadjuvant therapy in two high-volume tertiary centers, and aimed to present that ERAS protocols can be applied with success without increasing the complication rate. This retrospective study consisted of two groups: a non-ERAS group and an ERAS group. The ERAS group consisted of 106 patients and the non-ERAS group consisted of 104 patients. The time to first flatus was shorter in the ERAS group compared with the non-ERAS group: 2.8 (1–5) and 3.5 (1–5, p = 0.008), respectively. The average stay at the hospital was 9 (7–22) days in thenon-ERAS group and 6.5 (5–14) days in the ERAS group. Readmission to the hospital within first 15 days after discharge was observed in one (%0.9) patient in the non-ERAS group and in four (%3.8) patients in the ERAS group. ERAS protocols contribute positively to the nutritional status of patients by reducing surgical stress and the rate of hospitalization, and reducing health costs. However, it appears to be associated with increased readmission rates

Effects of sevoflurane versus TIVA on gastric mucosal pH and hemodynamic status in colon cancer surgery

BACKGROUND: Gastric tonometry is a minimally invasive device by which the adequacy of splanchnic blood flow is assessed indirectly. Patients undergoing major abdominal surgery are under the risk of developing splanchnic ischemia. The aim of this study was to compare gastric intramucosal pH and hemodynamic effects between sevoflurane and TIVA achieved by propofol. METHODS: Forty patients of ASA I-II were studied. Twenty patients received sevoflurane (Group S) and 20 patients received TIVA by propofol (Group P). Continuous measurements were made at four intervals: (a) 30 minutes before the starting of the surgery, (b) at the first hour of the surgery, (c) at the second hour of the surgery, (d) at the first hour after ending of the surgery. The mean arterial pressure, heart rate, SpO2, EtCO2, body temperature, central venous pressure, urine output, intramucosal and arterial pH were monitored. RESULTS: There were no significant differences between two groups regarding the studied parameters. CONCLUSIONS: Sevoflurane and propofol did not cause any significant difference in hemodynamic effects and splanchnic circulation measured by gastric tonometry in ASA I-II patients operated on for colon cancer

Systemic Inflammatory Biomarkers as Surrogate Markers for Stage in Colon Cancer

Background This study aimed to investigate whether the systemic inflammatory parameters currently in use in staging the disease can be used as biomarker tests operated colon cancer patients. Neutrophil, lymphocyte, monocyte, platelet, neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), platelet/lymphocyte ratio (PLR), neutrophil/monocyte ratio (NMR), CRP, albumin, lymphocyte/CRP ratio, CRP/albumin ratio, and neutrophil/albumin ratio as systemic inflammatory biomarkers and prognostic nutritional index (PNI) were evaluated. Methods This retrospective study included 592 patients. Patients with colon cancer in the cohort were divided into 2 subgroups: Tumor, nodes, metastases (TNM) stage 0, TNM stage 1, and TNM stage 2; early stage (n: 332) and TNM stage 3 and TNM stage 4; late stage (n: 260) colon cancer patients. Results LDH (P < .001), NLR (P < .001), PLR (P < .05), CRP/albumin (P < .01), and neutrophil/albumin (P < .01) were significantly higher, while monocyte count (P < .05) and PNI (P < .01) were found to be significantly lower in late stage colon cancer patients than in early stage colon cancer patients. Moderate negative correlation was found between the PNI and the neutrophil/albumin ratio in late stage colon cancer patients (r: -.568, P < .001). Conclusions Our data suggest that high serum LDH, NLR, PLR, CRP/albumin, and neutrophil/albumin may be useful predictive markers for advanced stage in colon cancer. According to the receiver operating characteristic analysis results, CRP/albumin ratio can be used to discriminate early from late stage. Preoperative low monocyte count and PNI are associated with postoperative staging patients with colon cancer

Clinicopathological features and management of colonic lipomas Case reports

Introduction: Colonic lipomas are benign tumors of adipose tissue that are often asymptomatic, but they may present with rectal bleeding or obstructive symptoms. These tumors are unique in that they are rarely encountered within the gastrointestinal system and can mimic malignant tumors in appearance. Surgical resection and endoscopic removal of tumors have been shown to be successful in their management. Patient concerns: In this report, we present 3 cases of colonic lipomas, 2 of which are located in the cecum and the other within the sigmoid colon. The presenting symptoms of the patients included abdominal pain, constipation, and dyspepsia. Diagnosis: Patients typically presented with anemia and an elevated C-reactive protein count. Colonoscopic and computerized tomography findings were used for diagnosis. Interventions: Hemicolectomy was performed, depending on the localization, and the pathologic specimens were consistent with lipoma. Outcomes: Surgical resection was curative in all patients. The postoperative period was uneventful in all patients and all patients are symptom-free and alive at 3 years follow-up. Conclusion: Colonic lipomas are benign mesenchymal tumors of the gastrointestinal system with a male predominance and are observed within the fourth to sixth decades of life. Various genetic abnormalities have been reported and they have been linked to the formation of intussusception. The squeeze sign on radiological imaging, cushion sign and tenting sign in colonoscopy, and naked fat sign during pathologic examination is helpful towards reaching a diagnosis. Surgical resection is the treatment of choice but minimally invasive endoscopic approaches have also been shown to be successful

Giant pedunculated liposarcoma of the esophagus

Background Liposarcoma is a common soft tissue neoplasm but its presence within the gastrointestinal system, especially the esophagus, is quite rare. It usually presents as an intraluminal or an intramural mass, with symptoms such as dysphagia and throat discomfort. Liposarcoma must be differentiated from benign tumors of the esophagus and managed appropriately. Case presentation In this report, we present the case of a 26-year-old woman who complained of dysphagia to liquids and solids and vague abdominal discomfort. The radiological modalities and endoscopic examination revealed a near-obstructing esophageal polypoid mass of 15 x 7.5 cm in size in the thoracal esophagus. A diagnosis of atypical lipomatous tumor/well-differentiated liposarcoma was made with morphological and immunohistochemical findings. Discussion Esophageal liposarcomas originate from primitive mesenchymal cells and are divided into several subtypes, with well-differentiated liposarcoma being the most common subtype. Various diagnostic tests are available, such as barium swallow, computerized tomography, magnetic resonance imaging, and esophagogastroduodenoscopy. Depending on the size and location of the tumor, minimally invasive endoscopic resection or more radical surgery such as esophagectomy can be performed. Conclusion Modern radiological imaging modalities have allowed better understanding and early diagnosis of lipomatous tumors of the esophagus. Optimal management varies, but minimally invasive techniques allow easy removal of the tumor stalk. However, more radical surgery such as esophagectomy is still performed. Due to its rarity, little is known about the prognosis of esophageal liposarcoma. Patients should be followed-up closely in the long term regarding recurrence

Effects of hypertonic saline replacement on colonic anastomosis in experimental hemorrhagic shock model in rats

BACKGROUND: Inadequate intestinal perfusion resulting from hemorrhagic shock negatively affects wound healing. In this experimental study, we aimed to evaluate the effects of resuscitation with hypertonic saline on colonic anastomosis in rats with controlled hemorrhagic shock

An investigation into the predictive role of serum inflammatory parameters in the diagnosis of complicated acute cholecystitis

BACKGROUND: Gallbladder gangrene and perforation are an important complication of acute calculous cholecystitis and are difficult to detect preoperatively. Therefore, in this study, we aimed to evaluate whether serum inflammatory parameters are predictive factors for complicated cholecystitis (CC). METHODS: In the present study, histopathological findings of 250 patients who were operated on with the diagnosis of acute cholecystitis (AC) in the emergency department between 2014 and 2019 were evaluated and the cases were divided into two groups as AC and CC. Parameters, including age, gender, body mass index, white blood cell (WBC) count, C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), mean platelet volume (MPV), and platelet distribution width (PDW), were examined for their ability to predict CC. RESULTS: The findings obtained in this study showed that WBC, CRP, and NLR were significantly higher in the CC group (p 0.05). WBC 9.000 cells/ml, CRP >29.0, and NLR >4.3 were the factors that could predict CC. There was no significant difference between the two groups concerning MPV and PDW (p>0.05). CC was observed more frequently in patients over 65 years of age, but there was not a statistically significant difference (p=0468). CONCLUSION: WBC, CRP, and NLR are valuable biochemical markers in predicting complicated AC. Advanced age may be a helpful predictive factor for CC. These factors may be helpful in making an early cholecystectomy decision