Nüks kolorektal kanserde cerrahi tedavi: Kısa ve uzun dönem sonuçlar

Aim: The aim of this study was to investigate the effect of surgical margin positivity on short- and long-term outcomes in patients undergoing recurrent colorectal cancer surgery. Method: Demographics, parameters related to primary tumor and previous surgery, recurrent tumor characteristics and perioperative features and long-term outcomes were compared between groups (R0 vs. R1) according to surgical margin positivity. Results: Of 57 patients who underwent surgery for recurrent colorectal cancer, 49 patients (86%) in whom curative resection was achieved were included in the study. Eleven (22.4%) cases had surgical margin positivity (R1) on pathological examination. Demographics, primary tumor localization, tumor stage, time to recurrence, adjuvant oncological treatments were comparable between R0 and R1 groups. Although the surgical procedures performed differed according to the location of the recurrent lesion, they were proportionally similar between the groups. The operative time, the amount of intraoperative bleeding, the need for transfusion, and the length of hospital stay were similar (p>0.05 for each variable). There were 17 (44.7%) and four (36.4%) postoperative complications in the R0 and R1 groups, respectively, but no difference was observed between the groups. Regional recurrence rate was 18.9% (n=7) in R0 group and 27.3% (n=3) in R1 group, respectively (p=0.675). Overall survival rates of R0 and R1 patients at 1, 3 and 5 years were 78.4% vs. 81.8%, (p=0.754), 43.2% vs. 36.4%, (p=0.720) and 27.0% vs. 27.3% (p=0.866), respectively. Conclusion: Complications are higher after recurrent colorectal cancer surgery. This study emphasizes that microscopic surgical margin positivity (R1) may not adversely affect short- and long-term outcomes in patients operated for recurrent colorectal cancer, and that local recurrence rates of these cases may be similar to those with complete resection (R0).Amaç: Nüks kolorektal kanser cerrahisi uygulanan hastalarda cerrahi sınır pozitifliğinin erken ve geç dönem sonuçlarını üzerine etkisini incelemektir. Yöntem: Nüks kolorektal kanser tanısıyla ameliyat edilen hastalarda cerrahi sınır pozitifliği durumuna göre demografik veriler, ilk hastalık ve operasyon bilgileri, nüks hastalık ve tedavi verileri ile uzun dönem sonuçları kıyaslandı. Bulgular: Nüks kolorektal kanser nedeniyle ameliyat edilen 57 hastanın küratif amaçlı rezeksiyonun başarıldığı 49’u (%86) çalışmaya dahil edildi. Bu olguların 11’inde (%22,4) patoloji raporlarında cerrahi sınır pozitifliği (R1) saptandı. R0 ve R1 grupları demografik veriler, ilk tümörün yerleşim ve evresi ile nükse kadar geçen süre, uygulanan onkolojik tedaviler açılarından istatistiki farklılık göstermiyordu. Uygulanan cerrahi işlemler nüks lezyonun yerleşimine göre farklılık göstermekle beraber oransal olarak gruplar arasında benzerdi. Operasyon süresi, ameliyat sırasında kanama miktarı, transfüzyon ihtiyacı ve miktarı ile hastanede kalış süreleri benzerdi (her bir değişken için p>0,05). R0 ve R1 gruplarında %44,7 (n=17) ve %36,4 (n=4) oranlarında postoperatif komplikasyon izlendi, ancak gruplar arasında farklılık gözlenmedi. R0 ve R1 gruplarında yer alan hastalarda yeniden bölgesel tekrarlama oranları %18,9 (n=7) ve %27,3 (n=3) idi (p=0,675). Hastaların 1, 3 ve 5 yıllık genel sağkalım oranları (%78,4 vs. %81,8, p=0,754; %43,2 vs. %36,4, p=0,720 ve %27,0 vs. %27,3, p=0,866) idi. Sonuç: Nüks kolorektal kanser ameliyatı sonrası komplikasyon oranları yüksektir. Bu çalışma nüks kolorektal kanser tanısı ile ameliyat edilen hastalarda mikroskobik cerrahi sınır pozitifliğinin (R1) erken ve geç dönem sonuçları olumsuz olarak etkilemeyebileceğini ve bu olguların lokal tekrarlama oranlarının tam rezeksiyon başarılan (R0) olgulara benzer olabileceğinin altını çizmektedir

Laparoscopic resection of primary tumor with synchronous conventional resection of liver metastases in patients with stage 4 colorectal cancer: A retrospective analysis

Aim: Aim of this study is to analyze the short and long term results of laparoscopic colorectal cancer resection with synchronous conventional resection of liver metastasis. Method: All cases operated on synchronous colorectal cancer and liver metastasis between 2009 and 2017 were retrospectively retrieved from a prospective database. Three and more liver segment resection was considered as major resection. Demographics, patient characteristics, operative and postoperative findings and survival were analyzed. Results: A total of 35 patients [23 (65.7%) male, median age: 56 (34-79)] was included to the study. The most common primary tumor localization was rectum (n=20, 57.1%). Neoadjuvant chemoradiotherapy and chemotherapy was applied in 15 (75%) and 14 (40%) cases, respectively. Major, minor resection or only ablative therapy performance was 12 (34.3%), 19 (54.3%) and 4 (11.4%), respectively, but 13 (37.1%) cases received both resection and ablative therapy. Mean operation time was 307.8±103.6 minutes and estimated blood loss was 300 (10-2200) cc. Blood transfusion was needed in 15 (42.9%) cases. Length of stay was 7 (4-17) days. Eleven complications developed in 10 (28.6%) cases, but none required re-operation. A patient (2.9%) underwent laparoscopic low anterior resection with major hepatectomy and radiofrequency ablation was deceased in postoperative 11th day due to liver failure and subsequent multiorgan failure. Three, 5, 7 and 9-year survival rates was 63%, 35%, 35%, and 35%. Conclusion: Laparoscopic colorectal resection with synchronous conventional liver resection in patients with metastatic colorectal cancer is safe and feasible. Long term survival rates are acceptable.Amaç: Bu çalışmanın amacı karaciğer metastazlı kolorektal kanserli kolorektal tümörün laparoskopik, karaciğer metastaz cerrahisinin ise açık yöntemle tamamlandığı hastalarda kısa ve uzun dönem sonuçları irdelemektir. Yöntem: Prospektif olarak bilgi girişi yapılan bir veri bankasından 2009-2017 yılları arasında senkron metastaz cerrahisi uygulanan ve laparoskopik kolorektal rezeksiyon yapılan hastalar derlendi. ≥3 segment rezeksiyonu majör rezeksiyon olarak nitelendirildi. Demografi ve hastalara ait verilerle, ameliyat ve ameliyat sonrası bilgiler ve sağkalım incelendi. Bulgular: Otuz beş hasta [23 (%65,7) erkek, ortanca 56,0 (34-79) yaş] bulundu. En sık yerleşim yeri rektumdu (n=20, %57,1). Neoadjuvant kemoradyoterapi ve/veya kemoterapi alan olgu sayısı 15 (%75) ve 14 (%40) idi. Majör, minör rezeksiyon veya sadece ablasyon uygulaması sırasıyla 12 (%34,3), 19 (%54,3) ve 4 (%11,4) hastada yapıldı. Ayrıca 13 (%37,1) hastaya hem rezeksiyon ve hem de ablasyon uygulandı. Ortalama operasyon süresi 307,8±103,6 dakikaydı ve kan kaybı miktarı 300 (10-2200) cc idi. On beş (%42,9) hastada kan transfüzyonu gerekti. Hastalar 7 (4-17) günde taburcu edildiler. Toplam 10 (%28,6) hastada en az bir, toplamda ise 11 komplikasyon gelişti. Hiçbir hastaya bu komplikasyonlara bağlı re-operasyon gerekmedi. Laparoskopik aşağı anterior rezeksiyon, majör hepatektomi ve radyofrekans ablasyon uygulanan bir olgu (%2,9) operasyondan 11 gün sonra karaciğer yetmezliğine ikincil gelişen çoklu organ yetmezliğine bağlı olarak kaybedildi. Hastalarda 3, 5, 7 ve 9 yıllık sağkalım oranları %63, %35, %35 ve %35 idi. Sonuç: Karaciğer metastazlı kolorektal kanserlerde, kolorektal kanserin laparoskopik, karaciğer metastaz cerrahisinin ise açık yöntemle uygulanabilir ve güvenilir bir yöntemdir. Uzun dönem sağkalım kabul edilebilir sınırlardadır

Türk kolon ve rektum cerrahisi derneği (TKRCD) terminoloji komisyonu çalışma raporu

This study aimed to explain the working order of the Terminology Commission, which was established at the workshop of the Turkish Society of Colon and Rectal Surgery (TKRCD) on February 22, 2020, the criteria and results in the preparation of the terminology report. The commission prepared a work plan to complete in three main steps. The working process continued in a way that the members expressed their opinions with equal rights and the decisions were taken by consensus or by majority vote. The main purpose of the commission study was determined as “determining the terms that need to be explained and agreed in colorectal surgery, and to define them in a way that is compatible with the literature and contributes to daily practice”. The first meeting of the commission was held on February 22, 2020, and the report was accepted by the TKRCD Board of Directors on May 25, 2021. A total of 20 meetings were held during this period. In the first step, five headings were determined for writing the terms: Anatomy, symptoms and diagnostic tools, diseases, treatments and complications. There was a consensus that the terms met the following three conditions: 1) the need for explanation and consensus in colorectal surgery, 2) literature support, and 3) use in daily practice. The terms were written in the following format: Terms and synonyms, English equivalents, definition, explanation and bibliography. In the second step, each commissioner wrote an average of 10.8±4.3 terms. The distribution of 89 terms in the final report was as follows: Anatomy (n=26, 29.2%), symptoms and diagnostic tools (n=8, 8.9%), diseases (n=20, 22.4%), treatments (n=28, 31.4%), and complications (n=7, 7.8%). Figures (n=7), all from the archives of the commission members, and figures drawn by a new commission member (n=53) were also added to the report. In the third step, the report was submitted to the TKRCD Management with the approval of the TKRCD President. The preparation process of the Terminology Commission report of TKRCD was presented. The final report is open to changes and expansions with future studies.Bu çalışma Türk Kolon ve Rektum Cerrahisi Derneği’nin (TKRCD) 22 Şubat 2020 tarihinde yaptığı çalıştayda kurulan Terminoloji Komisyonu’nun çalışma düzenini, terminoloji raporunun hazırlanmasındaki kriterleri ve sonuçlarını açıklamayı amaçlamaktadır. Komisyon üç ana basamakta tamamlayacak iş planı hazırlamıştır. Çalışma süreci üyelerin eşit haklarla görüş belirttiği ve kararların uzlaşı veya oy çokluğuyla alındığı bir şekilde sürdürülmüştür. Komisyon çalışmasının temel amacı “kolorektal cerrahide açıklanması ve uzlaşı sağlanması gerekli terimlerin belirlenmesi, literatüre uygun ve günlük pratiğe katkı sağlayacak bir şekilde tanımlanması” olarak saptanmıştır. Komisyon ilk toplantısı 22 Şubat 2020’de yapılmış, rapor ise TKRCD Yönetim Kurulu’nda 25 Mayıs 2021’de kabul edilmiştir. Bu dönemde toplam 20 toplantı yapılmıştır. İlk basamakta terimlerin yazılması için beş adet üst başlık belirlenmiştir: anatomi, semptomlar ve tanı gereçleri, hastalıklar, tedaviler ve komplikasyonlar. Terimlerin şu üç şartı sağlaması konusunda karar birliği oluşmuştur: 1) kolorektal cerrahide açıklanması ve uzlaşı sağlanması gerekliliği, 2) literatür desteği ve 3) günlük pratikte kullanılması. Terimler şu formatta yazılmıştır: terim ve eş anlamlıları, İngilizce karşılıkları, tanım, açıklama ve kaynakça. İkinci basamakta her bir komisyon üyesi ortalama 10,8±4,3 terim yazmıştır. Sonuç raporunda yer alan 89 terimin üst başlıklara dağılımı şu şekildedir: anatomi (n=26, %29,2), semptomlar ve tanı gereçleri (n=8, %8,9), hastalıklar (n=20, %22,4), tedaviler (n=28, %31,4) ve komplikasyonlar (n=7, %7,8). Tamamı komisyon üyelerinin arşivlerinden gelen resimler (n=7) ve yeni bir komisyon üyesi tarafından çizilen şekiller de (n=53) rapora eklenmiştir. Üçüncü basamakta rapor TKRCD Başkanının onayıyla TKRCD Yönetimi’ne sunulmuştur. TKRCD’nin Terminoloji Komisyonu raporunun hazırlık süreci sunulmuştur. Sonuç raporu ileride yapılacak çalışmalarla değişiklik ve genişletmelere açıktır

Akut ve perfore apandisitlerde laparoskopik apendektomi: Karşılaştırmalı analiz

Objective: The purpose of this study was to compare the short-term outcomes of laparoscopically operated uncomplicated acute appendicitis and perforated appendicitis. Methods: Laparoscopically operated uncomplicated acute and perforated appendicitis were screened, retrospectively. Demographics, operative variables, and postoperative complication rates were compared between the groups. Results: Among 155 patients, acute appendicitis was found in 130 patients (77 [59.2%] male; median age, 32 [16–72]), while 25 patients (15 [60.0%] male; median age, 39 [17–84]) had perforated appendicitis. The duration of the operation and hospitalization period were 45 (20–105) minutes and 1 (1–6) day, respectively, in the acute appendicitis group, and 60 (20–155) minutes and 2 (1–16) days, respectively, in the perforated group. Total complication rates were statistically significantly higher in the perforated group. Conclusion: Laparoscopic approach can be applied in selected cases of perforated appendicitis.Amaç: Bu çalışmanın amacı akut komplike olmamış apandisitler ile perfore apandisitlerde laparoskopinin kısa dönem sonuçlarını karşılaştırmaktır. Gereç ve Yöntem: Akut apandisitler tanısıyla laparoskopik apendektomi uygulanmış tüm hastaların kayıtları geriye dönük olarak derlendi. Akut ve perfore apandisit gruplarında demografik veriler, operasyon değişkenleri ve ameliyat sonrası komplikasyon oranları karşılaştırıldı. Bulgular: Toplam 155 hastanın 130’unda (77 [%59.2] erkek, ortanca yaş: 32 [16–72]) akut apandisit saptanmış olup 25 hastada (15 [%60.0] erkek, ortanca yaş: 39 [17–84]) perfore apandisit saptandı. Operasyon süreleri ve hastanede kalış süreleri akut apandisit için 45 (20–105) dakika ve bir (1–6) gün olup perfore apandisit grubunda 60 (20–155) dakika ve iki (1–16) gün idi. Toplam komplikasyon oranları perfore apandisit grubunda anlamlı olarak daha fazlaydı. Sonuç: Seçilmiş perfore apandisit olgularında laparoskopik apendektomi uygulanabilir

Outcomes of conversion from laparoscopy to open surgery in geriatric patients with colorectal cancer: A case-control study

Purpose: To evaluate the incidence, risk factors and outcomes of conversion from laparoscopic to open surgery in geriatric patients with colorectal cancer (CRC). Methods: All patients subjected to laparoscopic procedures for CRC between 2006 and 2018 were included. Patients older than 70 were divided into these necessitating or not necessitating conversion to open surgery (Con>70 and Lap>70 groups, respectively), and those younger than 70 requiring conversion were evaluated in Con70 group and the two other groups. Results: Conversion was significantly more common in Con>70 group than Con70 group than those in Lap>70 group. When conversion groups were compared, the rates of surgical site infection and evisceration were higher in geriatric patients. Pathological results revealed that Con>70 group had more advanced tumors than Lap>70 group regarding pT stage, number of malignant lymph nodes and perineural invasion rate. However, the numbers of harvested lymph nodes were similar in two groups. Conclusion: Conversion rate is higher in geriatric patients, particularly in female patients and those who necessitate multivisceral resections. Conversion worsens the perioperative outcomes in geriatric patients. Finally, since the number of harvested lymph nodes does not decrease with conversion, it probably does not threaten the quality of oncological surgery

Bilateral kasık fıtıklarında transabdominal preperitoneal onarım: Tek merkez deneyimi

Aim: To evaluate outcomes of transabdominal preperitoneal repair in patients with bilateral inguinal hernias. Methods: Sociodemographic data, and data about disease and operation with postoperative data of all patients with bilateral inguinal hernias, who were treated by transabdominal preperitoneal repair were prospectively collected. Patients were followed-up for recurrence and chronic pain in the long-term. Results: A total of 70 (67 [95.7%] males, mean age was 53.4±13.6 years) cases were included. Total 138 hernias (mostly Nyhus type 3 [n=116; 84.1%]) were repaired in 70 cases. Unilateral inguinal hernia was diagnosed in two cases during the operation. Mean operation time was 80.6±26.5 minutes. Inferior epigastric vein was injured in 2 (1.4%) cases. Parenteral analgesics were required in only 10 (14.3%) patients. Patients were discharged 1.21±0.67 days after the operation, and only 9 (12.8%) cases were hospitalized more than one day. Patients returned work or normal activity 10.5±4.7 days after the surgery. The mean follow-up period was 25.9±19.4 months. Symptomatic recurrence was observed in 2 (1.4%) patients. Six (8.7%) cases had chronic pain. Conclusion: Transabdominal preperitoneal repair may be an alternative approach in treatment of bilateral inguinal hernias.Amaç: Bilateral kasık fıtığı olan hastalarda transabdominal preperitoneal tamir sonuçlarını irdelemek. Yöntemler: Transabdominal preperitoneal yöntemle bilateral kasık fıtığı tamiri uygulanan tüm hastalarda prospektif olarak sosyodemografik veriler, hastalık ve operasyona ait veriler ile postoperative veriler değerlendirildi. Uzun dönemde hastalar kronik ağrı ve nüks açısından takip edildi. Bulgular: Toplam 70 hasta (67 [95.7%] erkek, ortalama yaş 53.4±13.6) çalışmaya dahil edildi. İki hastada ameliyat esnasında tek taraflı fıtık saptandığından toplam 138 fıtık (Nyhus tip 3 [n=116; %84.1]) tamiri yapıldı. Ortalama operasyon süresi 80.6±26.5 dakikaydı. İki hastada inferior epigastrik ven yaralanması görüldü. Sadece 10 (%14.3) hastada parenteral analjezik ihtiyacı gelişti. Ortalama hastanede kalış süresi 1.21±0.67 gün olup sadece 9 (%12.8) hastada bir günden fazla yatış gerekti. İş veya normal aktivitelere dönüş süresi 10.5±4.7 gündü. Hastalar ortalama 25.9±19.4 ay takip edildi. Semptomatik nüks 2 (%1.4) hastada gelişti. Kronik ağrı ise 6 (%8.7) hastada saptandı. Sonuç: Bilateral kasık fıtıklarında transabdominal preperitoneal tamir bir alternatif olarak düşünülebili

The feasibility of hepatic resections using a bipolar radiofrequency device (Habib®)

WOS: 000367103500006PubMed ID: 26702234The bipolar radiofrequency device (HabibA (R)) has been recently introduced in order to reduce intraoperative bleeding for a safe hepatic resection as an alternative to the conventional tools. However, indications, perioperative findings, and outcome of the device for hepatic resections remain and deserve to be analyzed. The current study aims to analyze the feasibility of the bipolar radiofrequency device (HabibA (R)) for hepatic resections. Information of the patients that underwent hepatic resection using with the HabibA (R) device between 2007 and 2011 was abstracted. Patient, disease, and operation-related findings and perioperative data were investigated. A total of 71 cases (38 [53.5 %] males, mean age was 56.8 A +/- 11.9) were analyzed. Metastatic disease (n = 55; 77.5 %) was the leading indication followed by primary liver and biliary malignancies (n = 7; 9.9 %), hemangioma (n = 5; 7 %), hydatid disease (n = 3; 2.8 %), and hepatic gunshot trauma (n = 1; 1.4 %). Metastasectomy was the most commonly performed procedure (n = 31; 56.3 %), but in 24 (77.4 %) cases, it was performed in addition to extended resections. Other procedures in the study patients include segmentectomy in 17, bisegmentectomy in 19, trisegmentectomy in 17, right or left hepatectomy in 8, and extended right/left hepatectomy in 3. The mean (+/- SD) operation time was 241.7 +/- 78.2 min. The median amount of bleeding was 300 cc (range 25-2500), and 23 (32.4 %) cases required perioperative transfusion. The median hospitalization period was 5 days (range 1-47). Lengthened drainage (n = 9, 12.7 %) and intraabdominal abscess (n = 8, 11.23 %) were the most common problems. Hepatic resections using the HabibA (R) device seem to be feasible in cases with primary and metastatic hepatic lesions and benign liver masses and even those with hepatic trauma. It may lessen the amount of intraoperative hemorrhage, although lengthened drainage and intraabdominal abscess were the major postoperative problems in these cases

Laparoscopic Resection of Primary Tumor with Synchronous Conventional Resection of Liver Metastases in Patients with Stage 4 Colorectal Cancer: A Retrospective Analysis

Aim: Aim of this study is to analyze the short and long term results of laparoscopic colorectal cancer resection with synchronous conventional resection of liver metastasis. Method: All cases operated on synchronous colorectal cancer and liver metastasis between 2009 and 2017 were retrospectively retrieved from a prospective database. Three and more liver segment resection was considered as major resection. Demographics, patient characteristics, operative and postoperative findings and survival were analyzed. Results: A total of 35 patients [23 (65.7%) male, median age: 56 (34-79)] was included to the study. The most common primary tumor localization was rectum (n=20, 57.1%). Neoadjuvant chemoradiotherapy and chemotherapy was applied in 15 (75%) and 14 (40%) cases, respectively. Major, minor resection or only ablative therapy performance was 12 (34.3%), 19 (54.3%) and 4 (11.4%), respectively, but 13 (37.1%) cases received both resection and ablative therapy. Mean operation time was 307.8±103.6 minutes and estimated blood loss was 300 (10-2200) cc. Blood transfusion was needed in 15 (42.9%) cases. Length of stay was 7 (4-17) days. Eleven complications developed in 10 (28.6%) cases, but none required re-operation. A patient (2.9%) underwent laparoscopic low anterior resection with major hepatectomy and radiofrequency ablation was deceased in postoperative 11th day due to liver failure and subsequent multiorgan failure. Three, 5, 7 and 9-year survival rates was 63%, 35%, 35%, and 35%. Conclusion: Laparoscopic colorectal resection with synchronous conventional liver resection in patients with metastatic colorectal cancer is safe and feasible. Long term survival rates are acceptable

Unusually located primary hydatid cysts

The hydatid disease caused by Echinococcus granulosus is an endemic parasitic disease affecting several Mediterranean countries. Echinococcal cysts are mostly located in the liver and the lung, but the disease can be detected anywhere in the body. In this study, we present uncommon extrahepatic localizations of primary hydatid disease. Patients who were operated on for hydatid disease or cystic lesions, which were later diagnosed as hydatid disease, between 2004 and 2010 were retrieved retrospectively. Patients with lesions localized outside the liver and the lung were enrolled in the study. Eight patients with extrahepatic primary hydatid disease were treated surgically at our clinic. The cysts were located in the scapular region, spleen, pancreas, lumbosacral region and gluteal muscle. Surgical techniques were partial or total cystectomy with or without tube drainage. Splenectomy was performed for splenic hydatid disease and partial pericystectomy, Roux-en-Y cystojejunostomy, cholecystectomy and T-tube drainage for pancreatic hydatid disease. There were no complications or mortality in the postoperative period. Hydatid cyst should be considered in the differential diagnosis of cystic lesions, especially in endemic areas. Surgical technique should be planned according to the location of the cyst