Person: UPRAK, TEVFİK KIVILCIM
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UPRAK
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TEVFİK KIVILCIM
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Publication Open Access Prognostic Impact of the Metastatic Lymph Node Ratio on Survival in Gastric Cancer(SPRINGER INDIA, 2016-03) GÜNAL, ÖMER; Attaallah, Wafi; Uprak, Kivilcim; Gunal, Omer; Yegen, CumhurResearch on the prognostic value of lymph node ratio (LNR) in gastric cancer (GC) remains limited and controversial results were obtained. In this study, we aimed to evaluate whether LNR was an independent prognostic factor for gastric carcinoma. A retrospective review of a database of gastric cancer patients was performed to determine the effect of the LNR on the overall survival (OS) and the disease-free survival (DFS). Of the total 135 patients with gastric cancer who underwent resection between March 2012 and December 2013, 44 patients with non metastatic gastric cancer were eligible for analysis. Survival curves were estimated using the Kaplan-Meier method. Cox regression analyses, after adjustments for potential confounders, were used to evaluate the relationship between the LNR and survival. According to the cutoff point 0.37 (37 %), the one-year OS rate for LNR <= 37 % was significantly better than that for LNR > 37 % (91.3 % and 61.9 %, respectively, P = 0.02). The one-year DFS for LNR <= 37 % was significantly better than that for LNR > 37 % (91.3 % and 66.7 %, respectively, P = 0.027). In stratified and multivariate analyses adjusted for age, gender, histology and tumor status, a higher LNR was associated with high pN stage and so associated with worse OS and DFS. Thus, the LNR 37% as a cutoff point was found not to be an independent factor for predicting the one-year OS or DFS in patients with non-metastatic GC. The LNR is a prognostic factor in GC. However, no single cut-off value was determined as an independent prognostic factor.Publication Open Access Percutaneous endoscopic gastrostomy: a secondary care hospital experience(2021-01-01) UPRAK, TEVFİK KIVILCIM; ERGENÇ M., Derici S. T. , UPRAK T. K.INTRODUCTION: Percutaneous endoscopic gastrostomy (PEG) is the most common enteral feeding method in patients with swallowing disorders. PEG is a minimally invasive procedure, but acute and chronic complications may develop after the procedure. Therefore, in this article, we evaluated PEG interventions that were performed in a secondary care hospital. METHODS: We performed a retrospective observational study of patients who underwent PEG intervention from January 2019 to June 2021 at the Istanbul Sultanbeyli State Hospital Endoscopy Unit. This study was approved by the local Ethics Committee and registered with ClinicalTrials.gov (NCT05012527). A total of 45 patients’ comorbidities, indications, complications, and 30-day mortality rates were analyzed. RESULTS: The majority of our population was elderly patients, and the mean age of the patients was 74. Most patients had multiple comorbidities such as hypertension, Alzheimer’s disease, stroke, and diabetes mellitus. The minor complication rate was 24.4%, and the major complication rate was 4.4%. Thirty-day mortality was observed in 18% of this cohort. DISCUSSION AND CONCLUSION: Before the PEG procedure, the patient’s general condition, the expected time of insufficient food intake, life expectancy, and comorbidities should be carefully examined. Our study has shown that PEG is a viable and safe procedure.Publication Open Access Factors Predicting Surgical Treatment in Patients with Adhesive Small Bowel Obstruction: Retrospective Single-centre Study(2022-09-01) UPRAK, TEVFİK KIVILCIM; AKIN, MUHAMMED İKBAL; COŞKUN, MÜMİN; YEGEN, ŞEVKET CUMHUR; UPRAK T. K. , AKIN M. İ. , COŞKUN M., Yegen C.Objective: To investigate the factors which predict treatment strategy in patients with adhesive small bowel obstruction.Study Design: Descriptive study.Place and Duration of Study: General Surgery Clinic, Marmara University Medical Faculty, Istanbul, Turkey, between January 2016 and December 2020. Methodology: Data of the patients with adhesive small bowel obstruction (ASBO) was retrospectively collected. The demo-graphic characteristics and laboratory findings were evaluated. Patients, who underwent conservative treatment and surgical intervention, were compared. Differences between the two groups in terms of demographic characteristics, prognostic nutri-tional index (PNI) scores, and neutrophil (NEU)-to-lymphocyte (LYM) ratio (NLR), were evaluated.Results: One-hundred thirty-seven patients were included in the study. Seventy-four (54%) of the patients had conservative treatment. There was no statistically significant difference between the surgical and conservative treatment groups according to the age, gender, and ASA score (p=0.77, 0.21 and 0.95 respectively). The patients with congenital aetiology and low PNI scores were in significantly higher numbers among the surgical treatment group (p <0.001 and p=0.004, respectively). In patients, who underwent surgery, the resection rate was found significantly higher in older age (63 vs. 52, p=0.01).Conclusion: Patients with low PNI scores and congenital adhesive small bowel obstruction undergo operative treatment more frequently than conservative treatment. Future studies focusing on diagnostic scores to predict early surgery in ASBO patients may include these variables.Publication Open Access Video-Based Learning Habits of General Surgeons in Turkey: A Survey Study(2021-01-01) UPRAK, TEVFİK KIVILCIM; COŞKUN, MÜMİN; KARATAŞ, SABRİ ALPER; UPRAK T. K. , Karatas S. A. , COŞKUN M.GİRİŞ ve AMAÇ: Genel cerrahi eğitiminde, multimedya tabanlı eğitim kullanımı sınırlıdır. Çoğu cerrah, özellikle cerrahi asistanlığı sonrası devam eden eğitimleri için cerrahi videoları izlemek veya yayınlamak için farklı platformlar kullanır. Bu anket çalışması ile genel cerrahlar arasında video kaynakları kullanma alışkanlıklarını incelemesi planlanmaktadır. YÖNTEM ve GEREÇLER: Google anketiyle hazırlanan 28 soru Türk Cerrahi Derneği'nin posta duyuru sistemi aracılığıyla genel cerrahlara gönderildi. Demografik özellikler, cerrahi video ve eğitim perspektifleri, video görüntüleme platformları, ideal video özellikleri sorgulandı. BULGULAR: Soruları 212 cerrah yanıtladı. Güncel yayınlar ve ders kitapları öğrenme için iki temel güvenilir kaynaktır.Cerrahların büyük kısmı online video kaynaklardan faydalandığını ifade etti. Websurg, web tabanlı öğrenme için bir numaralı kaynak olarak tercih edilirken ve onu Youtube ve Türk Cerrahi Derneği web sitesi takip etmekteydi. TARTIŞMA ve SONUÇ: Sonuç olarak, cerrahların büyük çoğunluğu bir video platformunu takip etmektedir. Ancak yeni bilgi veya teknik öğrenmek için özellikle güncel yayınları izlemektedirler. Ancak ilerleyen teknoloji ile birlikte video bazlı öğrenme önem kazanmaktadır. Anlaşılır ve güvenilir video kaynakları oluşturmak, uzmanlık sonrası devam eden eğitiminde etkili bir yöntem olabilir.Publication Open Access De novo myeloid sarcoma as a rare cause of small bowel obstruction: CT findings and histopathologic correlation(2019-12) ASLAN, BÜLENT; Aslan, Bülent; Tüney, Davut; Erçetin, Yiğit; Bozkurt, Süheyla Uyar; Uprak, Tevfik KıvılcımPublication Open Access Pancreatic neuroendocrine tumor mimicking intraductal papillary mucinous neoplasm: Case report(2021-01-01) AKMERCAN, AHMET; BAĞCI ÇULÇİ, PELİN; ATICI, ALİ EMRE; YEGEN, ŞEVKET CUMHUR; UPRAK, TEVFİK KIVILCIM; AKMERCAN A., UPRAK T. K., BAĞCI ÇULÇİ P., ATICI A. E., YEGEN Ş. C.ABSTRACTPancreatic neuroendocrine tumors (PanNETs) are rare pancreatic tumors. They usually exhibit parenchymal growing, however some cases can exhibit intraductal growing. PanNET with intraductal growth may cause intraductal papillary mucinous neoplasm (IPMN)- like clinic scenario by presenting as cystic formations secondary to duct obstruction. In our case, a 69-year- old man with a history of abdominal pain and nausea underwent a computed tomography scan that showed dilated pancreatic duct and cystic lesion which was 8 cm originating from the pancreas. Imaging and laboratory findings were considered to be consistent with an IPMN so the patient underwent distal pancreatectomy and splenectomy. However, the pathological examination of the surgical specimen showed a millimeter-sized PanNET located in pancreatic tail mimicking the IPMN by obstructing the pancreatic duct.Keywords: Gastroenteropancreatic neuroendocrine tumor; pancreatic intraductal neoplasmsPublication Open Access Gastric Cancer Surgery During the Pandemic: What It Costs?(SPRINGER, 2021-11-22) YEGEN, ŞEVKET CUMHUR; Yazici, Hilmi; Eren, Ayse; Uprak, Tevfik Kivilcim; Sahan, Cihan; Esmer, Ahmet Cem; Yegen, Sevket CumhurBackground From the early days of 2020, the COVID-19 pandemic continues to change whole life all around the world. Oncological patients are the most affected populations since these days. Because of decreasing numbers in surgery and endoscopy, gastric cancer patients had difficulties in treatment and diagnoses. Therefore, the early and long-term results may be affected during the pandemic. In this study, we aimed to evaluate pandemia effects on gastric cancer surgery in a single center. Patients-Methods Patients were categorized as the COVID group and the Pre-COVID group. Patients who received neoadjuvant chemotherapy were excluded from the study. In the COVID period, 50 patients underwent gastric cancer surgery, while 64 were operated on in the pre-COVID period. Patients' demographics and clinical and pathological outcomes were evaluated. Results There was no statistically significant difference in both periods among patient characteristics such as age, gender, and body mass index. Pre-operative laboratory results were similar between two groups. Although there was no difference in operation types, an increase was detected in Clavien-Dindo grade 3 and higher complications during the COVID period. During the pandemic, there was a significant difference in the pathological outcomes. Peritoneal cytology-positive patients were higher in the COVID group. More lymphovascular invasions were also detected in the COVID period. Finally, it resulted stage differences between two groups. Conclusion Because of COVID-19's heavy burden on healthcare system, delays in the diagnosis and treatment of oncological patients may occur. Therefore, this may be affected pathological and survival outcomes of cancer patients. Finally, further investigations are needed.Publication Open Access Appendiceal diverticulitis presenting as acute appendicitis and diagnosed after appendectomy(2022-03-01) UPRAK, TEVFİK KIVILCIM; Ergenc M., UPRAK T. K.IntroductionIntroduction Diverticular disease of the appendix (DDA) is a rare appendiceal pathology. It is usually present similar to acute appendicitis. Because of its rarity, the DDA is poorly comprehended. This study evaluates the incidence, clinical and pathological characteristics of appendiceal diverticulitis diagnosed after appendectomy. Methods We performed a retrospective analysis of patients who underwent appendectomy between January 2016 and January 2022 at the Istanbul Sultanbeyli State Hospital General Surgery Clinic. The following parameters were analyzed: age and gender, preoperative diagnosis, laboratory results, radiological imaging findings, surgical technique, histopathological examination of specimens, and complications. Results A total of 1586 patients were analyzed. In the pathology, diverticular disease of the appendix was detected in 10 patients (0.63%). The DDA patients’ mean age was 34.4 years, and the male to female ratio was 4:1. We detected low-grade appendiceal mucinous neoplasia in one of our patients. Conclusion Appendiceal diverticulitis is rare and usually presents as acute appendicitis. Most DDAs are detected incidentally during the postoperative period and are associated with an increased risk of appendiceal neoplasm. Appendectomy specimens should be carefully examined histopathologically to detect diverticular disease of the appendix.Publication Open Access Transanal Minimally Invasive Surgery (TAMIS) Using Single Incision Laparoscopic Surgery (SILS) Port for the Management of Benign Rectal Neoplasms: A Single Center Study(2021-01-01) UPRAK, TEVFİK KIVILCIM; ATALAY, VAFİ; UPRAK T. K. , ATALAY V.; Marmara Üniversitesi, Tıp Fakültesi, Cerrahi Tıp Bilimleri BölümüAim: Conventional transanal excision was described decades ago for treatment of benign rectal neoplasms. However, the chalanges of this technique leads to use alternative approachs. We evaluated the results of transanal minimally invasive surgery (TAMIS) with single incision laparoscopic surgery (SILS) port in treatment of benign rectal neoplasms. Method: Data of the patients who underwent TAMIS with SILS port in one center were retrospectively analyzed. SILS port was placed through in the anal canal and ultrasonic sealing device was used for excision the tumors. Complications during or after surgery were reported. Patients were followed-up by rectal examination with rectoscopy and recurrences were evaluated. Results: Between July 2015 and March 2020, 20 patients underwent TAMIS at one center. The median age of the patients was 67 (37-79). The procedure was performed in all of the patients with a lithotomy position. Full-thickness defect after complete resection of the lesion was observed in 5 (25%) patients. However, abdominal cavity was not exposed through the TAMIS procedure in any of the patients. The rectal wall defect was not repaired in any of the patients. No major complication occured in the patients. The hospital stay was 1 (1-4) days. The surgical margin was negative in 19 patients (95%). After the follow-up period of 9 (1-43) months, 3 (17%) patients had a recurrence and further surgery was performed. Conclusion: TAMIS using SILS port for the management of rectal neoplasms is a safe and effective for treatment benign rectal lesions.Publication Open Access Prognostic significance of metastatic lymph node ratio in gastric cancer: a Western-center analysis(2023-08-01) UPRAK, TEVFİK KIVILCIM; AKIN, MUHAMMED İKBAL; ÇELİKEL, ÇİĞDEM; YEGEN, ŞEVKET CUMHUR; ERGENÇ, MUHAMMER; Ergenç M., Uprak T. K., Akın M. İ., Hekimoğlu E. E., Çelikel Ç., Yegen Ş. C.BackgroundTumor-node-metastasis (TNM) staging is the central gastric cancer (GC) staging system, but it has some disadvantages. However, the lymph node ratio (LNR) can be used regardless of the type of lymphadenectomy and is considered an important prognostic factor. This study aimed to evaluate the relationship between LNR and survival in patients who underwent curative GC surgery.MethodsAll patients who underwent radical gastric surgery between January 2014 and June 2022 were retrospectively evaluated. Clinicopathological features of tumors, TNM stage, and survival rates were analyzed. LNR was defined as the ratio between metastatic lymph nodes and total lymph nodes removed. The LNR groups were classified as follows: LNR0 = 0, 0.01 < LNR1 ≤ 0.1, 0.1 < LNR2 ≤ 0.25 and LNR3 > 0.25. Tumor characteristics and overall survival (OS) of the patients were compared between LNR groups.ResultsAfter exclusion, 333 patients were analyzed. The mean age was 62 ± 14years. According to the LNR classification, no difference was found between groups regarding age and sex. However, TNM stage III disease was significantly more common in LNR3 patients. Most patients (43.2%,n = 144) were in the LNR3 group. In terms of tumor characteristics (lymphatic, vascular, and perineural invasion), the LNR3 group had significantly poorer prognostic factors. The Cox regression model defined LNR3, TNM stage II—III disease, and advanced age as independent risk factors for survival. Patients with LNR3 demonstrated the lowest 5-year OS rate (35.7%) (estimated mean survival was 30 ± 1.9months) compared to LNR 0–1–2.ConclusionOur study showed that a high LNR was significantly associated with poor OS in patients who underwent curative gastrectomy. LNR can be used as an independent prognostic predictor in GC patients.
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