Person: ERMERAK, NEZİH ONUR
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ERMERAK
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NEZİH ONUR
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Publication Metadata only Preoperative Chemoradiation Therapy Decreases the Number of Lymph Nodes Resected During Esophagectomy(SPRINGER, 2015) ÇELİKEL, ÇİĞDEM; Issaka, Adamu; Ermerak, Nezih Onur; Bilgi, Zeynep; Kara, Volkan Hasan; Celikel, Cigdem Ataizi; Batirel, Hasan FevziBackground This study aimed to analyze the effect of preoperative chemoradiation on the adequacy of lymph node dissection. Methods Patients with esophageal cancer treated with esophagectomy by the same surgeon between 2004 and 2011 were reviewed. Specimens were examined by the same pathologist. Patients were grouped into two depending on the type of treatment received. Results Forty-seven patients with curative esophagectomy were included in the study. Twenty patients had preoperative chemoradiation followed by surgery and 27 had surgery alone. Open and hybrid esophagectomy approaches were used. The average number of lymph nodes dissected was 16 +/- 10 (1-39). There was a significant decrease in the number of lymph nodes examined in patients with preoperative chemoradiotherapy in comparison to surgery alone (p = 0.001). Median length of stay was 12 days. R0 resection rate was 96 %. The median survival was 36.3 months, with a 42 % 5-year survival. Seven patients (25 %) had complete pathologic response following chemoradiation. No significant difference was recorded in terms of disease recurrence (p = 0.3). While morbidity was higher in the preoperative therapy group with 30 day mortality of 10 %, type of surgical approach does not seem to influence the number of lymph nodes dissected (p = 0.7). Conclusions Preoperative chemoradiation decreases the number of harvested lymph nodes following esophagectomy regardless of the surgical technique used. The optimum number of lymph nodes currently recommended to be dissected for accurate nodal staging and survival needs revision in this group of patients.Publication Open Access Surgical outcomes of patients with non-small cell lung cancer following neoadjuvant treatment(MARMARA UNIV, FAC MEDICINE, 2018-10-31) ERMERAK, NEZİH ONUR; Ocakcioglu, Ilhan; Alpay, Levent; Ermerak, Nezih Onur; Kiral, Hakan; Tezel, Cagatay; Baysungur, Volkan; Yalcinkaya, IrfanObjective: Although, anatomical resection of non-small cell lung cancer (NSCLC) following neoadjuvant therapy is still controversial, it is a widely accepted approach for thoracic surgery practice. The aim of this study is to briefly evaluate clinical results, long term survival, and factors affecting survival of the patients with locally advanced NSCLC, pancoast tumour and lung cancer with solitary brain metastasis, who have been operated at our institution following neoadjuvant therapy. Materials and Method: Between March 2006 and March 2012, 70 patients with NSCLC diagnosis who underwent anatomic pulmonary resection following neoadjuvant therapy were included in the study. Results: A three year survival (39%) and a 5-year survival (29%) were 16 +/- 6.8 and 37 +/- 9.89 months, respectively. The mean survival was found to be 37.15 +/- 3.06 months. When survival rate was evaluated according to localization of tumor, it was lower in central and left upper lobe tumors compared to other anatomical localizations (P=0.042). The mean 5-year survival times were 50.00 +/- 5.65 months in stage 0 patients, 35.39 +/- 5.85 months in stage 1 patients, 37.40 +/- 6.89 months in stage 2 patients and 21.44 +/- 3.10 months in stage 3 patients. Conclusion: We can achieve significant survival results by the anatomical pulmonary resection following neoadjuvant therapy.Publication Open Access Quality of life of patients who have undergone the minimally invasive repair of pectus carinatum(OXFORD UNIV PRESS INC, 2013-01) BOSTANCI, KORKUT; Bostanci, Korkut; Ozalper, Mehmet Hakan; Eldem, Barkin; Ozyurtkan, Mehmet Oguzhan; Issaka, Adamu; Ermerak, Nezih Onur; Yuksel, MustafaSeveral studies previously demonstrated an improvement in the quality of life (QoL) of the patients undergoing a minimally invasive repair of pectus excavatum, but there are no data about such improvement following the minimally invasive repair of pectus carinatum (PC) deformity. The purpose of this study was to investigate the effects of the minimally invasive repair of PC deformity on the psychosocial and physical functioning of the patients. Among 40 patients who underwent minimally invasive repair for PC deformity from July 2008 to March 2011, 35 patients accepted to answer the QoL questionnaires, and 30 of them who had completed the postoperative 6th month were evaluated in this study. The modified two-step Nuss questionnaire was used for the QoL assessment. All patients and their parents completed the appropriate questionnaires regarding the patients' preoperative psychosocial and physical functioning, and they were asked to answer the same questions on the postoperative 6th month. The results from these questionnaires were analysed using Wilcoxon signed rank test to investigate the effects of the minimally invasive repair of PC deformity on psychosocial and physical functioning of the patients. The questionnaires used in the study confirmed the positive impact of the surgical correction on psychosocial and physical well-being in the patients and their parents. Spearman's rho correlation coefficient determined how well the answers to the same question at two different times correlated with each other, and Cronbach's alpha demonstrated the internal consistency of these answers. These two parameters showed that the statistical results of the study were reliable enough. Statistical analysis of the scoring of the individual questions and the total scoring of individual patients revealed a statistically significant improvement (P < 0.05) following surgery. Similar significant improvements were observed in the total scoring of individual parents and in most scoring of the individual questions (10 of 13, 77%) in the parental questionnaire (P < 0.05). The results of this study confirm for the first time that minimally invasive repair of PC deformity has a positive impact on both psychosocial and physical functioning of the patient, which is supported by parental assessment.Publication Open Access Evaluation of the internal thoracic artery blood flow before and after Nuss operation: is it reversible?(MARMARA UNIV, FAC MEDICINE, 2017-01-15) BEKİROĞLU, GÜLNAZ NURAL; Kuru-Bektasoglu, Pinar; Ermerak, Nezih Onur; Cimsit, Canan; Cetinkaya, Cagatay; Ozbakir, Hincal; Bekiroglu, Nural; Lacin, Tunc; Yuksel, MustafaObjective: Obstruction of the internal thoracic arteries (ITAs) by the Nuss bars in minimally invasive repair of pectus excavatum (MIRPE) has been documented in the literature. In this study, we aim to investigate the patency of ITAs before and after repair of the pectus excavatum with the Nuss procedure, by using color Doppler ultrasonography (US). Materials and Methods: Nineteen patients who underwent Nuss procedure were included in this study prospectively. Color Doppler US examinations were performed for comparing ITA patency after insertion of the Nuss bars and after their removal. Patients were evaluated according to gender, age, symmetry of deformity, Haller index, and the number of Nuss bars inserted. Results: Nineteen patients operated with MIRPE (17 male and 2 females with a mean age 21.78 +/- 6.35) were enrolled in the study. Eight patients (42.1%) with normal ITA blood flow preoperatively had normal blood flow after removal of the bar. In preoperative examination, 6 patients had bilateral (n=2) or unilateral (n=4) obstruction of the ITA and 5 patients had bilateral (n=2) or unilateral (n=3) abnormally disturbed flow. After the bar removal only 2 (10%) of the affected patients (57.9 %) still had obstruction whereas patent blood flow of the ITAs has been noted in 9 patients. Conclusion: We have shown that after the Nuss bar removal, only 10% of the ITAs are compromised.