Person: YEGEN, ŞEVKET CUMHUR
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YEGEN
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ŞEVKET CUMHUR
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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 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 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.Publication Open Access Outcomes of proximal versus total gastrectomy for proximal gastric cancer: A propensity score-matched analysis of a western center experience(2023-01-01) UPRAK, TEVFİK KIVILCIM; ERGENÇ, MUHAMMER; AKMERCAN, AHMET; YEGEN, ŞEVKET CUMHUR; UPRAK T. K., ERGENÇ M., AKMERCAN A., YEGEN Ş. C.Purpose: In this western study, we aimed to compare perioperative outcomes, postoperative complications, and overall survival in patients who underwent total gastrectomy (TG) or proximal gastrectomy (PG) for proximal gastric cancer (GC). Methods: Patients who underwent GC surgery at Marmara University Hospital between January 2014 and December 2021 were evaluated retrospectively. Propensity score matching (PSM) was performed to balance the baseline characteristics of patients undergoing PG and TG. Data on patients’ demographics, clinicopathological features of tumors, complications, and survival rates were analyzed. Perioperative outcomes and overall survival of the patients were compared between PG and TG groups. Results: A total of 212 patients were included in this study, with 53 patients in the PG and 159 in the TG group. After 1:1 matching according to PSM, 46 patients in the PG group were matched to 46 in the TG group. After PSM, there were no differences in clinicopathological outcomes except retrieved lymph nodes. In terms of short-term outcomes, overall perioperative morbidity (Clavien Dindo ≥ 3a) was significantly higher in the PG group (p = 0.01). However, there was no significant difference when the complications were considered separately. In the long-term follow-up, reflux esophagitis was associated with the PG group (p=0.04). In multivariate analysis, positive surgical margin and lymphovascular invasion were significant factors related to overall survival. Overall, 5-year survival was 55% in matched patients. The difference in survival was not statistically significant (57 vs. 69 months, p = 0.3) between the two groups. Conclusions: Proximal gastrectomy is applicable to patients up to stage 3 disease, with no difference in overall survival, with caution in early complications and reflux esophagitis. Among all demographic and oncological factors, lymphovascular invasion and resection margin were significantly associated with worse survival.