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 Optimal waiting period to surgical treatment after neoadjuvant chemoradiotherapy for locally advanced rectum cancer: A retrospective observational study(2023-12-01) ATICI, ALİ EMRE; BOZKURTLAR, EMİNE; YEGEN, ŞEVKET CUMHUR; Aslanov K., ATICI A. E., Karaman D., BOZKURTLAR E., YEGEN Ş. C.Background: The optimal waiting period after neoadjuvant treatment in patients with locally advanced rectal cancers is still controversial. The literature has different results regarding the effect of waiting periods on clinical and oncological outcomes. We aimed to investigate the effects of these different waiting periods on clinical, pathological, and oncological outcomes. Methods: Between January 2014 and December 2018, a total of 139 consecutive patients with locally advanced rectal adenocarcinoma, who were treated in the Department of General Surgery at the Marmara University Pendik Training and Research Hospital, were enrolled in the study. The patients were split into three groups according to waiting time for surgery after neoadjuvant treatment: group 1 (n = 51) included patients that have 7 weeks and less (≤ 7 weeks) time interval, group 2 (n = 45) 8 to 10 weeks (8–10 weeks), group 3 (n = 43) 11 weeks and above (11 weeks ≤). Their database records, which were entered prospectively, were analyzed retrospectively. Results: There were 83 (59.7%) males and 56 (40.3%) females. The median age was 60 years, and there was no statistical difference between the groups regarding age, gender, BMI, ASA score, ECOG performance score, tumor location, and preoperative CEA values. Also, we found no significant differences regarding operation times, intraoperative bleeding, length of hospital stay, and postoperative complications. According to the Clavien–Dindo (CD) classification, severe early postoperative complications (CD 3 and above) were observed in 9 patients. The complete pathological response (pCR, ypT0N0) was observed in 21 (15.1%) patients. The groups had no significant difference regarding 3-year disease-free and 3-year overall survival (p = 0.3, p = 0.8, respectively). Local recurrence was observed in 12 of 139 (8.6%) patients and distant metastases occurred in 30 of 139 (21.5%) patients during the follow-up period. There was no significant difference between the groups in terms of both local recurrence and distant metastasis (p = 0.98, p = 0.43, respectively). Conclusion: The optimal time for postoperative complications and sphincter-preserving surgery in patients with locally advanced rectal cancer is 8–10 weeks. The different waiting periods do not affect disease-free and overall survival. While long-term waiting time does not make a difference in pathological complete response rates, it negatively affects the TME quality rate.Publication Metadata only Low anterior resection syndrome (LARS) after sphincter-sparing rectal cancer surgery. Incidence and risk factors(2022-07-01) DALKILIÇ, MUHAMMED SAİD; AKIN, MUHAMMED İKBAL; YEGEN, ŞEVKET CUMHUR; Yazici H., DALKILIÇ M. S. , AKIN M. İ. , YEGEN Ş. C. , Attaallah W.© 2022, Edizioni Luigi Pozzi. All rights reserved.BACKGROUNDS: Low anterior resection syndrome (LARS) was defined with symptoms such as frequency, incontinence, urgency, and constipation in patients who underwent Sphincter-Sparing Rectum Surgery (SSRC). In this study, LARS rates and risk factors of the patients who underwent SSRC were Investigated. MATERIAL METHOD:The medical records of patients with SSRC at general surgery department were examined retrospectively. Clinical characteristics, neo/adjuvant chemo-radiotherapies, distal resection levels, open/laparoscopic procedures, postoperative complications, and pathological outcomes were recorded. LARS scoring system defined by Emmertsen and Laurberg was used to calculate LARS scores. RESULTS: The number of eligible patients was 129. The rectal resection was performed by either low anterior resection (LAR) or very low anterior resection (VLAR). VLAR was used to specify that had anastomosis <5cm to the anal verge. The median follow-up time was 12 (1-30) months. LARS were detected in 60 (%47) patients. LARS rates were significantly higher in the patients underwent VLAR (n: 35 9% vs. 48%<0,001). In univariate analysis, the level of distal resection, open surgeries, neoadjuvant RT, and diversion with temporary stoma were significantly different in LARS group. However, in multivariate analysis, distal resection level was the only significant risk factor for LARS. CONCLUSION: Low anterior resection syndrome (LARS) was frequently seen in patients who underwent sphincter-sparing rectum surgery (SSRS). It was detected that distal resection levels were the most important risk factor for the development of LARS. This result showed that LARS should not be disregarded in patients underwent SSRS. Y.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.Publication Metadata only Investigation of the possible protective effect of phoenixin-14 on small intestine and lung damage due to mesenteric ischemia in rats(2023-01-01) KAHRAMAN, MERVE MERİÇ; YÜKSEL, MERAL; ERCAN, FERİHA; YEGEN, BERRAK; YEGEN, ŞEVKET CUMHUR; Sen L. S., Kahraman M. M., Mermer K. S., Akgun T., YÜKSEL M., ERCAN F., YEGEN B., Yegen C.Publication Metadata only Pankreas cerrahisi yapılan hastalarda eras uygulamasının etkisi(2021-06-14) ERGENÇ, MUHAMMER; KARPUZ, ŞAKİR; YEGEN, ŞEVKET CUMHUR; Ergenç M., Karpuz Ş., Ergenç E. M., Yegen Ş. C.Amaç:Cerrahi sonrası hızlandırılmış iyileşme (ERAS: Enhanced Recovery After Surgery) hastaya detaylı eğitim verilerek ve hasta güvenliği gözetilerek uygulanan, perioperatif dönemde intravenöz hidrasyonun kısıtlanması, postoperatif erken oral rejim başlanarak sıvı ihtiyacını bu yolla giderilmesi, daha etkin analjezi sağlanması, yerleştirilen drenlerin daha erken çekilmesi ve hastanın erken mobilize edilmesi esasına dayanan bir protokoldür. Son dekadda tanımlanan bu protokol ile elektif cerrahiler sonrası hastanede yatış sürelerinin kısaltılması ve ilişkili komplikasyonların azaltılması hedeflenmiştir. Bu çalışmada ERAS protokolünün pankreas cerrahisi hastalarında postoperatif komplikasyonlar, yatış süresi, tekrarlayan hastane yatışı ve reoperasyon oranlarına etkisinin araştırılması hedeflenmiştir.Gereç ve Yöntem:Çalışma Ocak 2016 ile Kasım 2018 tarihleri arasında Marmara Üniversitesi Pendik Eğitim Araştırma Hastanesi Genel Cerrahi Kliniği’nde laparotomi ile elektif pankreas kanseri cerrahisi geçiren hastalar üzerinde prospektif olarak yapılmış olup hastalar standart bakım ve ERAS protokolü esasına göre iki gruba randomize edildi. Hastaların demografik verileri, laboratuvar tetkik sonuçları ile birlikte perioperatif verilen sıvı miktarı, kanama ve transfüzyon durumu kaydedildi. Postoperatif sonda çekilme günleri, ağrı ve gelişen komplikasyonlar ve taburculuk günleri takip edilerek kaydedildi.İstatistiksel analizde sayısal değerler için nonparametrik t testi, kategorik değerler için ki kare kullanıldı.Bulgular:On sekizi ERAS protokolü, 20’si standar t bakım protokolü olmak üzere toplam 38 hastanın verileri istatiksel analize dahil edildi. Gruplar yaş cinsiyet, laboratuvar değerleri, cerrahi tipi ve ASA skorları açısından benzer dağılmaktaydı. Ameliyat süresi, ameliyatta verilen iv sıvı ve transfüzyon açısından fark saptanmadı. Kanama miktarı ERAS grubunda median değer 300 ml (100-550) iken, kontrol grubunda 500 ml (200-750) bulundu. Postoperatif takipte; günlük verilen iv sıvı ortalaması, nazogastrik çekilme günü, postoperatif vizüel analog skala skoru değerleri, mobilizasyon, postop gaz çıkışı ve defekasyon yönünden ERAS ve kontrol grubu arasında fark yoktu. ERAS gurunda tüm hastalara epidural analjezi uygulanırken kontrol grubunda uygulanmadı. ERAS grubunda 17 (%94) hastaya erken beslenme uygulanırken bu oran kontrol grubunda 11 (%55) idi. En sık gelişen komplikasyonlar olan gecikmiş mide boşalması ve pankreatik fistül dahil olmak üzere postoperatif komplikasyon açısından iki grup arasında fark izlenmedi. Çalışmanın primer çıkarımı olan hastanede kalma süresi ve yeniden yatış açısından ERAS ve kontrol grubu arasında anlamlı fark izlenmedi.Sonuç:Sunulan çalışmada ERAS uygulamalarının total komplikasyon oranını azalttığı, özellikle abdominal enfeksiyon, hastane yatış süresi, mide boşalma güçlüğü gibi hafif olanları etkilerken, pankreas fistülü, reoperasyon, tekrar yatış ve mortalite gibi ağır olanlar üzerine etkisi olmadığı ortaya konulmuştur. Bu uygulamaların başlatılması pankreas cerrahisi için güvenlik tehdidi oluşturmamaktadır.Anahtar kelimeler:Pankreas cerrahisi, Cerrahi sonrası hızlandırılmış iyileşme, ERASPublication Open Access Is systemic inflammatory response index (SIRI) a reliable tool for prognosis of gastric cancer patients without neoadjuvant therapy(2023-03-01) YEGEN, ŞEVKET CUMHUR; Yazici H., Yegen S. C.Background: The systemic inflammatory response index (SIRI), which depends on peripheral neutrophil, monocyte, and lymphocyte count, was found as an effective prognostic indicator for various malignancies. This study aims to investigate the predictive value of preoperative SIRI in the prognosis of gastric cancer patients without neoadjuvant therapy. Methods: The patients who underwent gastric cancer surgery in Marmara University Hospital\"s General Surgery Department between 2019 and 2021 were analyzed retrospectively. SIRI was calculated from preoperative peripheral blood samples\" neutrophil, lymphocyte, and monocyte count. The optimal cut-off value for SIRI was calculated by the receiver operating characteristics (ROC) curve and was found to be 1.35. The clinicopathological outcomes and overall survival (OS) were analyzed under two groups according to the SIRI values lower or higher than 1.35. Results: The number of eligible patients was 199. The median follow-up time was 25 (1-56) months. The higher SIRI was associated with male gender (p = 0.044), lower serum albumin (0.002) level, and Clavien-Dindo (CD) Grade III and higher complications (p = 0.018). However, there was no significant difference between the groups regarded pathological tumor, nodes, and metastases (TNM) stages, histological grade, and Lauren Type. In addition, OS and stage-specific OS were similar between the groups. Conclusions: SIRI may be a valuable and effective predictive indicator for postoperative morbidity. The prognostic performance of SIRI on long-term OS is still controversial. Further investigations are needed into this topic.