Person: ATICI, ALİ EMRE
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ATICI
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ALİ EMRE
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Publication Open Access J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results(ELSEVIER SCIENCE BV, 2017-11) ATICI, ALİ EMRE; Okkabaz, Nuri; Haksal, Mustafa; Atici, Ali Emre; Altuntas, Yunus Emre; Gundogan, Ersin; Gezen, Fazli Cem; Oncel, MustafaPurpose: To analyze the outcomes of j-pouch and side-to-end anastomosis in rectal cancer patients treated with laparoscopic hand-assisted low anterior resection. Methods: Prospective trial on cases randomized to have a colonic j-pouch or a side-to-end anastomosis after low anterior resection. Demographics, characteristics of disease and treatment, perioperative results, and functional outcomes and life quality were compared between the groups. Results: Seventy four patients were randomized. Reservoir creation was withdrawn in 17 (23%) patients, mostly related to reach problem (n = 11, 64.7%). Anastomotic leakage rate was significantly higher in j-pouch group (8 [27.6%] vs. 0, p = 0.004). Stoma closure could not be achieved in 16 (28.1%) patients. Life quality and functional outcomes, measured 4, 8 and 12 months after the stoma reversal, were similar. Conclusions: Colonic j-pouch and side-to-end anastomosis are similar regarding perioperative measures including operation time, rates of postoperative complications, reoperation and 30-day mortality, and hospitalization period except anastomotic leak rate, which is higher in j-pouch group. Postoperative aspects are not different in patients receiving either technique including functional outcomes and life quality for the first year after stoma closure. In our opinion, both techniques may be preferred during the daily practice while performing laparoscopic surgery; but surgeons may be aware of a possibly higher anastomotic leak rate in case of a j-pouch. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.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 Open Access Neuropeptide w alleviates hepatorenal oxidative damage in sepsis-induced rats(2020-05-01) ATICI, ALİ EMRE; PEKER EYÜBOĞLU, İREM; ERCAN, FERİHA; AKKİPRİK, MUSTAFA; YEGEN, BERRAK; ATICI A. E., ARABACI TAMER S., levent h. n., PEKER EYÜBOĞLU İ., ERCAN F., AKKİPRİK M., YEGEN B.Background: Despite modern surgical, medical and intensive care treatments, sepsis is still one of the most frequent causes of morbidity and mortality due to multiple life-threatening organ dysfunctions. We aimed to investigate the possible protective effect of neuropeptide W (NPW), a novel peptide effective in regulating neuroendocrine functions, against sepsisinduced hepatorenal damage. Methods: In male Sprague-Dawley rats (200–250 g), sepsis was induced by cecal ligation and puncture under ketamine anesthesia (n=48). Immediately after surgery, saline or TNF-alpha inhibitor (etanercept; 1 mg/kg) plus antibiotic (ceftriaxon; 100 mg/kg) (ET+C) or NPW (0.1, 0.3, 1 or 3 mg/kg) was given subcutaneously, and repeated at 12th and 24th hours, while sham-operated control group (n=8) received three saline injections within twenty-four hours. Rats were decapitated at the 25th hour of surgery and C-reactive protein (CRP), corticosterone and IL-6 levels were measured in serum samples. Kidney and liver samples were obtained for the measurement of myeloperoxidase activity (MPO), malondialdehyde and glutathione levels and nuclear factor kappa-B (NF-kB) mRNA expression levels. Histopathological evaluations were performed in hematoxylin-eosin-stained samples. ANOVA and Student's t-tests were used for data analysis. Results: Elevated serum levels of IL-6, corticosterone and CRP (p<0.05-0.01) in saline-treated sepsis group, as compared to controls, were depressed in the ET+C- (p<0.05) or NPW- (p<0.05-0.001) treated groups. Hepatic malondialdehyde and MPO levels, which were increased in salinetreated sepsis group (p<0.05 and p<0.001), were decreased by ET+C- (p<0.01) or NPW (p<0.05-0.001) treatments. Similarly, increased renal malondialdehyde level was depressed by NPW (p<0.05), but not by ET+C; while none of the treatments had an inhibitory effect on renal MPO. In contrast to replenished renal glutathione levels by all treatments, hepatic glutathione content was not changed by any of the treatments. Hepatic and renal NF-kB mRNA expressions were similar in all groups. Severe hepatocyte degeneration, sinusoidal congestion and inflammatory cell infiltration were observed in saline-treated sepsis group, while parenchymal degeneration, congestion and Kupffer cell activation were mild in ET+Cand NPW-treated sepsis groups. Similarly, severe degeneration of renal corpuscles and tubules with glomerular and interstitial congestion in the saline-treated sepsis group was replaced by moderate glomerular and interstitial vascular congestion and mild tubular congestion in both NPW- and ET+C-treated groups. Conclusion: NPW, applied during the first 24 hours of sepsis, exerted a dose-dependent protective effect against hepatorenal damage, which appears to involve an inhibitorPublication 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 Effects of preoperative drainage on postoperative complications in patients with periampullary tumors(2019) ATICI, ALİ EMRE; Şafak COŞKUN;Tolga Baha DEMİRBAS;Kivilcim Tevfik UPRAK;Ali Emre ATICI;Cumhur Şevket YEGENAim: Preoperative biliary drainage is suggested for patients with jaundice, considering that surgical operations may increasepostoperative complications in the presence of jaundice. The aim of this study was to test the effect of biliary drainage on possibleserious complications, deaths, or period of hospital stay.Material and Methods: Between January 2012 and June 2016, 160 patients with operable and resectable periampullary tumorswho were diagnosed with periampullary tumors underwent pancreaticoduodenectomy (Whipple’s procedure) in Marmara UniversityPendik Training and Research Hospital, Department of General Surgery. The patients’ demographics, accompanying comorbiddiseases, type of biliary drainage, drainage duration, pre- and post-drainage laboratory data, emerging complications and need forre-hospitalization were recorded retrospectively from the accessible files and records.Results: It was observed that out of 158 patients with periampullary tumors, 116 that were operated with drainage had a higheroccurrence of surgical site infections and anastomotic leaks, compared to the 42 patients that were operated without drainage.Similarly, when patient results were classified according to the Clavien-Dindo complication classification, the ratio was againagainst the patients that were operated with drainage. Drainage patients stayed in the hospital for a longer period; however, in termsof pancreatic fistula, re-hospitalization, need for intensive care and relaparotomy ratios, and especially in terms of mortality ratios, adifference between two patient groups was not observed.Conclusion: Investigating the data collected from patients that were operated without drainage, and specifically considering thebilirubin values of the patients who had complications, there was no threshold identified that contributed to a higher likeliness ofcomplications. Consequently, even though there were no results to motivate recommending drainage, it was concluded that applyingdrainage does not create any difference in short-term prognosis, but drainage increases infectious complications.Publication Open Access Pancreaticoduodenectomy in patients < 75 years versus ≥ 75 years old: a comparative study(2024-12-01) ERGENÇ, MUHAMMER; UPRAK, TEVFİK KIVILCIM; KARPUZ, ŞAKİR; COŞKUN, MÜMİN; YEGEN, ŞEVKET CUMHUR; ATICI, ALİ EMRE; ERGENÇ M., UPRAK T. K., Özocak A. B., KARPUZ Ş., COŞKUN M., YEGEN Ş. C., ATICI A. E.Objective: This study aimed to compare the postoperative outcomes of < 75-year-old patients and ≥ 75-year-old patients who underwent pancreaticoduodenectomy (PD) for pancreatic head and periampullary region tumors. Methods: Patients who underwent PD in our hospital between February 2019 and December 2023 were evaluated. Demographics, Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores, American Society of Anesthesiologists (ASA) scores, comorbidities, hospital stays, complications, and clinicopathological features were analyzed. Patients were divided into < 75 years (Group A) and ≥ 75 years (Group B) groups and compared. Results: The median age of the entire cohort (n = 155) was 66 years (IQR = 16). There was a significant difference between Group A (n = 128) and Group B (n = 27) regarding the ECOG-PS and ASA scores. There was no significant difference between the groups regarding postoperative complications. The 30-day mortality rate was greater in Group B (p = 0.017). Group B had a cumulative median survival of 10 months, whereas Group A had a median survival of 28 months, with a statistically significant difference (p < 0.001). When age groups were stratified according to ECOG-PS, for ECOG-PS 2–3 Group A, survival was 15 months; for ECOG-PS 2–3 Group B, survival was eight months, and the difference was not statistically significant (p = 0.628). Conclusions: With the increasing aging population, patient selection for PD should not be based solely on age. This study demonstrated that PD is safe for patients older than 75 years. In older patients, performance status and the optimization of comorbidities should be considered when deciding on a candidate’s suitability for surgery.