Pub Date : 2024-03-23eCollection Date: 2024-03-01DOI: 10.47717/turkjsurg.2024.20240101
Kaya Sarıbeyoğlu
{"title":"FROM THE EDITOR'S DESK.","authors":"Kaya Sarıbeyoğlu","doi":"10.47717/turkjsurg.2024.20240101","DOIUrl":"https://doi.org/10.47717/turkjsurg.2024.20240101","url":null,"abstract":"","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11257730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735116","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.47717/turkjsurg.2024.6308
Adnan Gündoğdu, M. Uluşahin, Arif Burak Çekiç, Seher Nazlı Kazaz, Ali Güner
Objective: This study aimed to determine clinical and pathological factors that identify a pathological complete response (pCR) in breast cancer patients undergoing neoadjuvant chemotherapy (NAC). Material and Methods: A retrospective, single-center study was conducted in women over the age of 18 who had been diagnosed with pathologically confirmed invasive breast cancer and who had received NAC between July 2016 and October 2021. Patient demographics, clinical, radiological, treatment, and pathological data were reviewed from the electronic hospital records. The primary outcome of interest was pCR, defined as the absence of residual invasive breast cancer in both the breast and axillary lymph nodes. Multivariable logistic regression analysis was used to identify factors associated with pCR. Results: A total of 119 patients were included in the analysis. The distribution of age was 54.5 ± 11.5 years. pCR was observed in 33 (27.7%) patients. pCR for breast tissue was observed in 43 (36.1%) patients. There was no statistically significant relation between the clinical stage and pCR. Age, age at first labor, extent of disease in the breast, NAC completeness, clinical tumor size (cT) stage, clinical lymph node (cN) stage, and molecular subtype were analyzed in a multivariable model. Analysis showed that molecular subtype was the only independent factor related to pCR. pCR rates across molecular subtypes were: 8.7% in luminal-A, 10.8% in luminal-B, 54.5% in human epidermal growth factor receptor 2 (HER-2)-positive, 42.4% in luminal-B (HER-2 positive) and 46.7% in triple-negative. There was no statistically significant difference between luminal-A and luminal-B subgroups (odds ratio 1.15, 95% confidence interval, 0.19-9.35, p= 0.881). Despite the limited number of patients in HER2-positive and triple-negative groups, both demonstrated statistically significant higher odds compared to reference group. Conclusion: The presented study underscores the relevance of molecular subtypes in determining the response to neoadjuvant chemotherapy in breast cancer patients. Particularly HER2-positive and triple-negative subtypes may demonstrate more favorable response rates.
{"title":"Pathological complete response and associated factors in breast cancer after neoadjuvant chemotherapy: A retrospective study","authors":"Adnan Gündoğdu, M. Uluşahin, Arif Burak Çekiç, Seher Nazlı Kazaz, Ali Güner","doi":"10.47717/turkjsurg.2024.6308","DOIUrl":"https://doi.org/10.47717/turkjsurg.2024.6308","url":null,"abstract":"Objective: This study aimed to determine clinical and pathological factors that identify a pathological complete response (pCR) in breast cancer patients undergoing neoadjuvant chemotherapy (NAC).\u0000 Material and Methods: A retrospective, single-center study was conducted in women over the age of 18 who had been diagnosed with pathologically confirmed invasive breast cancer and who had received NAC between July 2016 and October 2021. Patient demographics, clinical, radiological, treatment, and pathological data were reviewed from the electronic hospital records. The primary outcome of interest was pCR, defined as the absence of residual invasive breast cancer in both the breast and axillary lymph nodes. Multivariable logistic regression analysis was used to identify factors associated with pCR.\u0000 Results: A total of 119 patients were included in the analysis. The distribution of age was 54.5 ± 11.5 years. pCR was observed in 33 (27.7%) patients. pCR for breast tissue was observed in 43 (36.1%) patients. There was no statistically significant relation between the clinical stage and pCR. Age, age at first labor, extent of disease in the breast, NAC completeness, clinical tumor size (cT) stage, clinical lymph node (cN) stage, and molecular subtype were analyzed in a multivariable model. Analysis showed that molecular subtype was the only independent factor related to pCR. pCR rates across molecular subtypes were: 8.7% in luminal-A, 10.8% in luminal-B, 54.5% in human epidermal growth factor receptor 2 (HER-2)-positive, 42.4% in luminal-B (HER-2 positive) and 46.7% in triple-negative. There was no statistically significant difference between luminal-A and luminal-B subgroups (odds ratio 1.15, 95% confidence interval, 0.19-9.35, p= 0.881). Despite the limited number of patients in HER2-positive and triple-negative groups, both demonstrated statistically significant higher odds compared to reference group.\u0000 Conclusion: The presented study underscores the relevance of molecular subtypes in determining the response to neoadjuvant chemotherapy in breast cancer patients. Particularly HER2-positive and triple-negative subtypes may demonstrate more favorable response rates.","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140399801","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.47717/turkjsurg.2022.4655
Mehmet Sertkaya, Mehmet Şirik, Mehmet Tepe, S. Özdaş, Mustafa Göksu
Superior mesenteric artery syndrome is defined as a collection of clinical symptoms and findings that result from compression of the third part of the duodenum between the aorta and the superior mesenteric artery. Here, we describe two patients who were diagnosed with superior mesenteric artery syndrome. Two patients, 18 and 38 years old, respectively, presented to our clinic with complaints of nausea, vomiting, and weight loss. Computed tomography scans of both patients supported diagnoses of superior mesenteric artery syndrome. The 18-year-old patient recovered with conservative treatment. However, our 38-year-old patient did not recover with conservative treatment and required two surgeries. In the first operation, duodenal release with Treitz’s ligament dissection and pyloroplasty were performed because of concomitant hypertrophic pyloric stenosis. Because the patient exhibited gastroparesis and gastric ptosis after the first operation, subtotal gastrectomy and Roux-n-Y gastrojejunostomy were performed in the second operation. No complications were observed during follow-up after the second operation. Superior mesenteric artery syndrome should be considered in the differential diagnosis of patients with nausea, vomiting, and weight loss of unknown cause. During treatment, weight-gaining conservative approaches should be attempted initially, but surgical treatment should not be excessively delayed in patients who do not respond to medical treatment.
{"title":"A rare cause of upper gastrointestinal system obstruction: Superior mesenteric artery syndrome (Wilkie’s syndrome); two different case reports","authors":"Mehmet Sertkaya, Mehmet Şirik, Mehmet Tepe, S. Özdaş, Mustafa Göksu","doi":"10.47717/turkjsurg.2022.4655","DOIUrl":"https://doi.org/10.47717/turkjsurg.2022.4655","url":null,"abstract":"Superior mesenteric artery syndrome is defined as a collection of clinical symptoms and findings that result from compression of the third part of the duodenum between the aorta and the superior mesenteric artery. Here, we describe two patients who were diagnosed with superior mesenteric artery syndrome. Two patients, 18 and 38 years old, respectively, presented to our clinic with complaints of nausea, vomiting, and weight loss. Computed tomography scans of both patients supported diagnoses of superior mesenteric artery syndrome. The 18-year-old patient recovered with conservative treatment. However, our 38-year-old patient did not recover with conservative treatment and required two surgeries. In the first operation, duodenal release with Treitz’s ligament dissection and pyloroplasty were performed because of concomitant hypertrophic pyloric stenosis. Because the patient exhibited gastroparesis and gastric ptosis after the first operation, subtotal gastrectomy and Roux-n-Y gastrojejunostomy were performed in the second operation. No complications were observed during follow-up after the second operation. Superior mesenteric artery syndrome should be considered in the differential diagnosis of patients with nausea, vomiting, and weight loss of unknown cause. During treatment, weight-gaining conservative approaches should be attempted initially, but surgical treatment should not be excessively delayed in patients who do not respond to medical treatment.","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.47717/turkjsurg.2024.6375
Philipp K. Haber, F. Krenzien, Kaya Sarıbeyoğlu, Johann Pratschke, W. Schöning
The treatment landscape of hepatocellular carcinoma has evolved rapidly within the last decade. Minimally-invasive techniques have reached a new level of safety, affording surgeons to pursue more aggressive treatment strategies to ultimately improve oncological outcomes. These procedures have been increasingly applied to treat patients with more progressed tumors and in select case even patients with advanced stage disease confined to the liver. Concomitantly, a dramatic increase in research into immunotherapy has altered the treatment paradigm in advanced disease stages, where the emerging treatment regimens can provide durable responses in a subset of the patient population for whom prognosis is dramatically improved. These treatments are now tested in early-stage disease to address the pressing unmet need of high recurrence rates after resection and in intermediate stage to complement the proven efficacy of intraarterial embolization in delaying progression. This review provides an in-depth discussion of these trends and describes how the treatment landscape has already changed and which impediments remain.
{"title":"Integrating the new systemic treatment landscape and surgical therapy in hepatocellular carcinoma","authors":"Philipp K. Haber, F. Krenzien, Kaya Sarıbeyoğlu, Johann Pratschke, W. Schöning","doi":"10.47717/turkjsurg.2024.6375","DOIUrl":"https://doi.org/10.47717/turkjsurg.2024.6375","url":null,"abstract":"The treatment landscape of hepatocellular carcinoma has evolved rapidly within the last decade. Minimally-invasive techniques have reached a new level of safety, affording surgeons to pursue more aggressive treatment strategies to ultimately improve oncological outcomes. These procedures have been increasingly applied to treat patients with more progressed tumors and in select case even patients with advanced stage disease confined to the liver. Concomitantly, a dramatic increase in research into immunotherapy has altered the treatment paradigm in advanced disease stages, where the emerging treatment regimens can provide durable responses in a subset of the patient population for whom prognosis is dramatically improved. These treatments are now tested in early-stage disease to address the pressing unmet need of high recurrence rates after resection and in intermediate stage to complement the proven efficacy of intraarterial embolization in delaying progression. This review provides an in-depth discussion of these trends and describes how the treatment landscape has already changed and which impediments remain.","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140403925","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.47717/turkjsurg.2024.6237
Gitika Nanda Singh, P. Suryavanshi, Shariq Ahmad, Shubhajeet Roy
Objective: Dysfunction of shoulder movements could be a limiting factor to the use of Latissimus dorsi (LD) flap. This study aimed to assess the impact of LD flap reconstruction on shoulder dysfunction and the quality of life. Material and Methods: This study comprised 28 early breast cancer cases who underwent breast conserving surgery (BCS) with LD flap and 40 controls. Subjective and objective assessments were done a year later. Results: Mild and moderate disability were found in 85.71% and 14.3% cases vs. 100% and 0% controls (p= 0.316) respectively. Physical and emotional functioning were 84.29 ± 5.61 and 66.67 ± 6.05 in cases vs. 86.67 ± 8.38 and 70.0 ± 6.84 in controls (p= 0.36, 0.23) respectively. Pain score in cases was 23.8 ± 15.6 vs. 12.17 ± 8.4 in controls (p= 0.018). LD muscle strength in extension was 4.39 ± 0.35 in cases vs. 4.88 ± 0.22 in controls (p< 0.001), 4.43 ± 0.18 for adduction in cases vs. 4.65 ± 0.24 in controls (p= 0.006). ROM of shoulder in flexion was 151.61 ± 4.86° in cases and 153.88 ± 2.36° in controls (p= 0.08), 40.36 ± 3.52° in cases vs. 49.13 ± 1.86° in controls for extension (p< 0.001), in abduction it was 150.54 ± 3.69° in cases vs. 150.00 ± 0.00° in controls (p= 0.518), in adduction was 30.89 ± 4.0° in cases vs. 38.13 ± 1.11° in controls (p< 0.001), in external rotation was 73.57 ± 3.63° in cases vs. 77.63 ± 2.36° in controls (p< 0.001), and internal rotation was 69.46 ± 3.56° in cases vs. 79.00 ± 1.26° in controls (p< 0.001). Conclusion: We conclude that functional impairment should not be a determining factor for LD flap in breast reconstruction surgery.
{"title":"A prospective case-control study of disability, quality of life, and functional impairment of shoulder movements after latissimus dorsi myocutaneous flap reconstruction in breast cancer patients","authors":"Gitika Nanda Singh, P. Suryavanshi, Shariq Ahmad, Shubhajeet Roy","doi":"10.47717/turkjsurg.2024.6237","DOIUrl":"https://doi.org/10.47717/turkjsurg.2024.6237","url":null,"abstract":"Objective: Dysfunction of shoulder movements could be a limiting factor to the use of Latissimus dorsi (LD) flap. This study aimed to assess the impact of LD flap reconstruction on shoulder dysfunction and the quality of life.\u0000 Material and Methods: This study comprised 28 early breast cancer cases who underwent breast conserving surgery (BCS) with LD flap and 40 controls. Subjective and objective assessments were done a year later.\u0000 Results: Mild and moderate disability were found in 85.71% and 14.3% cases vs. 100% and 0% controls (p= 0.316) respectively. Physical and emotional functioning were 84.29 ± 5.61 and 66.67 ± 6.05 in cases vs. 86.67 ± 8.38 and 70.0 ± 6.84 in controls (p= 0.36, 0.23) respectively. Pain score in cases was 23.8 ± 15.6 vs. 12.17 ± 8.4 in controls (p= 0.018). LD muscle strength in extension was 4.39 ± 0.35 in cases vs. 4.88 ± 0.22 in controls (p< 0.001), 4.43 ± 0.18 for adduction in cases vs. 4.65 ± 0.24 in controls (p= 0.006). ROM of shoulder in flexion was 151.61 ± 4.86° in cases and 153.88 ± 2.36° in controls (p= 0.08), 40.36 ± 3.52° in cases vs. 49.13 ± 1.86° in controls for extension (p< 0.001), in abduction it was 150.54 ± 3.69° in cases vs. 150.00 ± 0.00° in controls (p= 0.518), in adduction was 30.89 ± 4.0° in cases vs. 38.13 ± 1.11° in controls (p< 0.001), in external rotation was 73.57 ± 3.63° in cases vs. 77.63 ± 2.36° in controls (p< 0.001), and internal rotation was 69.46 ± 3.56° in cases vs. 79.00 ± 1.26° in controls (p< 0.001).\u0000 Conclusion: We conclude that functional impairment should not be a determining factor for LD flap in breast reconstruction surgery.","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140401062","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.47717/turkjsurg.2024.6168
Yasir Tajdar, Sakshi Singh, Ankit Raj, A. Raj, V. Bhushan
Objective: Topical silver treatments and silver dressings are increasingly being utilized for the local treatment of wounds; nevertheless, the evidence for their usefulness is unclear. The aim of this study was to investigate the impact of conventional dressings and silver colloid dressing on diabetic foot ulcers (DFU) with and without compression therapy. Material and Methods: This prospective, double-blind experiment included 50 patients with non-ischemic DFUs, split into two groups of 25 patients each. The study was conducted for a period of six months. The primary endpoint was to evaluate the entire epithelialization (total healing) of all ulcers on the study leg. Results: The ulcer area significantly decreased in the colloidal silver group (67.77 ± 17.82%) compared to the conventional saline group (21.70 ± 23.52%). When compared to the conventional group, the colloidal silver group required considerably fewer days to reach the endpoint (23.15 ± 8.15 days vs. 48.35 ± 18.07 days), and by day 14, ulcer area reduction (from 100%) was greater (48% in the silver group vs. 89.69% in the conventional group). Conclusion: In managing DFUs, unstructured hydrogel wound dressings using silver colloids based on ionic silver are more effective than regular saline dressings since they heal wounds more quickly in fewer days while also drastically reducing ulcer areas over time.
{"title":"Effect of silver colloid dressing over conventional dressings in diabetic foot ulcer: A prospective study","authors":"Yasir Tajdar, Sakshi Singh, Ankit Raj, A. Raj, V. Bhushan","doi":"10.47717/turkjsurg.2024.6168","DOIUrl":"https://doi.org/10.47717/turkjsurg.2024.6168","url":null,"abstract":"Objective: Topical silver treatments and silver dressings are increasingly being utilized for the local treatment of wounds; nevertheless, the evidence for their usefulness is unclear. The aim of this study was to investigate the impact of conventional dressings and silver colloid dressing on diabetic foot ulcers (DFU) with and without compression therapy.\u0000 Material and Methods: This prospective, double-blind experiment included 50 patients with non-ischemic DFUs, split into two groups of 25 patients each. The study was conducted for a period of six months. The primary endpoint was to evaluate the entire epithelialization (total healing) of all ulcers on the study leg.\u0000 Results: The ulcer area significantly decreased in the colloidal silver group (67.77 ± 17.82%) compared to the conventional saline group (21.70 ± 23.52%). When compared to the conventional group, the colloidal silver group required considerably fewer days to reach the endpoint (23.15 ± 8.15 days vs. 48.35 ± 18.07 days), and by day 14, ulcer area reduction (from 100%) was greater (48% in the silver group vs. 89.69% in the conventional group).\u0000 Conclusion: In managing DFUs, unstructured hydrogel wound dressings using silver colloids based on ionic silver are more effective than regular saline dressings since they heal wounds more quickly in fewer days while also drastically reducing ulcer areas over time.","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140400134","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.47717/turkjsurg.2024.6358
Csaba Gajdos, Carrie Ryan, Goda Savulionyte, Steven Schwaitzberg, Nader Nader
Objective: This study aimed to compare surgical resection versus ablation for managing liver malignancies in patients 65 and older. Material and Methods: Cases with liver tumors were extracted from the NSQIP database for patients aged ≥65 years. Following propensity score matching, multivariate Cox regression was used for 30-day morbidity and mortality for liver resection and ablation. Results: Following a propensity score matching, 1048 patients were 1:1 matched for comorbid conditions. Patients stayed in the hospital three days longer after resection (p<0.001). Mortality was lower after ablation (p= 0.013). This difference was more prominent in patients with primary liver tumors (p= 0.008). Group A had a 10-fold lower risk of developing an abdominal abscess, a fourfold decrease in hospital-associated pneumonia (p= 0.001) and reintubation, a 10-fold reduction in bleeding requiring transfusion (p<0.001), and a three-fold decrease in risk of developing sepsis (p<0.001). Conclusion: Despite being a generally sicker patient population with worse underlying liver function, ablative techniques were associated with a lower risk of adverse outcomes when compared to more aggressive resection of primary malignant tumors of the liver.
{"title":"Liver resection versus ablation in geriatric populations - Does one method impart improved in-hospital mortality?","authors":"Csaba Gajdos, Carrie Ryan, Goda Savulionyte, Steven Schwaitzberg, Nader Nader","doi":"10.47717/turkjsurg.2024.6358","DOIUrl":"https://doi.org/10.47717/turkjsurg.2024.6358","url":null,"abstract":"Objective: This study aimed to compare surgical resection versus ablation for managing liver malignancies in patients 65 and older.\u0000 Material and Methods: Cases with liver tumors were extracted from the NSQIP database for patients aged ≥65 years. Following propensity score matching, multivariate Cox regression was used for 30-day morbidity and mortality for liver resection and ablation.\u0000 Results: Following a propensity score matching, 1048 patients were 1:1 matched for comorbid conditions. Patients stayed in the hospital three days longer after resection (p<0.001). Mortality was lower after ablation (p= 0.013). This difference was more prominent in patients with primary liver tumors (p= 0.008). Group A had a 10-fold lower risk of developing an abdominal abscess, a fourfold decrease in hospital-associated pneumonia (p= 0.001) and reintubation, a 10-fold reduction in bleeding requiring transfusion (p<0.001), and a three-fold decrease in risk of developing sepsis (p<0.001).\u0000 Conclusion: Despite being a generally sicker patient population with worse underlying liver function, ablative techniques were associated with a lower risk of adverse outcomes when compared to more aggressive resection of primary malignant tumors of the liver.","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140401163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.47717/turkjsurg.2024.6292
Ahmet Çağrı Büyükkasap, Kursat Dikmen, Aydın Yavuz, Saygın Altiner, Hüseyin Göbüt, Ahmet Cihangir Emral, H. Bostancı, Mustafa Kerem
Objective: The aim of this study was to evaluate the predictive value of the first postoperative day (POD1) drain fluid amylase in predicting pancreatic fistula formation following pancreaticoduodenectomy (PD). Material and Methods: One-hundred and eighty-five prospective patients undergoing PD between April 2014 and April 2018 were studied retrospectively. Cut-off point to predict the development of POPF was determined by median values for drain fluid amylase of 1883 U/L. Patients were classified into two groups according to POD1 drain fluid amylase values: <1883 U/L (Group 1) and ≥1883 U/L (Group 2). Differences between the groups with clinically relevant POPF and without POPF were evaluated. Results: The incidence of POPF was 17.2%. POD1 amylase level was the strongest predictor of POPF, with levels of higher than 1883 U/L demonstrating the best accuracy (87.5%), sensitivity (78.1%), specificity (89.5%), positive predictive value (60.9%), and negative predictive value (95.1%). One-hundred and forty-four patients (77.8%) had a POD1 drain amylase level of less than 1883 U/L, and POPF developed in only seven (3.7%) cases, whereas in patients with POD1 drain amylase level of 1883 U/L or higher (n= 41), the POPF rate was 31.4% [OR: 22.24, 95% CI (7.930–62.396), p<0.001]. Conclusion: The cut-off point of POD1 drain fluid amylase level (1883 U/L) might predict the clinically relevant POPF with adequate sensitivity and specificity rates in patients undergoing pancreatic resection.
{"title":"Predictive value of drain fluid amylase level on postoperative day one after pancreatic resection for predicting postoperative pancreatic fistula","authors":"Ahmet Çağrı Büyükkasap, Kursat Dikmen, Aydın Yavuz, Saygın Altiner, Hüseyin Göbüt, Ahmet Cihangir Emral, H. Bostancı, Mustafa Kerem","doi":"10.47717/turkjsurg.2024.6292","DOIUrl":"https://doi.org/10.47717/turkjsurg.2024.6292","url":null,"abstract":"Objective: The aim of this study was to evaluate the predictive value of the first postoperative day (POD1) drain fluid amylase in predicting pancreatic fistula formation following pancreaticoduodenectomy (PD).\u0000 Material and Methods: One-hundred and eighty-five prospective patients undergoing PD between April 2014 and April 2018 were studied retrospectively. Cut-off point to predict the development of POPF was determined by median values for drain fluid amylase of 1883 U/L. Patients were classified into two groups according to POD1 drain fluid amylase values: <1883 U/L (Group 1) and ≥1883 U/L (Group 2). Differences between the groups with clinically relevant POPF and without POPF were evaluated.\u0000 Results: The incidence of POPF was 17.2%. POD1 amylase level was the strongest predictor of POPF, with levels of higher than 1883 U/L demonstrating the best accuracy (87.5%), sensitivity (78.1%), specificity (89.5%), positive predictive value (60.9%), and negative predictive value (95.1%). One-hundred and forty-four patients (77.8%) had a POD1 drain amylase level of less than 1883 U/L, and POPF developed in only seven (3.7%) cases, whereas in patients with POD1 drain amylase level of 1883 U/L or higher (n= 41), the POPF rate was 31.4% [OR: 22.24, 95% CI (7.930–62.396), p<0.001].\u0000 Conclusion: The cut-off point of POD1 drain fluid amylase level (1883 U/L) might predict the clinically relevant POPF with adequate sensitivity and specificity rates in patients undergoing pancreatic resection.","PeriodicalId":23374,"journal":{"name":"Turkish Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":0.6,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140405154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-01DOI: 10.47717/turkjsurg.2022.4805
Emel Tekin, Toros Taskin, Semin Ayhan
Mucinous cystic neoplasm of the liver (MCN-L) is a rare tumor which accounts for less than 5% of all liver cysts. Although they are considered to be “benign cysts” radiologically and clinically because of their slow growth, they are considered as premalignant. We present two radiologically misdiagnosed cases that operated in a short time range, in order to increase awareness for these rare tumors. A 47-year-old female patient who had no active complaints 58 x 40 mm cystic lesion was detected in the liver, which was diagnosed hydatid cyst radiologically. The pathological examination showed multiloculated cysts which was covered by low-grade mucinous epithelium and ovarian-type stroma on the cyst wall. A 50-year-old female patient presented with abdominal distention. The radiographical screening revealed a 204 x 140 mm cystic lesion that completely fills left lobe of liver which interpreted in favor of hydatid cyst. Histopathologically, the inner surface of the cyst was covered with low grade mucinous epithelium. Ovarian-type stroma was detectable only by immunohistochemistry due to significant bleeding and edema on the wall. The diagnosis of both of our cases was low grade MCN-L. Since cysts were not intact at the time of gross examination, we could not make any comment about surgical margins or total excision. MCN-L is a tumor that creates difficulty in presurgical differential diagnosis because of its rarity and lack of specific radiologic features. Although the prognosis is excellent as a result of total excision in the benign group, relapses have also been reported.
肝脏黏液囊性瘤（MCN-L）是一种罕见的肿瘤，占所有肝脏囊肿的 5%以下。虽然由于其生长缓慢，在放射学和临床上被认为是 "良性囊肿"，但它们被认为是癌前病变。我们介绍两例在短时间内手术的放射误诊病例，以提高人们对这种罕见肿瘤的认识。一名 47 岁的女性患者，无活动性主诉，肝脏发现 58 x 40 毫米的囊性病变，放射学诊断为包虫囊肿。病理检查显示囊肿呈多房性，囊壁被低级粘液上皮和卵巢型基质覆盖。一名 50 岁的女性患者因腹胀就诊。放射学检查发现一个 204 x 140 毫米的囊性病变，完全充满了肝脏左叶，解释为水瘤囊肿。组织病理学检查显示，囊肿内表面覆盖着低级别粘液上皮。由于囊壁明显出血和水肿，只有通过免疫组化才能检测到卵巢型基质。我们两个病例的诊断结果都是低级别 MCN-L。由于大体检查时囊肿并不完整，我们无法对手术切缘或全切作出任何评论。MCN-L 是一种手术前鉴别诊断困难的肿瘤，因为其罕见且缺乏特殊的放射学特征。虽然在良性肿瘤组中完全切除后预后良好，但也有复发的报道。
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Pub Date : 2024-03-01DOI: 10.47717/turkjsurg.2024.6278
Sabri Selçuk Atamanalp
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