Turkish Journal of Surgery最新文献

Objective: Gastric cancer (GC), with a five-year survival rate of approximately 20%, frequently displays aggressive behavior when HER-2 is overexpressed. While trastuzumab, a monoclonal antibody against human epidermal growth factor receptor-2 (HER-2), has improved outcomes in advanced GC, its effect in resectable disease is less studied.

Material and methods: This retrospective study included patients who underwent total gastrectomy with D2 lymph node dissection between 2016 and 2021. Among 180 patients, HER-2 status was determined for 97 cases. Of these, 20 HER-2 positive patients received trastuzumab-containing therapies. A control group of 40 HER-2 negative patients was randomly selected. Overall survival (OS) was compared between groups. Univariate and multivariate analyses were used to identify prognostic factors.

Results: Sixty patients with a median follow-up of 29.5 months were analyzed. HER-2 positivity was associated with significantly improved OS (p=0.038). Univariate analyses revealed that HER-2 positivity (p=0.047), younger age (p=0.001), advanced tumor stage (p<0.001), and larger tumor size (p=0.010) were significantly related to OS. In the multivariate model, advanced tumor stage [hazard ratio (HR)=3.634, p=0.001] and younger age (HR=0.213, p<0.001) remained independent predictors of worse survival, while HER-2 positivity and tumor size lost their significance. Tumor subtype and location did not significantly influence OS.

Conclusion: The findings suggest that trastuzumab-containing treatment strategies can markedly improve survival in resectable HER-2 positive GC. Routine assessment of HER-2 status and integration of targeted therapies may enhance patient outcomes. In addition, advanced stage and younger age emerged as key prognostic factors.

Living donor liver transplantation (LDLT) is a useful therapeutic option for end-stage liver disease due to the shortage of deceased donor liver grafts, particularly in Asia and Türkiye. Right liver LDLT is frequently performed in adults and some cases require anterior section venous drainage. Synthetic grafts, particularly expanded polytetrafluoroethylene (e-PTFE), are often preferred for venoplasties. Despite its many advantages, some complications associated with these grafts have been reported, such as gastrointestinal tract migration, perforation, and bleeding. Here we present an extremely rare case about an e-PTFE graft.

Objective: Emergency laparotomy carries a 10-18% mortality risk, influenced by factors such as age, medical conditions, and sarcopenia. Scoring models like the Portsmouth physiological and operative severity score (P-POSSUM) and the National Emergency Laparotomy Audit (NELA) have been developed to predict outcomes and assist decision-making. Both models are widely used, but their effectiveness in predicting outcomes, particularly in the Indian context, requires further evaluation. This study aimed to compare the P-POSSUM and NELA scores in predicting 30-day mortality for patients undergoing emergency laparotomy.

Material and methods: This single-institution prospective observational study included 238 adult patients of age ≥18 years undergoing emergency laparotomy for acute abdominal conditions, following ethical approval. P-POSSUM and NELA scores were calculated preoperatively, and their predictive accuracy was evaluated by comparing predicted versus observed mortality using sensitivity, specificity, positive and negative predictive values, and the area under the receiver operating characteristic curve.

Results: The NELA area under the curve was 0.699, while the P-POSSUM area under the curve was 0.687. NELA demonstrated higher sensitivity (73.9%) and specificity (45.6%) than P-POSSUM, which had a sensitivity of 52.2% and specificity of 27.4%. P-POSSUM and NELA scores were significantly higher in patients requiring intensive care unit admission than in those who did not.

Conclusion: Our study found that the NELA score outperforms the P-POSSUM score in predicting 30-day mortality in emergency laparotomy patients, indicating that NELA is a more reliable tool for preoperative risk stratification and clinical decision-making.

Everolimus is one of the immunosuppressive drugs used in solid organ transplantation. Many side effects have been described for these immunosuppressive drugs, similar to other drugs in this category. The purpose of this case presentation is to draw attention to drug-induced pneumonitis, which is a rare and life-threatening side effect of everolimus. A nineteen-year-old female patient who received liver transplantation for toxic hepatitis was admitted to our institute with cough and dyspnea. Everolimus had been started in conjunction with tacrolimus therapy 6 months prior to admission. Her chest imaging were consistent with pneumonitis. Markers of infection and cultures were all negative. After discontinuation of everolimus, symptoms and radiological findings resolved. The adverse effects of the drug should be kept in mind while investigating possible infectious agents in liver transplant recipients who are prone to opportunistic infections.

Objective: The aim of this study is to compare the results of repeat colonoscopies performed on the same day and by appointment in patients with inadequate bowel cleansing.

Material and methods: The study was designed as a prospective randomized controlled study. Eighty patients with inadequate bowel cleansing detected in elective colonoscopies were included in the study. Patients were randomly divided into 2 groups: Group I: Same day group and Group II: Appointment day group. Same day colonoscopy group was given day hospitalization, sennoside A+B calcium was given and colonoscopy procedure was repeated. Patients in Group II were rescheduled and standard colonoscopy preparation protocol was applied. Boston bowel preparation scale (BBPS) was used for bowel preparation quality. Cecal intubation time, cecal intubation rate, procedure time, BBPS score and polyp detection rate were compared between the groups.

Results: In the same-day group, 52.5% of the patients were female while 45.9% were female in the appointment group. There was no significant difference between the two groups in terms of age or gender (p>0.05). The rate of cecum intubation was higher in the same-day group than it was in the appointment group (p=0.022). The total BBPS score was 7.9±1.79 in the same-day group and 6.89±2.23 in the appointment group, and the difference was statistically significant (p=0.03). When the two groups were compared in terms of tolerability of the procedure, no difference was detected (p>0.05).

Conclusion: Same-day colonoscopy is an effective method and can be performed safely in patients with inadequate bowel cleansing.

Acute mesenteric ischemia represents a group of diseases, which lead to an abrupt interruption of blood flow to the small intestine resulting in intestinal necrosis. Its first symptoms are vague and in the majority of cases nonspecific, so the diagnostic suspicion is of the utmost importance to establish the correct diagnostic and prompt treatment. It is a complex and difficult event, that needs a multidisciplinary approach involving different specialties such as gastrointestinal and vascular surgeons, interventional radiologists, and expertise from the acute care unit team. The fundamental aspect is the precocity of diagnostic based on abdominal computed angio-tomography and the immediate re-establishment of blood supply to the affected areas. In this report, we introduce a case of a patient with mesenteric venous thrombosis, who has beenundergone a percutaneous endovascular treatment (portal-mesenteric mechanical thrombectomy, besides an intravenous thrombolytic infusion), due to poor clinical response after anticoagulation approach that needed mechanical ventilation.

The case involves a one-year-old male with a mesenchymal hamartoma involving the right hepatic lobe. The tumor-free segments comprised 17% of the liver volume, which placed the patient at risk for post-resection liver failure. A staged approach, the associating liver partition with portal vein ligation for staged hepatectomy, was employed. This allowed the interval growth of the liver remnant and thereafter enabled right lobectomy with adequate liver function.

Objective: The acquisition of communication skills, which form the basis of solution-focused thinking, also develops self-confidence in organ transplantation coordinators, enabling them to plan appropriate care in the organ donation process. The aim of this study was to determine the levels of self-confidence, communication skills, and solution-focused approaches in organ transplantation coordinators.

Material and methods: A descriptive and correlational study. The study was conducted with 203 organ transplantation coordinators in Türkiye between August and September 2023. The data were collected using a personal information form, the self-confidence scale, the communication skills scale, and the solution-focused inventory.

Results: A positive, weak correlation was determined between the solution-focused inventory and communication skills (r=0.261, p<0.001) and self-confidence (r=0.269, p<0.001), and a positive high-level correlation was determined between communication skills and self-confidence (r=0.811, p<0.001). Self-confidence (β=0.614) and the solution-focused approach inventory (β=0.076) explained 65.6% of the communication skills (corrected R²=0.656).

Conclusion: The solution-focused approach and self-confidence were found to increase the communication skills of the organ transplantation coordinator.