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- MakaleYalnız künye2012Safety and effectiveness of 5-mm and 10-mm electrothermal bipolar vessel sealers (LigaSure) in laparoscopic resections for sigmoid colon and rectal cancers
Gezen, Cem; Kement, Metin; Altuntas, Yunus E.; Aksakal, Nihat; Okkabaz, Nuri; Civil, Osman; Vural, Selahattin; Oncel, Mustafa
Background: LigaSure™ (Covidien, Mansfield, MA) has been used in cases undergoing laparoscopic colon and rectal resections. This study aims to analyze the efficacy and safety of the 5-mm and 10-mm devices. Subjects and Methods: Patients who received a laparoscopic or hand-assisted laparoscopic operation for a tumor located in the sigmoid colon or rectum since 2006 were abstracted from a prospectively designed database, and findings were analyzed in two groups based on size of the device used during the procedure. The videotapes of the procedures were watched, and operation reports were read to obtain further information on specific intra- and postoperative complications. Demographics, tumor and operation-related information, and postoperative data were compared. Results: Among 215 (128 [59.5%] males; median age, 59.5±13.8 years) patients, data obtained from the 5-mm (n=32) and 10-mm (n=183) groups were identical regarding demographics and data related to tumor (localization and stage) and operation (number of harvested lymph nodes, conversion rates, operation time, intraoperative bleeding, transfusion requirement, reoperation rates, complications, 30-day mortality, and length of hospital stay). However, more patients underwent an anterior resection in the 10-mm group than in the 5-mm group (31.7% versus 15.6%, P<.05). Further analyses found device-related bleeding in 8 (3.7%) cases (2 [6.3%] versus 6 [3.3%] in the 5-mm versus 10-mm group, respectively, P>.05), requiring further attempts for hemorrhage control (n=6), conversion to open surgery (n=1), or relaparotomy (n=1). Conclusions: The 5-mm and 10-mm LigaSure devices are similarly effective and safe during laparoscopic sigmoid colon and rectal resections. Severe bleeding from larger vessels may be observed, requiring conversion to open surgery or relaparotomy.
- MakaleYalnız künye2012Complete versus partial mobilization of splenic flexure during laparoscopic low anterior resection for rectal tumors: A comparative study
Gezen, Cem; Altuntas, Yunus E.; Kement, Metin; Vural, Selahattin; Civil, Osman; Okkabaz, Nuri; Aksakal, Nihat; Oncel, Mustafa
Background: The aim of the current study is to compare the results after partial and complete splenic flexure mobilization (SFM). Subjects and Methods: The records of laparoscopic and hand-assisted laparoscopic procedures for primary rectal tumor patients were abstracted from a prospectively designed database. The phrenicocolic and splenocolic ligaments were divided via a four-trocar technique in the partial SFM group, and dissection was continued with the separation of gastrocolic and pancreaticomesocolic attachments via a five-trocar procedure in the complete SFM group. The following data were compared between the groups: Demographics, intra- and postoperative information, and pathological features. Results: In total, 122 cases (77 [63.1%] male, 58.2±13.2 years old) who underwent a partial (n=36, 29.5%) or a complete (n=86, 70.5%) SFM were included. Reservoir creation (48.8% versus 19.4%, P=.003) was more common and conversion (8.1% versus 22.2%, P=.039) was less frequent in the complete SFM group, but there were significantly more T4 tumors in the partial group (16.7% versus 2.3%, P=.008). Demographics, other intra- and postoperative parameters, and pathological features were identical. Conclusions: In our study, complete SFM decreased conversion rates, but this finding may be related to the higher rate of T4 tumors in the partial SFM group. Complete SFM assures an increase in reservoir creation in patients receiving a low anterior resection. Because other parameters are identical, the decision for the level of SFM is better left to the surgeon in cases undergoing a low anterior resection, but complete SFM may be preferred in cases who are candidates for a reservoir formation.
- MakaleYalnız künye2012Laparoscopic and conventional resections for low rectal cancers: A retrospective analysis on perioperative outcomes, sphincter preservation, and oncological results
Gezen, Cem; Altuntas, Yunus E.; Kement, Metin; Aksakal, Nihat; Okkabaz, Nuri; Vural, Selahattin; Oncel, Mustafa
Background: This study aims to compare the results of laparoscopic and conventional techniques in patients with low rectal cancers. Subjects and Methods: A retrospective data analysis was initiated in patients underwent laparoscopic or conventional surgery for cancers located in the low (<6 cm) rectum. Patient and tumor-related information, outcomes of operations, and survival were compared between the groups. Results: Among 142 patietns (91 men [64.1%]; mean±standard deviation age, 57.7±14.6 years) who had tumors located <6 cm from the dentate line, 92 (64.8%) were operated on with the laparoscopic technique. Demographics, tumor stage, and localization (2.9±2.0 versus 2.9±2.1 cm from the dentate line in laparoscopic and conventional arms, respectively; P=.968) were similar. However, there were more patients in the laparoscopic group who received neoadjuvant chemoradiation therapy (92.4% versus 80.0%; P=.03), since there were significantly fewer cases with stage I tumors in this group (3.3% versus 14%; P=.33). The conversion rate was 14.1% (n=13). The amount of bleeding and the requirement for transfusion decreased (P<.05 for both), and the possibility of sphincter-saving procedures (66.3% versus 34.0%; P<.001) increased, in the laparoscopy group. Other parameters were identical. In the laparoscopy group, the number of harvested lymph nodes (10.2±5.4 versus 12.4±6.0; P=.025) and the rate of vascular invasion (27.5% versus 47.8%; P=.021) were less, and Kaplan-Meier analysis revealed an improved survival (P=.042), although the follow-up period was significantly shorter in this group (P<.001). Conclusions: Laparoscopic surgery for low rectal cancers may be technically feasible and oncologically safe. Laparoscopy may increase the possibility of sphincter preservation.
- MakaleAçık Erişim2012Results after multivisceral resections of locally advanced colorectal cancers: An analysis on clinical and pathological t4 tumors
Gezen, Cem; Kement, Metin; Altuntas, Yunus E.; Okkabaz, Nuri; Seker, Mesut; Vural, Selahattin; Gumus, Mahmut; Oncel, Mustafa
Background: Locally advanced colorectal cancers are best treated with multivisceral resections. The aim of this study is to evaluate early and late results after multivisceral resections.Methods: All patients operated for primary colorectal cancer between 2001 and 2010 were -reviewed. These were compared within the patients underwent single organ and multivisceral resections: demographics, tumor and procedure related parameters, perioperative results, early oncological outcomes and 5-year survival.Results: A total of 354 patients (59.6 ± 13.8 years old, 210 [59.3%] males) were abstracted. Ninety (25.4%) patients underwent multivisceral resections for clinical T4 tumors and en-bloc R0 resection was achieved in 82 (91.1%). Only 31 (34.4% and 8.8% of clinical T4 and all cancers, respectively) cases had actual adjacent organ invasions (pT4). Males (20%) had lower risk for locally advanced tumors than females (33.3%) (p < 0.05). PT4 cancers were more common, if the clinical T4 tumor is located in the colon (48.8% vs 21.3%; p < 0.01). Laparoscopy was seldom initiated and the risk of conversion was higher in clinical T4 tumors (p < 0.05). The rates of sphincter-saving procedures were not different. Operation time, bleeding and transfusion requirements increased when multivisceral resections were necessitated (p < 0.05), but hospital stay, complications and 30-day mortality rates were similar. The 5-year survival rates were identical (p > 0.05).Conclusions: Clinical T4 tumors are not rare and more common in women. An actual invasion (pT4) may be observed in one third of all clinical T4 tumors, and more frequent in colon cancers. An en-bloc, R0, multivisceral resection may be achieved in most cases. Multivisceral resections do not alter the rates of sphincter-saving procedures, morbidity and 30-day mortality; do not worsen survival but increase operation time, intraoperative bleeding and perioperative transfusion requirements.
- MakaleYalnız künye2012The importance of multifocal/multicentric tumor on the disease-free survival of breast cancer patients: Single center experience
Ustaalioglu, Basak Oven; Bilici, Ahmet; Kefeli, Umut; Şeker, Mesut; Oncel, Mustafa; Gezen, Cem; Gumus, Mahmut; Demirelli, Fuat
OBJECTIVES:: Multifocal/multicentric breast cancers have been comprehensively studied and their outcomes have been compared with unifocal tumors. We evaluated the impact of multifocality and multicentricity on the disease-free survival (DFS) and overall survival of breast cancer patients and tried to analyze the correlation between multifocality/multicentricity (M/M) and other prognostic factors. MATERIAL AND METHODS:: Between 1994 and 2009, we analyzed retrospectively 697 breast cancer patients. Multicentric and multifocal breast cancer were defined as the presence of 2 or more invasive tumor foci within the different quadrants of the same breast or within a same quadrant of the breast, respectively. M/M and other prognostic factors were evaluated using univariate and multivariate analyses. RESULTS:: Multifocal/multicentric tumors were seen in 107 (15.4%) of the 697 breast cancer patients. pT and pN stage were related with the presence of multifocal/multicentric tumors. As tumor size increased and the number of axillary lymph nodes metastasis increased, the incidence of M/M increased significantly (P=0.003 vs. P=0.02, respectively). Overall, the median DFS time of patients with multifocal/multicentric tumors was significantly worse than that of the unifocal tumors (55 vs. 137 mo, P<0.001). Multivariate analysis showed that the presence of M/M was the most important prognostic factor for DFS (P=0.001, hazard ratio (HR): 0.33; 95% confidence interval (CI), 0.18-0.58), as were pN stage and extracapsular extension of the tumor (P=0.01, HR: 1.74; 95% CI, 1.13-2.69) (P=0.03, HR: 1.9; 95% CI, 1.04-3.47, respectively). M/M were not also statistically significant prognostic factors in breast cancer for overall survival (P=0.06). CONCLUSIONS:: M/M imparts an unfavorable prognosis on the DFS of breast cancer patients in comparison to unifocal tumors and the presence of multifocal/multicentric tumors were associated with advanced pT and pN stages.
- MakaleAçık Erişim2011Breast Conserving Surgery and Modified Radical Mastectomy in Turkish Women with Breast Cancer: A Prospective Analysis of Quality of Life
Kement, Metin; Gezen, Cem; Asik, Ayla; Karaöz, Alev; Ustaalioglu, Basak Oven; Bilici, Ahmet; Öncel, Mustafa
Objective: The aim of this study is to compare the postoperative quality of life of the patients who underwent breast conserving surgery followed by radiotherapy (BCT) and the patients who underwent modified radical mastectomy (MRM) in our clinic. Material and Methods: The patients who were operated on with diagnosis of breast cancer in our clinic between January 2006 and January 2008 were included in the study. Those who received neoadjuvant therapy and who required radiotherapy after modified radical mastectomy and those in ASA classes 3 and 4 were excluded. The patients who were treated with modified radical mastectomy were included in the first group (Group MRM) and the patients who were treated with breast conserving therapy and radiotherapy thereafter were included in the second group (Group BCT). Quality of life of the patients were assessed using Medical Outcome Syudy-Short Form 36 (MOS SF-36) form six months after their treatment (surgery, radiotherapy, chemotherapy) was completed. Results: There were no significant differences between two groups in terms of age, evaluated socioeconomic parameters (education, income, marital status) and clinical parameters (stage, complications, adjuvant chemotherapy). Quality of life of the patients who underwent BCT (n=27) was worse than that of general Turkish population in six of eight (except vitality and social function) SF-36 scale and worse than mean values of normal individuals in NSABP BCPT trial in seven of eight (except vitality) scales. Besides, while physical component score was worse than that of general population (45.3 vs 52.6), mental component score (MCS) was relatively similar to general population (53.4 vs 51.7). When quality of life of the patients who underwent MRM (n=23) and BCT were compared, mean values of BCT group were found to be better in all scales and the difference was found to be statistically significant in six out of eight (except vitality and social function) scales (p<0.05). Conclusion: It can be stated that quality of life of the patient who underwent BCT due to breast cancer is impaired in terms of physical status, however did not change in terms of mental status. It can also be stated that quality of life of the patients who underwent breast conserving therapy were better than the ones who underwent modified radical mastectomy in terms of both physical and mental status.
- MakaleYalnız künye2011Laparoscopic abdominoperineal resections for mid or low rectal adenocarcinomas: A retrospective, comparative study
Gezen, Cem; Altuntas, Yunus E.; Kement, Metin; Okkabaz, Nuri; Bilici, Ahmet; Vural, Selahattin; Gumus, Mahmut; Oncel, Mustafa
BACKGROUND: Laparoscopic abdominoperineal resection (APR) has been seldom studied apart from low anterior resections, and deserves to be separately analyzed. This study aims to compare perioperative and oncological outcomes of laparoscopic and conventional APRs performed for the treatment of mid and low rectal adenocarcinomas. MATERIALS AND METHODS: Patients operated for primary mid or low rectal adenocarcinoma between 2001 and 2009 in our institution were retrospectively investigated. These data were abstracted and compared within conventional and laparoscopic resection groups: demographics, tumor and procedure-related parameters, perioperative results, early oncological outcomes, and survival. RESULTS: Demographics and tumor and procedure-related parameters were similar within the laparoscopic (n=31) and conventional (n=36) groups, except intraoperative bleeding and requirement for transfusion, which were significantly lower after laparoscopic APRs. Perioperative results including complication, reoperation, and 30-day mortality rates were identical. Early oncological results and 3-year survival rates were alike. CONCLUSIONS: The perioperative results and oncological outcomes are similar after laparoscopic and conventional APRs. As current data include limited number of patients in a retrospective design, further studies comparing laparoscopic and conventional APR techniques are required.