Sürdürülebilir Kalkınma Amaçları
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- MakaleAçık Erişim2012Scopus SJRQ1Results 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.
AtıfScopus74WoS64OpenAlex85İncele - MakaleYalnız künye2012Scopus SJRQ3The 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.
AtıfScopus36WoS35OpenAlex41İncele - MakaleYalnız künye2011Scopus SJRQ2Laparoscopic 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.
AtıfScopus8WoS8OpenAlex9İncele - MakaleYalnız künye2010Scopus SJRQ1Prognostic significance of perineural invasion in patients with gastric cancer who underwent curative resection
Bilici, Ahmet; Seker, Mesut; Ustaalioglu, Bala Basak Oven; Kefeli, Umut; Yildirim, Emre; Yavuzer, Dilek; Aydin, Fatih Muhammed; Salepci, Taflan; Oncel, Mustafa; Gumus, Mahmut
Background: The prognostic significance of perineural invasion (PNI) in gastric cancer has been previously investigated in a few studies, but had not reached a consensus. The aim of this study was to determine the prognostic value of PNI in patients with gastric cancer who underwent curative resection. Materials and Methods: We retrospectively analyzed 238 patients who had undergone curative gastrectomy. Paraffin sections of surgical specimens from all patients were stained with hematoxylin and eosin. PNI was defined when carcinoma cells infiltrated into the perineurium or neural fascicles. PNI and the other prognostic factors were evaluated by univariate and multivariate analysis. Results: PNI was detected as positive in 180 of the 238 patients (75.6%). pT stage, tumor size, lymph node metastasis, clinical stage, tumor differentiation, Borrmann classification, histological type, lymphatic vessel invasion, and blood vessel invasion were closely associated with the presence of PNI. The PNI-positive tumors had significantly larger size and more lymph node metastasis than the PNI-negative tumors (P =.001 and P <.001, respectively). The median survival of the PNI-positive patients was significantly worse than that of the PNI-negative patients (28.1 vs. 64.9 months, P =.001). Multivariate analysis indicated that the positivity of PNI was an independent prognostic factor (P =.02, hazard ratio [HR]: 2.75; 95% confidence interval [95% CI]:1.12-3.13) as were classical clinicopathological features. Conclusion: Our results showed that the frequency of PNI was high in patients with gastric cancer who underwent curative gastrectomy and the proportion of PNI positivity increased with progression and clinical stage of disease. PNI may be useful in detecting patients who had poor prognosis after curative resection in gastric cancer.
AtıfScopus101WoS98OpenAlex108İncele - MakaleYalnız künye2010Scopus SJRQ2Does the metastatic lymph node ratio influence the disease-free survival of patients with breast cancer: Single-center experiences
Oven Ustaalioglu, Bala Basak; Bilici, Ahmet; Kefeli, Umut; Şeker, Mesut; Yildirim, Emre; Salepci, Taflan; Oncel, Mustafa; Kement, Metin; Gumus, Mahmut
Background: Axillary lymph nodes (ALNs) are the most important prognostic factor for survival in breast cancer. Pathological evaluation can affect the number of involved lymph nodes. In the current study, we evaluated whether the metastatic lymph node ratio (n ratio) is important in predicting disease-free survival (DFS) for breast cancer patients. Material and Methods: From 802 breast cancer cases, 427 patients with ALN metastasis were analyzed retrospectively. The n ratio was categorized as n ratio 1 (1-10%), n ratio 2 (10.01-50%) and n ratio 3 (>50%). DFS was established according to the Kaplan-Meier method. Predicting risk factors for relapse were analyzed using the Cox proportional hazards model. Results: The n ratio was significantly higher in breast cancer patients with advanced pathologic pT, pN and clinical stage, undifferentiated histology, lymphovascular and extracapsular invasion, more resected ALNs and positive progesterone receptor. In the univariate analysis, multicentricity, necrosis, grade, pN stage, estrogen receptor and progesterone receptor positivity, trastuzumab and neoadjuvant chemotherapy usage, the presence of inflammatory breast cancer and n ratio were found to be important factors in predicting DFS. Multivariate analysis indicated that multicentricity, neoadjuvant chemotherapy, trastuzumab usage and n ratio were significantly associated with prognosis. Conclusions: The n ratio is inexpensive, easily available and a simple prognostic factor for breast cancer patients with positive ALNs.
AtıfScopus8WoS7OpenAlex11İncele