Surgical laparoscopy, endoscopy & percutaneous techniques, Oct 1, 2019
This study was designed to evaluate the impact of a standardized laparoscopic total mesorectal ex... more This study was designed to evaluate the impact of a standardized laparoscopic total mesorectal excision (TME) on the long-term oncologic outcome of unselected patients with rectal cancer (RC). Methods: Unselected consecutive patients with histologically proven RC underwent a standardized laparoscopic TME with medial to lateral approach encompassing 9 sequential steps: (1) ligation of inferior mesenteric vessels, (2) mobilization of the left colon and sigmoid colon (medial to lateral), (3) posterior dissection of the rectum, (4) lateral mobilization of the sigmoid, left colon, and splenic flexure, (5) left and right side dissection of the rectum, (6) anterior dissection of the rectum, (7) transection of the rectum, (8) delivery of the specimen, and (9) colorectal anastomosis. Results: From 2005 to June 2012, laparoscopic sphincter-preserving TME was attempted in 217 patients with a 6.5% conversion rate. There were 91 women and 126 men, aged 58.3 years (range, 22 to 84 y), with body mass index of 26.10 (range, 20 to 45), operative time was 150.4 minutes (range, 60 to 330 min), and 24.7 (range, 4 to 98) lymph nodes were harvested. Length of stay was 7.56 days (range, 3 to 32 d). Complication rate was 17.05%. The mean follow-up time of all patients was 36.12 months (range, 1 to 89 mo). Local recurrence rate was 3.6% and distant recurrence rate was 8.7%. The 5-year disease-free survival rates were 81.5%. Conclusions: A standardized laparoscopic sphincter-preserving TME resulted in a favorable short-term outcome in unselected patients with RC.
Background Young-onset rectal cancer, in patients less than 50 years, is expected to increase in ... more Background Young-onset rectal cancer, in patients less than 50 years, is expected to increase in the coming years. A watch-and-wait strategy is nowadays increasingly practised in patients with a clinical complete response (cCR) after neoadjuvant treatment. Nevertheless, there may be reluctance to offer organ preservation treatment to young patients owing to a potentially higher oncological risk. This study compared patients aged less than 50 years with those aged 50 years or more to identify possible differences in oncological outcomes of watch and wait. Methods The study analysed data from patients with a cCR after neoadjuvant therapy in whom surgery was omitted, registered in the retrospective–prospective, multicentre International Watch & Wait Database (IWWD). Results In the IWWD, 1552 patients met the inclusion criteria, of whom 199 (12.8 per cent) were aged less than 50 years. Patients younger than 50 years had a higher T category of disease at diagnosis (P = 0.011). The diseas...
Background:The study aimed to assess if adherence to a total-neoadjuvant-treatment (TNT) protocol... more Background:The study aimed to assess if adherence to a total-neoadjuvant-treatment (TNT) protocol followed by observation(watch-and-wait) led to the successful nonoperativemanagement of low-rectal-cancer. Methods: In this study, patients with primary, resectable-T3-T4, N0-N1 distal-rectaladenocarcinoma underwent-chemoradiotherapy+consolidation-chemotherapy (TNT). During the-TNT-period, endoscopy, MRI, and FDG-PET/CT were performed. We allocated patients with complete-clinical-tumor-regression, who underwent endoscopy every two months, MRI
Magnetic resonance imaging (MRI) and computerized tomography (CT) are used in the diagnosis and f... more Magnetic resonance imaging (MRI) and computerized tomography (CT) are used in the diagnosis and follow-up of pituitary adenoma cases. Sometimes, these methods cannot display the post-operative residual tissue. It has been shown that some radionuclides were taken up by the pituitary adenomas. The aim of this study was to evaluate the uptake of the technetium-99m (Tc-99m) tetrofosmin (TF) in the pituitary adenoma and normal pituitary tissue and assess the ability of Tc-99m TF to predict tumor malignancy in pituitary gland. The patients with pituitary adenoma (7 invasive and 8 non-invasive) were compared with control group (no. 13). Single-photon emission computed tomography (SPECT) imaging of pituitary gland was performed in both groups. Tc-99m uptake indices were evaluated statistically with the use of Mann-Whitney U test. The average tetrofosmin uptake index of pituitary adenoma is 2.44+/-1.54 for the patients and 1.69+/-0.71 for the control group. Any significant difference was not observed between the groups (p 0.3). The average index was calculated as 3.04+/-2.15 for invasive adenomas and 1.92+/-0.33 for the non-invasive group, and there was no significant difference between the two groups regarding uptake of the agent (p 0.53). Furthermore, it was determined that the invasive and non-invasive adenomas displayed an uptake of Tc-99m TF similar to normal pituitary tissue. Since the pituitary adenoma and normal pituitary tissue gave similar results regarding Tc-99m TF uptake, it was concluded that this agent would not be useful in the diagnosis of pituitary adenoma.
Akut skrotumun ayırıcı tanısı özellikle akut epididimit ve testis torsiyonu için hızla yapılmalıd... more Akut skrotumun ayırıcı tanısı özellikle akut epididimit ve testis torsiyonu için hızla yapılmalıdır. Çünkü testiküler torsiyon gerçek bir cerrahi acildir. Bu makalede akut skrotal ağrısı olan ve tanısında testis sintigrafisi ve Doppler Ultrasonografisi kullanılan iki vakayı ...
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2020
BACKGROUND A robotic surgical approach provides advantages compared to laparoscopy in male patien... more BACKGROUND A robotic surgical approach provides advantages compared to laparoscopy in male patients with mid- and low-lying rectal cancer located in the narrow pelvic space. The aim of this report is to present a single-surgeon experience with robotic sphincter-saving total mesorectal excision of rectal cancer in male patients. METHODS A series of 103 consecutive male patients who underwent robotic rectal surgery between January 2012 and June 2019 were analyzed retrospectively in terms of demographics, histopathological data, and surgical and oncological outcomes. RESULTS All of the patients underwent robotic sphincter-saving resection: 76 (73.8%) underwent low-anterior resection and 27 (26.2%) underwent intersphincteric resection with colo-anal anastomosis. There was no conversion. The median distal resection margin of the operative specimen was 3 (0.2-7) cm. The circumferential resection margin was positive in 3 (2.91%) cases. The median number of retrieved lymph nodes was 22 (18-...
ABSTRACT Objectives: 18F-fluorodeoxyglucose positron emission tomography and computed tomography ... more ABSTRACT Objectives: 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG-PET/CT) has been used with increased frequency in the diagnostic algorithm of patients with soft tissue sarcomas to predict malignant potential of tumors, risk of recurrence, survival and response to chemotherapy. The purpose of this study is to evaluate the sensitivity of PET/CT for the detection, histopathologic correlation and accurate discrimination between newly diagnosed low-grade and high-grade sarcomas, on the basis of FDG avidity. Methods: This retrospective analysis included 42 consecutive patients with known soft tissue sarcoma who all had undergone PET/CT imaging for the initial staging or assessment of recurrence of disease. The maximum standardized uptake value (SUVmax) of each primary and/or most intense metastatic lesion was measured and compared with the histological findings. Results: 18F-FDG- PET/CT detected 97.8% of all sarcomas were FDG avid (median SUVmax 7.7, range 1.6-12.8) with a sensitivity of 93.7% for soft tissue sarcomas. Most (89%) of tumors were intermediate or high grade (FNCLCC grade 2-3). The primary tumor was stage T2b in 64% of cases. The most common pathological diagnoses were leiomyosarcoma (21.4%), undifferentiated or pleomorphic (18.9%), fibrosarcoma (16.5%), liposarcoma (14.2%), synovial sarcoma (12%), malignant peripheral nerve sheath tumor (9.5%), and epitheliod sarcoma (5.5%).The sensitivities of the most common sarcoma histologies were 100% for leiomyosarcomas, 75% for liposarcomas, 80% for synovial sarcomas, 75% for malignant peripheral nerve sheath tumors, 100% for fibroblastic and myoblastic sarcomas, and 100% for malignant fibrohistiocytic tumors. Conclusions: PET/CT is emerging as an reliable combined functional and morphological diagnostic imaging modality in the management of patients with sarcoma.
UNLABELLED Hyper-functioning parathyroid glands with autonomous overproduction of PTH is the most... more UNLABELLED Hyper-functioning parathyroid glands with autonomous overproduction of PTH is the most frequent cause of hypercalcemia in outpatient populations with primary hyper-parathyroidism. It is generally caused by a solitary adenoma in 80%-90% of patients. Despite the various methodologies that are available for preoperative localization of parathyroid lesions, there is still no certain preoperative imaging algorithm to guide a surgical approach prior to the management of primary hyper-parathyroidism (P-HPT). Minimally invasive surgery has replaced the traditional bilateral neck exploration (BNE) as the initial approach in parathyroidectomy at many referral hospitals worldwide. In our study, we investigated diagnostic contributions of SPECT-CT combined with conventional planar scintigraphy in the detection of hyper-functioning parathyroid gland localization, since planar imaging has limitations. We also evaluated the efficacy of preoperative USG in adding to initial diagnostic im...
Surgical laparoscopy, endoscopy & percutaneous techniques, Oct 1, 2019
This study was designed to evaluate the impact of a standardized laparoscopic total mesorectal ex... more This study was designed to evaluate the impact of a standardized laparoscopic total mesorectal excision (TME) on the long-term oncologic outcome of unselected patients with rectal cancer (RC). Methods: Unselected consecutive patients with histologically proven RC underwent a standardized laparoscopic TME with medial to lateral approach encompassing 9 sequential steps: (1) ligation of inferior mesenteric vessels, (2) mobilization of the left colon and sigmoid colon (medial to lateral), (3) posterior dissection of the rectum, (4) lateral mobilization of the sigmoid, left colon, and splenic flexure, (5) left and right side dissection of the rectum, (6) anterior dissection of the rectum, (7) transection of the rectum, (8) delivery of the specimen, and (9) colorectal anastomosis. Results: From 2005 to June 2012, laparoscopic sphincter-preserving TME was attempted in 217 patients with a 6.5% conversion rate. There were 91 women and 126 men, aged 58.3 years (range, 22 to 84 y), with body mass index of 26.10 (range, 20 to 45), operative time was 150.4 minutes (range, 60 to 330 min), and 24.7 (range, 4 to 98) lymph nodes were harvested. Length of stay was 7.56 days (range, 3 to 32 d). Complication rate was 17.05%. The mean follow-up time of all patients was 36.12 months (range, 1 to 89 mo). Local recurrence rate was 3.6% and distant recurrence rate was 8.7%. The 5-year disease-free survival rates were 81.5%. Conclusions: A standardized laparoscopic sphincter-preserving TME resulted in a favorable short-term outcome in unselected patients with RC.
Background Young-onset rectal cancer, in patients less than 50 years, is expected to increase in ... more Background Young-onset rectal cancer, in patients less than 50 years, is expected to increase in the coming years. A watch-and-wait strategy is nowadays increasingly practised in patients with a clinical complete response (cCR) after neoadjuvant treatment. Nevertheless, there may be reluctance to offer organ preservation treatment to young patients owing to a potentially higher oncological risk. This study compared patients aged less than 50 years with those aged 50 years or more to identify possible differences in oncological outcomes of watch and wait. Methods The study analysed data from patients with a cCR after neoadjuvant therapy in whom surgery was omitted, registered in the retrospective–prospective, multicentre International Watch & Wait Database (IWWD). Results In the IWWD, 1552 patients met the inclusion criteria, of whom 199 (12.8 per cent) were aged less than 50 years. Patients younger than 50 years had a higher T category of disease at diagnosis (P = 0.011). The diseas...
Background:The study aimed to assess if adherence to a total-neoadjuvant-treatment (TNT) protocol... more Background:The study aimed to assess if adherence to a total-neoadjuvant-treatment (TNT) protocol followed by observation(watch-and-wait) led to the successful nonoperativemanagement of low-rectal-cancer. Methods: In this study, patients with primary, resectable-T3-T4, N0-N1 distal-rectaladenocarcinoma underwent-chemoradiotherapy+consolidation-chemotherapy (TNT). During the-TNT-period, endoscopy, MRI, and FDG-PET/CT were performed. We allocated patients with complete-clinical-tumor-regression, who underwent endoscopy every two months, MRI
Magnetic resonance imaging (MRI) and computerized tomography (CT) are used in the diagnosis and f... more Magnetic resonance imaging (MRI) and computerized tomography (CT) are used in the diagnosis and follow-up of pituitary adenoma cases. Sometimes, these methods cannot display the post-operative residual tissue. It has been shown that some radionuclides were taken up by the pituitary adenomas. The aim of this study was to evaluate the uptake of the technetium-99m (Tc-99m) tetrofosmin (TF) in the pituitary adenoma and normal pituitary tissue and assess the ability of Tc-99m TF to predict tumor malignancy in pituitary gland. The patients with pituitary adenoma (7 invasive and 8 non-invasive) were compared with control group (no. 13). Single-photon emission computed tomography (SPECT) imaging of pituitary gland was performed in both groups. Tc-99m uptake indices were evaluated statistically with the use of Mann-Whitney U test. The average tetrofosmin uptake index of pituitary adenoma is 2.44+/-1.54 for the patients and 1.69+/-0.71 for the control group. Any significant difference was not observed between the groups (p 0.3). The average index was calculated as 3.04+/-2.15 for invasive adenomas and 1.92+/-0.33 for the non-invasive group, and there was no significant difference between the two groups regarding uptake of the agent (p 0.53). Furthermore, it was determined that the invasive and non-invasive adenomas displayed an uptake of Tc-99m TF similar to normal pituitary tissue. Since the pituitary adenoma and normal pituitary tissue gave similar results regarding Tc-99m TF uptake, it was concluded that this agent would not be useful in the diagnosis of pituitary adenoma.
Akut skrotumun ayırıcı tanısı özellikle akut epididimit ve testis torsiyonu için hızla yapılmalıd... more Akut skrotumun ayırıcı tanısı özellikle akut epididimit ve testis torsiyonu için hızla yapılmalıdır. Çünkü testiküler torsiyon gerçek bir cerrahi acildir. Bu makalede akut skrotal ağrısı olan ve tanısında testis sintigrafisi ve Doppler Ultrasonografisi kullanılan iki vakayı ...
European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology, 2020
BACKGROUND A robotic surgical approach provides advantages compared to laparoscopy in male patien... more BACKGROUND A robotic surgical approach provides advantages compared to laparoscopy in male patients with mid- and low-lying rectal cancer located in the narrow pelvic space. The aim of this report is to present a single-surgeon experience with robotic sphincter-saving total mesorectal excision of rectal cancer in male patients. METHODS A series of 103 consecutive male patients who underwent robotic rectal surgery between January 2012 and June 2019 were analyzed retrospectively in terms of demographics, histopathological data, and surgical and oncological outcomes. RESULTS All of the patients underwent robotic sphincter-saving resection: 76 (73.8%) underwent low-anterior resection and 27 (26.2%) underwent intersphincteric resection with colo-anal anastomosis. There was no conversion. The median distal resection margin of the operative specimen was 3 (0.2-7) cm. The circumferential resection margin was positive in 3 (2.91%) cases. The median number of retrieved lymph nodes was 22 (18-...
ABSTRACT Objectives: 18F-fluorodeoxyglucose positron emission tomography and computed tomography ... more ABSTRACT Objectives: 18F-fluorodeoxyglucose positron emission tomography and computed tomography (18F-FDG-PET/CT) has been used with increased frequency in the diagnostic algorithm of patients with soft tissue sarcomas to predict malignant potential of tumors, risk of recurrence, survival and response to chemotherapy. The purpose of this study is to evaluate the sensitivity of PET/CT for the detection, histopathologic correlation and accurate discrimination between newly diagnosed low-grade and high-grade sarcomas, on the basis of FDG avidity. Methods: This retrospective analysis included 42 consecutive patients with known soft tissue sarcoma who all had undergone PET/CT imaging for the initial staging or assessment of recurrence of disease. The maximum standardized uptake value (SUVmax) of each primary and/or most intense metastatic lesion was measured and compared with the histological findings. Results: 18F-FDG- PET/CT detected 97.8% of all sarcomas were FDG avid (median SUVmax 7.7, range 1.6-12.8) with a sensitivity of 93.7% for soft tissue sarcomas. Most (89%) of tumors were intermediate or high grade (FNCLCC grade 2-3). The primary tumor was stage T2b in 64% of cases. The most common pathological diagnoses were leiomyosarcoma (21.4%), undifferentiated or pleomorphic (18.9%), fibrosarcoma (16.5%), liposarcoma (14.2%), synovial sarcoma (12%), malignant peripheral nerve sheath tumor (9.5%), and epitheliod sarcoma (5.5%).The sensitivities of the most common sarcoma histologies were 100% for leiomyosarcomas, 75% for liposarcomas, 80% for synovial sarcomas, 75% for malignant peripheral nerve sheath tumors, 100% for fibroblastic and myoblastic sarcomas, and 100% for malignant fibrohistiocytic tumors. Conclusions: PET/CT is emerging as an reliable combined functional and morphological diagnostic imaging modality in the management of patients with sarcoma.
UNLABELLED Hyper-functioning parathyroid glands with autonomous overproduction of PTH is the most... more UNLABELLED Hyper-functioning parathyroid glands with autonomous overproduction of PTH is the most frequent cause of hypercalcemia in outpatient populations with primary hyper-parathyroidism. It is generally caused by a solitary adenoma in 80%-90% of patients. Despite the various methodologies that are available for preoperative localization of parathyroid lesions, there is still no certain preoperative imaging algorithm to guide a surgical approach prior to the management of primary hyper-parathyroidism (P-HPT). Minimally invasive surgery has replaced the traditional bilateral neck exploration (BNE) as the initial approach in parathyroidectomy at many referral hospitals worldwide. In our study, we investigated diagnostic contributions of SPECT-CT combined with conventional planar scintigraphy in the detection of hyper-functioning parathyroid gland localization, since planar imaging has limitations. We also evaluated the efficacy of preoperative USG in adding to initial diagnostic im...
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