Browsing by Author "Arikan, Akif Enes"

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Breast Surgery can be Performed Safely During the COVID-19 Pandemic: A Retrospective Single-Center Analysis
(ISTANBUL TRAINING \& RESEARCH HOSPITAL, 2022-01-01) Arikan, Akif Enes; Kara, Halil; Dulgeroglu, Onur; Uras, Cihan
Introduction: The Coronavirus disease-2019 (COVID-19) outbreak has affected the diagnosis and treatment of various diseases including breast cancer. This study aimed to investigate whether breast surgery can be performed safely during the COVID-19 pandemic. Methods: Patients who underwent surgery for breast cancer or suspicious breast lesions in the pre-pandemic, first wave, and second wave periods of the pandemic were evaluated retrospectively. Results: Data of 220 patients who underwent breast surgery were analyzed. No significant difference was found between the pre-pandemic, first wave, and second wave periods of the COVID-19 pandemic in terms of patient characteristics, complications, types of complication, Clavien-Dindo classification of complications, and complications requiring intervention. No COVID-19 related complication was also observed. Conclusion: Breast surgery can be performed safely in the COVID-19 pandemic. For safe surgery, appropriate precautionary measures against COVID-19 and COVID-19 screening should be initiated. COVID-19-free surgical pathway is also important for safe surgery. With the continuation of surgeries, fear of upstaging, subsequent requirement of more aggressive treatment for tumors, and post-pandemic overload can be prevented.
Comparison of effects of energy based devices on quality of life after sutureless thyroidectomy
(LIPPINCOTT WILLIAMS \& WILKINS, 2022-01-01) Arikan, Akif Enes; Ozyegin, Mustafa Ates
Objective: In current literature, no studies evaluated effect of energy-based vessel-sealing-devices on quality of life after sutureless total thyroidectomies. This study aimed to identify any potential differences between two energy-based vessel-sealing-devices (Harmonic Focus, Ligasure LF1212) in patients with benign thyroid disorders who underwent sutureless total thyroidectomy. Materials and methods: Differences in quality of life of patients were evaluated using data obtained by Thy-PRO-39-Tr questionnaire prior to and four-week after surgery. Total and domain-based alterations in quality of life were compared between groups according to energy-based vessel-sealing-devices type (Group L, Group H). Additionally, data including demographics, height, weight, body mass index, neck circumference, sternomental distance were collected. Results: Of 1032 patients, 200 were eligible for study, at the end 193 were analysed. There were no differences between groups in terms of age, sex, body mass index, tobacco use. Analysis did not reveal any differences in overall quality of life between groups (P = .42). However, in ``eye symptoms{''} (P < .001) and ``cognitive functions{''} (P = .002) domains, Harmonic provided statistically improved quality of life. Effect on cognitive function was greater in patients of advanced age. Conclusions: Especially in elderly patients with worsening eye conditions and cognitive functions, use of Harmonic may enhance patients' outcome by increasing quality of life in addition to optimizing surgical outcome when compared to Ligasure.
Do prognosis and clinicopathological features differ in young early-stage breast cancer?
(FRONTIERS MEDIA SA, 2022-01-01) Arikan, Akif Enes; Kara, Halil; Dulgeroglu, Onur; Erdogan, Esin Nur; Capkinoglu, Emir; Uras, Cihan
BackgroundBreast cancer is the most frequently detected cancer and the leading cause of cancer-related death in women. Although it is mostly seen in older patients, breast cancer affects women aged 24 to >70 years, with poorer prognosis in young patients. Young age remains a controversial topic in the literature. This study aimed to identify subtype differences and the effect of age on early-stage breast cancer outcomes. MethodsA total of 300 consecutive patients underwent surgery between 2011 and 2015 for early-stage breast cancer. Of these, 248 were eligible for this study and were divided into three groups: group Y (aged <= 35 years), group M (aged >35 and <= 45 years), and group E (aged >45 years). The clinical and pathological features and data related to recurrence, metastasis, and death were recorded. ResultsNo statistical differences were found between groups regarding histopathological features except for higher histological grade and Ki-67 levels in group M. Additionally, group Y recorded no progression (recurrence or metastasis) or death. Disease-free survival was 117.8 months (95\% CI 111.8-123.8) for group M, which was significantly shorter than that for group E (p < 0.001). Additionally, the hazard ratio (HR) for progression from group M to group E was 10.21 with significant difference (p = 0.003, 95\% CI 2.26-46.08). However, the HR of group Y to group E was 0.04, without significance (p = 0.788, 95\% CI 0.18-345 x 10(6)). The overall 5-year survival was 100\% in group Y, 98.8\% in group M, and 99.3\% in group E, without significance. ConclusionA very young age cannot be considered an independent risk factor for poor prognosis. Rather than age, histological grade and Ki-67 index are more important factors in early-stage breast cancer.
Efficacy of PET-CT in the prediction of metastatic adrenal masses that are detected on follow-up of the patients with prior nonadrenal malignancy: A nationwide multicenter case-control study
(LIPPINCOTT WILLIAMS \& WILKINS, 2022-01-01) Arikan, Akif Enes; Makay, Ozer; Teksoz, Serkan; Vatansever, Safa; Alptekin, Husnu; Albeniz, Gurcan; Demir, Ali; Ozpek, Adnan; Tunca, Fatih
Metastasis is the second most common type of adrenal gland mass. In patients undergoing follow-up for nonadrenal malignancy, adrenalectomy is performed when metastasis to adrenal gland is suspected on the basis of positron emission tomography-computed tomography (PET-CT) imaging. This study investigated the efficacy of PET-CT in the discrimination of metastatic lesions from nonmetastatic lesions in the adrenal glands. In this multicentric study, data was collected from enrolled centers. Forty-one patients who underwent surgery for suspected adrenal metastases were evaluated retrospectively. The following data types were collected: demographic, primary tumor, maximum standardized uptake value of adrenal mass (a-SUVx) and detectability in computed tomography and/or magnetic resonance imaging, and specimen size and histopathology. Six patients were excluded due to unavailability of PET-CT reports and 4 for being primary adrenal malignancy. The rest were divided into 2 groups (metastatic: n = 17, 55\% and nonmetastatic: n = 14, 45\%) according to histopathology reports. There was no statistical difference between the analyzed values, except the a-SUVx (P < .05). The a-SUVx cutoff value was defined as 5.50 by receiver operating characteristic curves and compared with literature. There was no statistical difference when each group was divided as low and high (P > .05). It was found that PET-CT was able to discriminate metastatic lesions from primary benign lesions (P = .022). PET-CT can discriminate primary benign lesions and metastatic lesions by cutoff 5.5 value for a-SUVx.
Has the COVID-19 Pandemic Affected Breast Cancer Stage and Surgical Volume?
(FRONTIERS MEDIA SA, 2022-01-01) Kara, Halil; Arikan, Akif Enes; Dulgeroglu, Onur; Tutar, Burcin; Tokat, Fatma; Uras, Cihan
BackgroundThis study investigates the effects of COVID-19 on the breast cancer stage and the volume of breast cancer surgery in a specialized breast institute. MethodsData of 332 patients who were diagnosed and treated for breast cancer between December 2019 and November 2020 were evaluated retrospectively according to periods of pandemic. ResultsA significant decrease in the number of operations, especially upfront surgeries rather than surgeries after neoadjuvant chemotherapy, was detected in the early period of the COVID-19 pandemic. It was found that patients with complaints were mostly admitted during this period (p = 0.024). No statistical significance was found for age, sex, side of the tumor, type of tumor, surgery to breast, and axilla. Following the early period of the pandemic, it was observed that patients with mostly luminal, early-stage, and less axillary nodal involvement (p < 0.05) were admitted, and as a result, it was founded that upfront surgeries increased, although no change in TNM staging was observed. However, it did affect the decision of initial treatment. Thus, the number of upfront surgeries was significantly higher than the NCT group (p = 0.027) following the early period. ConclusionSurgical volume is significantly affected in the early period of the COVID-19 pandemic. To overcome overload due to delayed surgeries related to pandemics, some hospitals should be spared for oncological treatments. Following the early period, mostly luminal type, early-stage patients were admitted, probably because of increased self-awareness and short wave duration, but the breast cancer stage was not affected.
Management of Mechanical Problems of Totally Implantable Venous Catheters
(MARMARA UNIV, INST HEALTH SCIENCES, 2020-01-01) Kara, Halil; Arikan, Akif Enes; Dulgeroglu, Onur; Uras, Cihan
Objective: Although the most common complications of totally implantable venous catheters(TIVC) are infection and thrombosis, mechanical complications can also affect the treatment and cause catheter removal. This study aimed to investigate mechanical complications of TIVC and prevention methods. Methods: Data of 983 procedures in 961patients who underwent TIVC implantation between 2010 and 2019 in AcibademMaslak, Bakirkoy, and Atakent Hospitals were retrospectively analyzed for mechanical complications. Results: Mechanical complications were encountered in 33(3.3\%) cases: 12(1.2\%) were detachment of TIVC, 8(0.8\%) occlusions, 5(0.5\%) pneumothorax, 1(0.1\%) hemothorax, 1(0.1\%) malposition, 1(0.1\%) extravasation, 2(0.2\%) TIVC rotation, 3(0.3\%) skin necrosis and extrusions. Conclusion: The catheter tip should be placed in distal superior vena cava, reservoir pocket must be sufficient in size, reservoir should be fixed to pectoral muscle or fascia at least two points with nonabsorbable sutures. Subcutaneous fatty tissue resection from reservoir pocket should be performed in obese patients. The nature of the withdrawn blood form Seldinger needle should be checked visually whether venous or not. Risk of pneumothorax and detachment can be reduced by inserting the catheter from 1/3 outer part of the clavicle during percutaneous technique. While complication rate can be reduced by peroperative fluoroscopy use, control X-ray should be taken in symptomatic patients, not routinely. Malposition can be seen in the peroperative period and can usually be corrected by good manipulation. Percutaneous transcatheter retrieval in addition to surgery is the gold standard treatment for detachment of TIVC. The most important factors in preventing complications are surgical experience and good care.
Robotic nipple sparing mastectomy through a single incision: Advantages of starting with posterior dissection
(TURKISH SURGICAL ASSOC, 2020-01-01) Uras, Cihan; Arikan, Akif Enes; Kara, Halil; Dulgeroglu, Onur; Avsar, Yakup
Objective: Loss of breast, which is an important body marking of women, causes a huge decrease in quality of life (QoL) after treatment. In order to overcome this morbidity and increase QoL, nipple sparing mastectomy (NSM) has been developed. Even though the demand for better cosmetic results has yielded endoscopic nipple sparing mastectomy, limitations like unsuitable optical window and limited manual control of rigid-tip instruments, and struggling to keep dissection space have led robotic nipple sparing mastectomy (rNSM) to be developed. Material and Methods: Records of three patients who underwent to rNSM for invasive breast carcinoma with DaVinci Xi (Intuitive Surgical, Sunnyvale, CA) in affiliated hospitals of Acibadem Mehmet Ali Aydinlar University, Research Institute of Senology in 2018 were investigated retrospectively. In all breasts (n= 4), dissection was started from the posterior side of breast. Results: In the unit, 738 breast cancer patients underwent surgery between 2018 and 2019 with an NSM ratio of 31.4\% (n= 232). Of these patients, three underwent rNSM with DaVinci Xi robotic system. The operation was performed on the left breast in one patient, right in one, and bilateral in one patient. Only in patient \#2, who was a neoadjuvant chemotherapy recipient, seroma was observed six weeks after surgery (3 weeks after removal of drains) and spontaneously resolved in 4 weeks. No other complication was seen in all patients. In the follow-up period of median 21 months, no loco-regional recurrence or distant metastasis was seen. Conclusion: A single incision robotic mastectomy can be performed easily and safely when the dissection starts from the pre-pectoral plane rather than the subcutaneous plane.
Role of Sentinel Lymph Node Biopsy During Contralateral Prophylactic Mastectomy
(ISTANBUL TRAINING \& RESEARCH HOSPITAL, 2020-01-01) Kara, Halil; Arikan, Akif Enes; Dulgeroglu, Onur; Uras, Cihan
Introduction: Contralateral prophylactic mastectomy (CPM) is the removal of the opposite breast with the aim of risk reduction in cases of unilateral breast carcinoma. Routine use of sentinel lymph node biopsy (SLNB) at the time of CPM is controversial due to low occult breast cancer risk. This study aims to determine the rate of occult breast carcinoma and to evaluate whether SLNB should be performed during CPM. Methods: Ninety-four patients who underwent CPM between 2009 and 2018 were evaluated retrospectively. Occult breast carcinoma detection rate and approach to axilla were evaluated. Results: Occult invasive breast carcinoma was detected in three patients (3.2\%): two invasive ductal carcinoma and one multifocal invasive lobular carcinoma. Axillary staging was performed in second session. SLNB was performed in two patients and a micro-metastasis in one of four sentinel lymph nodes (SLN) was detected in one patient. Axillary lymph node dissection was performed in one patient in whom SLN was not detected. Conclusion: SLNB can be performed in patients with suspicious lesion in the absence of biopsy or in patients with high-risk of occult breast cancer (postmenopausal, high Gail score, lobular histology, multi-centric tumor, ipsilateral high-risk lesion)