Browsing by Author "Uras, Cihan"

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Actinomycosis of Cecum Associated with Entamoeba Infection Mimicking Perforated Colon Cancer
(HINDAWI LTD, 2013-01-01) Boler, Deniz Eren; Uras, Cihan; Goksel, Sha; Karaarslan, Andmehmet
Actinomycosis is a granulomatous disease caused by Actinomyces that mimics other intra-abdominal pathologies especially neoplasms. Correct diagnosis can be rarely established before radical surgery. On the other hand Entamoeba infection affects a considerable number of people worldwide. To our knowledge only one case has been reported to be affected by both organisms. We report a man who has been operated for a mass in the cecum mimicking a perforated colon cancer. Abdominal CT revealed amass with features of an invading neoplasm. After radical surgery, definitive pathology revealed that the mass was due to actinomycosis associated with Entamoeba infection. The postoperative period was uneventful and the patient was on long-course antibiotherapy. It is important to consider actinomycosis especially in patients with intra-abdominal masses with unusual aggressiveness to prevent unnecessary surgery. However, surgery can be unavoidable especially in the presence of complicated disease or high index of suspicion for malignancy.
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.
Correlations Between Oncotype DX Recurrence Score and Classic Risk Factors in Early Breast Cancer: Results of A Prospective Multicenter Study in Turkey
(AVES, 2016-01-01) Ozmen, Vahit; Atasoy, Ajlan; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, Engin; Demircan, Orhan; Isikkdogan, Abdurrahman; Cabioglu, Neslihan; Sen, Fatma; Saip, Pinar
Objective: Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the correlations between Recurrence Score (RS) and routine risk factors. Materials and Methods: Ten academic centers across Turkey participated in this prospective trial. Consecutive patients with breast cancer who had pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at tumor conferences. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classic risk factors were evaluated using univariate and multivariate analyses. Results: Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of the 165 patients, 57\% had low RS, 35\% had intermediate RS, and 8\% had high RS, respectively. Multivariate analysis indicated that progesterone receptor (PR) and Ki67 scores were significantly related to RS. Conclusion: Oncotype DX Recurrence Score does not seem to have a significant correlation with the majority of classic risk factors, but it may have a correlation with PR score and Ki67 score.
Cost effectiveness of Gene Expression Profiling in Patients with Early-Stage Breast Cancer in a Middle-Income Country, Turkey: Results of a Prospective Multicenter Study
(AVES, 2019-01-01) Ozmen, Vahit; Cakar, Burcu; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, Engin; Demircan, Orhan; Isikdogan, Abdurrahman; Saip, Pinar
Objective: Breast cancer is a heterogenous disease, and genetic profiling helps to individualize adjuvant treatment. The Oncotype DX is a validated test to predict benefit of adjuvant systemic treatment. The aims of this study are to determine the costs of chemotherapy in government hospitals in Turkey and evaluate the cost-effectiveness of the Oncotype DX from the national insurance perspective. Materials and Methods: A Markov model was developed to make long term projections of distant recurrence, survival, quality adjusted life expectancy, and direct costs for patients with ER+, HER2-, node-negative or up to 3 node-positive early stage breast cancer. Turkish decision impact study patient data were captured for model reference. In that study, ten academic centers across Turkey participated in a prospective trial. Of 165 patients with pT1-3, pN0-N1mic, ER-positive, and HER-2 negative tumors, 57\% had low recurrence score (RS), 35\% had intermediate RS, and 8\% had high RS, respectively. The overall rate of change in chemotherapy treatment decisions following Oncotype DX was 33\%. Results: The cost of adjuvant chemotherapy in public hospitals was estimated at \$3.649, and Oncotype Dx test was \$5.141. Based on the cost-effectiveness analysis, Oncotype DX testing was estimated to improve life expectancy (+0.86 years) and quality-adjusted life expectancy (+0.68 QALYs) versus standard care. The incremental cost-effectiveness ratio (ICERs) of Oncotype DX was estimated to be \$7207.9 per QALY gained and \$5720.6 per LY gained versus current clinical practice. Conclusion: As Oncotype DX was found both cost-effective and life-saving from a national perspective, the test should be introduced to standard care in patients with ER+, HER-2 negative early-stage breast cancer in Turkey.
Dealing with the gray zones in the management of gastric cancer: The consensus statement of the Istanbul Group
(AVES, 2019-01-01) Aytac, Erman; Aslan, Fatih; Cicek, Bahattin; Erdamar, Sibel; Gurses, Bengi; Guven, Koray; Falay, Okan; Karahasanoglu, Tayfun; Selcukbiricik, Fatih; Selek, Ugur; Atalar, Banu; Balik, Emre; Tozun, Nurdan; Rozanes, Izzet; Arican, Ali; Hamzaoglu, Ismail; Baca, Bilgi; Mandell, Nil Molinas; Saruc, Murat; Goksel, Suha; Demir, Gokhan; Agaoglu, Fulya; Yakicier, Cengiz; Ozbek, Ugur; Ozben, Volkan; Ozyar, Enis; Guner, Ahmet Levent; Er, Ozlem; Kaban, Kerim; Bolukbasi, Yasemin; Bugra, Dursun; Ahishali, Emel; Asian, Fatih; Boz-bas, Aysun; Hamzaoglu, Hulya; Karaman, Ahmet; Kucukmetin, Nurten Turkel; Vardareli, Eser Kutsal; Onder, Fatih Oguz; Sisman, Gurhan; Tiftikci, Arzu; Unal, Hakan Umit; Yapali, Suna; Acar, Sami; Agcaoglu, Orhan; Aghayeva, Afag; Akyuz, Ali; Atasoy, Deniz; Batik, Emre; Bayraktar, Ilknur Erenler; Bayram, Onur; Bilgic, Cagri; Bilgin, Ismail Ahmet; Can, Ugur; Dulgeroglu, Onur; Durukan, Ugur; Gencosmanoglu, Rasim; Gonenc, Murat; Gurbuz, Bulent; Kaya, Mesut; Omarov, Nail; Ozben, Volkan; Ozgur, Ilker; Ozoran, Emre; Sobutay, Erman; Uras, Cihan; Uymaz, Derya; Zenger, Serkan; Ozbek, Ugur; Yakicier, M. Cengiz; Afsar, Cigdem Usul; Bozkurt, Mustafa; Demir, Atakan; Er, Ozlem; Kanitez, Metin; Korkmaz, Taner; Mandel, Nil Molina; Mert, Askhan Guven; Ozer, Leyla; Sonmez, Ozlem; Tunali, Didem; Uluc, Basak Oyan; Yazar, Aziz; Yildiz, Ibrahim; Demirkurek, Cengiz; Guner, Ahmet Levent; Vardareli, Erkan; Armutlu, Aye; Baba, Fisun; Ersozlu, Ilker; Kapran, Yersu; Sahin, Davut; Abacioglu, Mehmet Ufuk; Bese, Nuran; Durankus, Nilufer Kilic; Gural, Zeynep; Ozyar, Enis; Sengoz, Meric; Sezen, Duygu; Caliskan, Can; Guven, Koray; Karaaslan, Ercan; Kizilkaya, Esref; Suleyman, Erdogan; Grp, Istanbul
The geographical location and differences in tumor biology significantly change the management of gastric cancer. The prevalence of gastric cancer ranks fifth and sixth among men and women, respectively, in Turkey. The international guidelines from the Eastern and Western countries fail to manage a considerable amount of inconclusive issues in the management of gastric cancer. The uncertainties lead to significant heterogeneities in clinical practice, lack of homogeneous data collection, and subsequently, diverse outcomes. The physicians who are professionally involved in the management of gastric cancer at two institutions in Istanbul, Turkey, organized a consensus meeting to address current problems and plan feasible, logical, measurable, and collective solutions in their clinical practice for this challenging disease. The evidence-based data and current guidelines were reviewed. The gray zones in the management of gastric cancer were determined in the first session of this consensus meeting. The second session was constructed to discuss, vote, and ratify the ultimate decisions. The identification of the T stage, the esophagogastric area, imaging algorithm for proper staging and follow-up, timing and patient selection for neoadjuvant treatment, and management of advanced and metastatic disease have been accepted as the major issues in the management of gastric cancer. The recommendations are presented with the percentage of supporting votes in the results section with related data.
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.
Favorable locoregional control in clinically node-negative hormone-receptor positive breast cancer with low 21-gene recurrence scores: a single-institution study with 10-year follow-up
(BMC, 2022-01-01) Uras, Cihan; Cabioglu, Neslihan; Tokat, Fatma; Er, Ozlem; Kara, Halil; Korkmaz, Taner; Bese, Nuran; Ince, Umit
Background Recent studies have shown a lower likelihood of locoregional recurrences in patients with a low 21-gene recurrence score (RS). In this single-institution study, we investigated whether there are any associations between different cutoff values of 21-gene RS, histopathological factors, and outcome in patients with long-term follow-up. Methods The study included 61 patients who had early-stage (I-II) clinically node-negative hormone receptor-positive and HER2-negative breast cancer and were tested with the 21-gene RS assay between February 2010 and February 2013. Demographic, clinicopathological, treatment, and outcome characteristics were analyzed. Results The median age was 48 years (range, 29-72 years). Patients with high histologic grade (HG), Ki-67 >= 25\%, or Ki-67 >= 30\% were more likely to have intermediate/high RS (>= 18). Based on the 21-gene RS assay, only 19 patients (31\%) received adjuvant chemotherapy. At a median follow-up of 112 months, 3 patients developed locoregional recurrences (4.9\%), which were treated with endocrine therapy alone. Among patients treated with endocrine treatment alone (n = 42), the following clinicopathological characteristics were not found to be significantly associated with 10-year locoregional recurrence free survival (LRRFS): age < 40 years, age < 50 years, high histological or nuclear grade, high Ki-67-scores (>= 15\%, >= 20\%, >= 25\%, >= 30\%), presence of lymphovascular invasion, luminal-A type, multifocality, lymph node positivity, tumor size more than 2 cm, RS >= 18, and RS > 11. However, patients with RS >= 16 had significantly poorer 10-year LRRFS compared to those with RS < 16 (75\% vs. 100\%, respectively
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.
Impact of Oncotype DX Recurrence Score on Treatment Decisions: Results of a Prospective Multicenter Study in Turkey
(CUREUS INC, 2016-01-01) Ozmen, Vahit; Atasoy, Ajlan; Gokmen, Erhan; Ozdogan, Mustafa; Guler, Nilufer; Uras, Cihan; Ok, Engin; Demircan, Orhan; Isikdogan, Abdurrahman; Saip, Pinar
Introduction: Breast cancer is the most common malignancy among Turkish women and the rate of early stage disease is increasing. The Oncotype DX (R) 21-gene assay is predictive of distant recurrence in ER-positive, HER2-negative early breast cancer. We aimed to evaluate the impact of the Recurrence Score (R) (RS) on treatment decisions and physician perceptions in Turkey. We also studied correlations between RS and routine risk factors. Patients and Methods: Ten academic centers across Turkey participated in this prospective trial. Consecutive breast cancer patients with pT1-3, pN0-N1mic, ER-positive, and HER2-negative tumors were identified at multidisciplinary tumor conferences. The initial treatment decision was recorded before tumor blocks were sent to the central laboratory. Each case was brought back to tumor conference after receiving the RS result. Both pre- and post-RS treatment decisions and physician perceptions were recorded on questionnaire forms. Correlations between RS and classical risk factors were evaluated using univariate and multivariate analyses. Results: Ten centers enrolled a total of 165 patients. The median tumor size was 2 cm. Of 165 patients, 57\% had low RS, 35\% had intermediate RS, and 8\% had high RS, respectively. The overall rate of change in treatment decision was 33\%. Initially, chemotherapy followed by hormonal therapy (CT+HT) was recommended to 92 (56\%) of all patients, which decreased to 61 (37\%) patients post-RS assay (p<0.001). Multivariate analysis indicated that progesterone receptor (PR) and Ki-67 scores were significantly related to RS. Conclusion: Oncotype DX testing may provide meaningful additional information in carefully selected patients.
LASER-ASSISTED-INDOCYANINE-GREEN-ANGIOGRAPHY VERSUS CONVENTIONAL ASSESSMENT TO PREDICT OR LOCATE NECROTIC AREAS ON MASTECTOMY FLAPS: A PROSPECTIVE CLINICAL TRIAL
(ISTANBUL UNIV, FAC MEDICINE, PUBL OFF, 2019-01-01) Balci, Fatih Levent; Uras, Cihan
Objective: The aim of this study was to determine whether laser-assisted-indocyanine-green-angiography (LA-ICGA) could accurately predict flap necrosis in comparison to conventional clinical assessment and visually identify its location during immediate reconstruction following a nipple-sparing mastectomy (NSM). Methods: Twenty-one patients with breast cancer were prospectively enrolled to undergo NSM with immediate implant reconstruction. In 19 cases LA-ICGA numbers were used to show the level of laser absorption of hypo-perfused areas on the mastectomy flaps. Those numbers were compared to conventional assessment to assess the predictive value of LA-ICGA. Results: Of the 19 mastectomy flaps, 3 (15.8\%) examples of partial skin flap necrosis with an LA-ICGA value of <= 7 was observed. The sensitivity, specificity, false-positive rate, and accuracy of LA-ICGA were 43\%, 100\%, 57\%, and 79\%, respectively. Patients with an LA-ICGA value of <= 7 were found more likely to develop mastectomy flap necrosis, whereas patients aged >60 or, a history of smoking, a BMI >30, or intraoperative use of tumescence solution containing epinephrine were more likely to have an LA-ICGA score <= 7 which is not clinically reliable in predicting necrosis. Conclusion: Our results indicate that a low LA-ICGA score <= 7 is the only significant factor in predicting mastectomy flap necrosis. LA-ICGA could accurately show the location of necrosis.
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.
Mide Ülserli Hastalarda Endoskopi Tekrarı Akılcı Bir Yaklaşım mı?
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2010-01-01) Saruç, Murat; Böler, Deniz; Karaarslan, Mehmet; İnce, Ümit; Raşa, Kemal; Uras, Cihan; Çakmakçı, Metin; Tözün, Nurdan
ÖZET Giriş ve Amaç: Midede izlenen lezyonlarda benign olanlar ile malign olanların ayrımında tekrar endoskopi gerekliliği yaygın olarak kabul edilmiş bir yaklaşımdır. Fakat klinik pratikte hastaları ikinci veya üçüncü gastroskopi için ikna etmek kolay olmamaktadır. Gastroenteroloğun kendi kliniği tabanlı verileri ile endikasyonlarını kontrol etmesi, hastalarına kanıta dayalı tıp uygulayabilmesi için gereklidir. Bu çalışmada kliniğimizdeki tekrar endoskopi endikasyon ve sonuçlarını değerlendirdik. Yöntem: Tekrar endoskopiyi kabul eden ve ilk endoskopisinde malign olduğu kanıtlanabilen lezyonu olmayan hastalar çalışmamıza alındı. Hastalar son tanı, tanıya ulaşabilmek için gereken endoskopik işlem sayısı ile endoskopik ve patolojik bulgular yönünden değerlendirildiler. Bulgular: Gastrik ülserli seksen üç hastaya tekrar endoskopisi yapıldı. Ortalama endoskopi sayısı 2.15 idi. Dokuz hastada 3, 3 hastada 4 endoskopi işlemi gerekli olmuşken, hiç bir hastada 5.kez endoskopi işlemi yapmak gerekli olmamıştır. Seksen üç hastanın 77’sinde tekrar endoskopide ülser gözlenmedi. Fakat 6 hastada (%7.2) malign ülser olduğu kanıtlandı. Bunların 4’ü ikinci endoskopide tanınırken, iki hastanın tanısı ancak 3. işlemler sonrasında doğrulanabildi. Hastaların 5’inde gastrik adenokanser bulunurken, diğer olguda gastrik lenfoma saptandı. Beş gastrik kanserli hastanın 2’sinde (%40) erken mide kanseri olduğu görüldü. Sonuç: Çalışma sonuçlarımız gastrik ülser saptanan hastalarda tekrar endoskopilerinin gerekliliğini doğrulamaktadır. Olgularımızdaki malignansi oranı %7.2’dir. Bu yüksek oran klinisyeni ve endoskopisti tekrar endoskopileri yaparak gastrik ülser iyileşmesinin doğrulanması gerekliliği konusunda cesaretlendirmelidir.
Oncologic safety of nipple-sparing mastectomy in patients with short tumor-nipple distance
(WILEY, 2019-01-01) Balci, Fatih Levent; Kara, Halil; Dulgeroglu, Onur; Uras, Cihan
Background There is a tendency to avoid nipple-sparing mastectomy (NSM) when a tumor-nipple distance (TND) is NSM with immediate reconstruction are oncologically safe when TND is NSM followed by immediate reconstruction for breast cancer were retrospectively analyzed. Patients who are negative for nipple-base in either frozen-section or paraffin histopathology were included. MRI was used to obtain TNDs to compare local-recurrence-free and disease-free survival in group I (TND <2 cm) and group II (TND >= 2 cm). Disease-free survival rates were determined to assess the outcome. Results Of the 214 cases with malignancy on MRI, 21 cases diagnosed with pure ductal carcinoma in situ were excluded. Among the 193 NSM cases diagnosed with invasive cancer, TND was <2.0 cm in 59 (30.56\%) cases and >= 2.0 cm in 134 (69.43\%) cases. No significant differences were found between groups in regards to ER, PR, HER2-neu status, and nodal involvement (P = 0.34, P = 0.41, P = 0.54, and P = 0.12 respectively). In a median follow-up time of 62 months (range
Primary surgery in patients with de novo stage IV BC
(2021-01-01) Soran, Atilla; Ozmen, Vahit; Ozbas, Serdar; Karanlik, Hasan; Muslumanoglu, Mahmut; Igci, Abdullah; Canturk, Zafer; Utkan, Zafer; Ozaslan, Cihangir; Evrensel, Turkkan; Uras, Cihan; Aksaz, Erol; Soyder, Aykut; Ugurlu, Umit; Col, Cavit; Cabioglu, Neslihan; Erdem, Ergun; Gurleyik, Gunay; Sezgin, Efe
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.
Robotic single port cholecystectomy (R-LESS-C): Experience in 36 patients
(ELSEVIER SINGAPORE PTE LTD, 2014-01-01) Uras, Cihan; Boler, Deniz Eren; Erguner, Ilknur; Hamzaoglu, Ismail
Background: Laparoendoscopic single-site surgery (LESS) has emerged as a result of a search for ``pain-less{''} and ``scar-less{''} surgery. Laparoendoscopic single-site cholecystectomy (LESS-C) is probably the most common application in general surgery, although it harbors certain limitations. It was proposed that the da Vinci Single-Site (Si) robotic system may overcome some of the difficulties experienced during LESS, providing three dimensional views and the ability to work in a right-handed fashion. Thirty-six robotic single port cholecystectomies (R-LESS-C) performed with the da Vinci Si robotic system are evaluated in this paper Materials and methods: R-LESS-C performed in 36 patients were reviewed. The data related to the perioperative period (i.e., anesthesia time, operation time, docking time, and console time) was recorded prospectively, whereas the hospitalization period, postoperative visual analogue scale (VAS) pain scores were collected retrospectively. Results: A total number of 36 patients, with a mean age of 40.1 years (21-64 years), underwent R-LESS-C. There were five men and 31 women. The mean anesthesia and operation times were 79.3 minutes (45-130 minutes) and 61.8 minutes (34-110 minutes), respectively. The mean docking time was 9.8 minutes (4-30 minutes) and the mean console time was 24.9 minutes (7-60 minutes). The mean hospital stay was 1.05 days (1-2 days) and the mean pain score (VAS) was 3.6 (2-8) in the first 24 hours. Incisional hernia was recorded in one patient. Conclusion: R-LESS-C can be performed reliably with acceptable operative times and safety. The da Vinci Si robotic system may ease LESS-C. Two issues should be considered for routine use: expensive resources are needed and the incidence of incisional hernia may increase. Copyright (C) 2013, Asian Surgical Association. Published by Elsevier Taiwan LLC. All rights reserved.
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)
Usual and Unusual Pathologies of Appendicitis: A Retrospective Analysis of 385 Patients
(Acıbadem Mehmet Ali Aydınlar Üniversitesi, 2021-12-01) Yardımcı, Veysi Hakan; Uras, Cihan
ABSTRACT Purpose: Appendectomy is the most common abdominal surgery performed worldwide. In this report, we evaluated the results of pathological examinations of acute appendicitis specimens. Methods: We performed a retrospective analysis of patients operated on for acute appendicitis at our surgical department from 2009 to 2017. Data on age, gender, and pathological diagnostic parameters were analyzed. Results: A total of 385 patients (168 women [43.6%] and 217 men [56.4%]), were classified into acute appendicitis (Group 1), normal appendix (Group 2), and unusual pathological findings (Group 3) groups. The patients undergoing appendectomy were mostly in the 21–30 (n = 136, 35.3%) and 31–40 years (n = 118, 30.6%) age groups. The negative appendectomy rate was 4.4% in Group 2, and the proportion of women (70.6%) was significantly higher in that group than the other groups (p <0.05). In total, 24 (6.2%) patients had unexpected findings. Among the appendix tumors (n = 12 [3.1%]) in our series, low-grade mucinous neoplasm (n = 6, 1.6%) was the most common, followed by a well differentiated neuroendocrine tumor (n = 3, 0.8%). Conclusion: Although unusual pathological findings are rare during appendectomy, all appendectomy specimens should be sent for routine histopathological examination. The abnormal incidental findings of 24 cases in this series had a significant impact on management. Patients with rare abnormalities should be treated according to the results of their pathological reports.
Vacuum-assisted stereotactic breast biopsy in the diagnosis and management of suspicious microcalcifications
(TURKISH SOC RADIOLOGY, 2016-01-01) Esen, Gul; Tutar, Burcin; Uras, Cihan; Calay, Zerrin; Ince, Umit; Tutar, Onur
PURPOSE We aimed to present our biopsy method and retrospectively evaluate the results, upgrade rate, and follow-up findings of stereotactic vacuum-assisted breast biopsy (VABB) procedures performed in our clinic. METHODS Two hundred thirty-four patients with mammographically detected nonpalpable breast lesions underwent VABB using a 9 gauge biopsy probe and prone biopsy table. A total of 195 patients (median age 53 years, range 32-80 years) with 198 microcalcification-only lesions with a follow- up of at least one year were included in the study. The location of the lesion relative to the needle was determined from the postfire images, and unlike the conventional technique, tissue retrieval was predominantly performed from that location, followed by a complete 360 degrees rotation, if needed. RESULTS The median core number was 8.5. Biopsy results revealed 135 benign, 24 atypical, and 39 malignant lesions. The total upgrade rate at surgery was 7.7\% (6.1\% for ductal carcinomas in situ and 10.5\% for atypical lesions). Patients with benign lesions were followed up for a median period of 27.5 months, with no interval change. At the follow-up, scar formation was seen in 23 patients (17\%)