Araştırma Çıktıları
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Item Hypofractionated Preoperative Chemoradiotherapy In Locally Advanced Rectal Cancer: Preliminary Results(KARE PUBL, 2019-01-01) Oskeroglu Kaplan, Sedenay; Akboru, Halil; Dincer Tabak, Selvi; Baskaya Yucel, Serap; Meral, Ibrahim; Sarali, Yunus; Sengiz Erhan, Selma; Altin, SuleymanOBJECTIVE The aim of the present study was to evaluate the efficacy and safety of preoperative hypofractionated chemoradiotherapy in our patients with locally advanced rectum cancer, which was previously observed in the Far East (KROG 11-02). METHODS Twenty-seven patients with locally advanced rectal cancer (cT3-4N0-2M0) between November 2014 and August 2016 were included in the study. A 2-week schedule of hypofractionated radiotherapy, 33 Gy/10 fractions, with concurrent 1 cycle of oral capecitabine (1650 mg/m2/day) was applied. Patients were planned to undergo surgery 6-8 weeks after the completion of chemoradiotherapy. End points were tumor responses and toxicity. RESULTS All patients underwent total mesorectal excision except for only 1 patient, and statistical analysis was performed on 26 patients. Of the 27 patients, 10 (38.4\%) were downstaged, and 3 (11.5\%) had a pathologically complete response. No grade 3-4 toxicity was observed in the patient group. Grade 1-2 hematologic toxicity developed in 2 (8\%) patients, and no biochemical abnormality was observed. Gastrointestinal toxicity was observed in 17 (65\%), genitourinary toxicity in 8 (30\%), and radiodermatitis in 3 (11\%) patients. One patient had permanent anastomosis and wound dehiscence, and presacral abscess was also seen in one patient. Enterocutaneous fistula developed in only one patient. CONCLUSION A 2-week schedule of radiotherapy with oral capecitabine in patients with locally advanced rectal cancer resulted in similar toxicity levels and tumor response rate in comparison with previous results.Item Totally Robotic Versus Totally Laparoscopic Surgery for Rectal Cancer(LIPPINCOTT WILLIAMS \& WILKINS, 2018-01-01) Esen, Eren; Aytac, Erman; Agcaoglu, Orhan; Zenger, Serkan; Balik, Emre; Baca, Bilgi; Hamzaoglu, Ismail; Karahasanoglu, Tayfun; Bugra, DursunIn this study, perioperative and short-term postoperative results of totally robotic versus totally laparoscopic rectal resections for cancer were investigated in a comparative manner by considering risk factors including obesity, male sex, and neoadjuvant treatment. In addition to overall comparison, the impact of sex, obesity (body mass index >= 30 kg/m(2)), and neoadjuvant treatment was assessed in patients who had a total mesorectal excision (TME). Operative time was longer in the robotic group (P<0.001). In obese patients who underwent TME, the mean length of hospital stay was shorter (7 +/- 2 vs. 9 +/- 4 d, P=0.01), and the mean number of retrieved lymph nodes was higher (30 +/- 19 vs. 23 +/- 10, P=0.02) in the robotic group. Totally robotic and totally laparoscopic surgery appears to be providing similar outcomes in patients undergoing rectal resections for cancer. Selective use of a robot may have a role for improving postoperative outcomes in some challenging cases including obese patients undergoing TME.Item Turnbull-Cutait technique without ileostomy after total mesorectal excision is associated with acceptably low early post-operative morbidity(WILEY, 2021-01-01) Guner, Osman Serhat; Tumay, Latif VolkanBackground: This study aimed to compare the standard one-stage coloanal anastomosis (CAA) technique plus diverting ileostomy and the Turnbull-Cutait (T-C) technique with delayed CAA in terms of early post-operative morbidity in patients with low rectal cancer. Methods: A total of 33 patients with non-metastatic distal rectal cancer who were operated with one of the two different reconstruction methods (one-stage CAA plus diverting ileostomy or two-stage T-C technique with delayed CAA) after total mesorectal excision were included in this retrospective study. The two groups were compared for early postoperative morbidity within 30 post-operative days using complication frequency, Clavien-Dindo classification and Comprehensive Complication Index scores. Results: The two groups did not differ in terms of morbidity parameters, including frequency of any morbidity, presence of grade 3b morbidity requiring management under general anaesthesia, as well as Comprehensive Complication Index score (P > 0.05 for all). Conclusion: Our findings suggest that the two techniques did not differ in terms of early post-operative morbidity. Owing to its comparable morbidity and safety to CAA plus concomitant ileostomy performed at the same session, the T-C technique may be considered in distal rectal cancer patients refusing to have a temporary stoma and in patients in whom CAA poses technical difficulties during the initial operation.Item Optimizing the Personalized Care for the Management of Rectal Cancer: A Consensus Statement(AVES, 2022-01-01) Aytac, Erman; Ozer, Leyla; Baca, Bilgi; Balik, Emre; Kapran, Yersu; Taskin, Orhun Cig; Uluc, Basak Oyan; Abacioglu, Mehmet Ufuk; Gonenc, Murat; Bolukbasi, Yasemin; Cil, Barbaros E.; Baran, Bulent; Aygun, Cem; Yildiz, Mehmet Erdem; Unal, Kemal; Erkol, Burcak; Yalti, Tunc; Ozbek, Ugur; Attila, Tan; Tozun, Nurdan; Gurses, Bengi; Erdamar, Sibel; Er, Ozlem; Bese, Nuran; Bilge, Orhan; Ceyhan, Guralp Onur; Mandel, Nil Molinas; Selek, Ugur; Yakicier, Cengiz; Karabey, Hulya Kayserili; Saruc, Murat; Ozben, Volkan; Esen, Eren; Ozoran, Emre; Vardareli, Erkan; Guner, Levent; Hamzaoglu, Ismail; Bugra, Dursun; Karahasanoglu, Tayfun; Grp, IstanbulColorectal cancer is the third most common cancer in Turkey. The current guidelines do not provide sufficient information to cover all aspects of the management of rectal cancer. Although treatment has been standardized in terms of the basic principles of neoadjuvant, surgical, and adjuvant therapy, uncertainties in the management of rectal cancer may lead to significant differences in clinical practice. In order to clarify these uncertainties, a consensus program was constructed with the participation of the physicians from the Acibadem Mehmet Ali Aydinlar and Koc Universities. This program included the physicians from the departments of general surgery, gastroenterology, pathology, radiology, nuclear medicine, medical oncology, radiation oncology, and medical genetics. The gray zones in the management of rectal cancer were determined by reviewing the evidence-based data and current guidelines before the meeting. Topics to be discussed consisted of diagnosis, staging, surgical treatment for the primary disease, use of neoadjuvant and adjuvant treatment, management of recurrent disease, screening, follow-up, and genetic counseling. All those topics were discussed under supervision of a presenter and a chair with active participation of related physicians. The consensus text was structured by centralizing the decisions based on the existing data.Item Robotic Rectal Cancer Surgery with the da Vinci Xi System: First 100 Cases(ISTANBUL TRAINING \& RESEARCH HOSPITAL, 2019-01-01) Ozben, Volkan; Dogruoz, Alper; Boga, Salih Anil; Aytac, Erman; Baca, Bilgi; Hamzaoglu, Ismail; Karahasanoglu, TayfunIntroduction: The da Vinci Xi system, the latest model of the robotic technology, is proposed to enable multiquadrant abdominal surgery to be performed in a fully robotic approach without the need for a laparoscopic assistance, robot re-docking or re-positioning of the trocars. However, the literature has limited data on this topic. In this study, we aimed to evaluate the feasibility of the Xi robot use in rectal cancer surgery, a multiquadrant surgical procedure. Methods: Patients undergoing robotic mezorectal excision for rectal adenocarcinoma using the da Vinci Xi system between December 2014 and June 2017 were included in this study. Data were collected prospectively and analyzed retrospectively. Demographic data, perioperative clinical findings, histopathologic data and postoperative 30-day outcomes were analyzed. Results: One hundred patients were included in this study. There were 57 male and 43 female patients with a mean age of 61.4 +/- 12.3 years. Low anterior resection and abdominoperineal recetion were performed in 90 and 10 patients, respectively. In all the operations, the abdominal and pelvic stages of the procedure were completed robotically without a need for dual docking or trocar re-positioning. The mean operative time was 328.4 +/- 105.8 min and blood loss was 131.7 +/- 170.3 mL. Intraoperative complication occurred in 2 patients (2\%). Two procedures were converted to open surgery (2\%). The mean number of harvested lymph nodes was 25.3 +/- 12.0. All the surgical margins were clear except for four patients (4\%). The rate of incomplete mesorectal fascia was 3.2\%. The mean length of hospital stay was 6.6 +/- 3.6 days and the overall postoperative morbidity rate was 25\%. Conclusion: The da Vinci Xi model enables rectal cancer operations to be performed in a fully robotic fashion. This feature of the robot helps surgeon to benefit optimally from the advantages robotic surgery in all stages of the procedure.