In this paper, we determined the rates of Bethesda IV thyroid nodules and calculated the malignancy rates of these nodules in a university hospital located in an endemic area for thyroid diseases. We aimed to define the predictive factors for malignancy to select patients who need surgery. We included in the study 221 patients who had a preoperative biopsy for follicular neoplasm or because of suspicion for follicular neoplasm and underwent thyroidectomy between January 2012 and December 2018. We evaluated the data about patient characteristics, preoperative ultrasound results, indications for operation and postoperative pathological valuation results and calculated ratio of Bethesda Category IV nodules and incidental malignancy rates. The malignancy rate of Bethesda Category IV nodules was 48.9 %, while the incidental malignancy rate was 30.7 %. There was no statistical difference between patients with benign and malignant pathology results in terms of gender, age, preoperative diagnosis, size of the index nodule, number and results of biopsies and the thyroidectomy performed. The most important risk factor among all parameters was hypoechogenicity of the nodule. The solid structure increases this risk. Ultrasonographic hypoechogenicity is the most important risk factor for preoperative malignancy risk assessment for Bethesda Category IV thyroid nodules. Centers should determine their malignancy rates with particular risk factors and surgical approaches in endemic regions.
Aim: Systemic immune-inflammation (SII) index may provide more promising prognostic information in patients with cancer surgery. However, to the best of our knowledge, the prognostic value of SII index in patients with pancreatic cancer who underwent pancreaticoduodenectomy has not been studied. Thus, this study aimed to evaluate and compare the prognostic value of SII index in patients with pancreatic cancer who underwent pancreaticoduodenectomy. Materials and Methods: All patients over 18 years-old that underwent successful pancreaticoduodenectomy due to pancreatic cancer between February 20, 2019 and June 30, 2021 at Ankara City Hospital Department of General Surgery were included. The main predictor of interest was SII index which was measured by neutrophil*platelet / lymphocyte count. The main outcome of the study was long-term all-cause mortality. Results: A total of 223 patients were included in the current study. Multivariable cox regression analysis revealed that history of congestive heart failure [HR (95%CI): 3.682 (1.140-11.892)], and SII index [HR (95%CI): 1.001 (1.001-1.001)] were independently associated with all cause long-term mortality. The accuracy of predicting mortality for SII index was assessed by the area under the ROC curve which was = 0.77. A higher value of 1305 of SII index was found with 76% sensitivity and 67% specificity for predicting all-cause long-term mortality. Conclusions: The results of the study suggest that measurement of the SII index, an easily available and relatively cheap marker, is an independent predictor of long-term survival after pancreaticoduodenectomy in patients with pancreatic cancer.
Aim:The aim of this study is to demonstrate the efficiency of non-invasive imaging method-MR proton density fat fraction (PDFF); ideal IQ sequence-on detecting the effects of bariatric surgery on liver and pancreatic fatty infiltration. Materials and Methods:Thirty-nine patients (25 females, 14 males) who underwent bariatric surgery between May 2016 and April 2017 were analyzed retrospectively in this study. Body mass index (BMI) and body weight (BW) values of all patients were noted one week before and one month after bariatric surgery, and meanwhile an unenhanced upper abdominal MR imaging was performed. Liver fat fraction (LFF), pancreas fat fraction (PFF), liver volume (LV) and craniocaudal length of liver (LL) were measured with MR-PDFF and T2 weighted images. Changes in all parameters after the surgery were recorded and the correlation of these changes with the change in LFF was analyzed.Results: At the end of first month of bariatric surgery, a significant decrease on mean values of LFF and PFF has been observed along with a decrease of LV, LL, BW and BMI (p<0.0001). A moderate positive linear correlation was observed between LFF and PFF, LV, LL (r=0.69, 0.61, 0.49; respectively) while a weak positive linear correlation was noticed between LFF and BMI, BW (r=0.34, 0.21; respectively). Conclusion:Ideal IQ sequence enables quantitative analysis of fatty infiltration of the liver and pancreas and thus may be used as a non-invasive tool to monitor the positive effects of the bariatric surgery on fatty infiltration of these visceral organs in the postoperative period.
Background and Aims: Intrahepatic cholangiocarcinoma is a cancer of the biliary tract. The only current curative treatment for intrahepatic cholangiocarcinoma is liver resection. The aim of this study is given the result of the lymph node dissection, surgical management and recurrens ratio of intrahepatic cholangiocarcinomas in our center. Material and Methods: The medical record of patients who were treated for intrahepatic cholangiocarcinoma in our clinic were retrospectively evaluated between January 2019 to January 2023. Results: Twenty four patients were operated in our clinic. Of the patients, 12 were female, 12 were male, and the mean age was 52.75 ± 10.20 years. The median tumor size was 8.50 cm. Twelve patients had right hepatectomy, 6 patients had left hepatectomy, 2 patients had extended left hepatectomy, 2 patients had central hepatectomy and 2 patients had segment 4 plus 5 resection in the operation. The mean number of lymph node removed was 9.95 ± 3.56. Malignant lymph node was seen in 5 patients. Postoperative median hospital stay was 13.50 days. Mortality was observed in only 2 patient in the first 3 months postoperatively. The median overall survival of the patients was 318.50 days. Conclusions: As a result of our study, in patients with intrahepatic cholangiocarcinoma, patients who will be selected with preoperative correct staging, aggressive surgery by evaluating the comorbidities and conditions of patients with resectable tumors, removal of hepatoduodenal lymph nodes during surgery, and liver volume expansion procedures in patients who may develop remnant liver volume failure, to force to resection, which is the only curative chance of patients is demonstrated that it is necessary.
Background and Aims: The aim of this study is to examine the early and late results of patients with adjacent organ invasion (cT4b) who were operated for locally advanced gastric cancer in a high-volume center and to investigate the factors affecting survival. Material and Methods: Patients who underwent gastrectomy and en-bloc adjacent organ resection due to locally advanced gastric cancer between 2015 and 2019 were included in the study. Results: Radical gastrectomy and en-bloc additional organ resection were performed in 54 patients out of 435 patients who were operated for gastric cancer due to clinical T4b tumors. The mean age of all patients was 61.87 ± 12.67years. The median survival was found to be 16.5 (1 - 72) months. First-year survival was achieved in 37 (68.5%) patients, three-year survival in 11 (20.3%) and five-year survival in only 4 (7.4%) patients. Considering the factors affecting long-term survival, it was seen that postoperative complications affected survival significantly (p = 0.04). We found that performing R1 resection (p = 0.001), large tumor diameter (p = 0.02), presence of lymphovascular invasion (p = 0.024) and presence of perineural invasion (p = 0.024) adversely affected long-term survival. Conclusion: Adequate lymph node dissection and en bloc R0 resection with adjacent organ are important for long-term survival in patients with clinical T4b gastric cancer. Surgery should be performed regardless of the T-stage of the tumor. In this respect, surgery performed with adequate R0 resection can be considered as an independent prognostic factor affecting survival. Other factors affecting long-term survival are lymph node metastasis, tumor size, post-operative complications, and vascular and perineural invasion.
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