İsmail Cem Eray

Background and Objectives: We compared the prognostic value of the preoperative hemoglobin–albumin–lymphocyte–platelet (HALP) index and Cancer Inflammation Prognostic Index (CIPI) after colorectal cancer surgery. Materials and Methods: This single-center retrospective study included 264 patients who underwent colorectal adenocarcinoma resection between 2014 and 2019. The primary Cox model entered both log₂-transformed indices simultaneously and adjusted for age, sex, ASA class, neoadjuvant treatment, and recorded pathological stage. Discrimination was assessed using 3- and 5-year time-dependent ROC analysis and Harrell’s C-index. Cut-off-based analyses were exploratory. Results: Over a median follow-up of 86.9 months, 120 patients (45.5%) died. In the primary model, the adjusted hazard ratio per doubling was 0.822 for HALP (95% CI 0.661–1.023) and 1.058 for CIPI (95% CI 0.978–1.145). The 3-year AUCs were 0.649 for HALP and 0.699 for CIPI (p = 0.261). The 5-year AUCs were 0.631 and 0.636, respectively (p = 0.887). In exploratory analyses, the cohort-derived high-CIPI group had poorer adjusted survival (aHR 1.703, 95% CI 1.138–2.548). Both continuous indices were associated with survival in stage I–III disease, whereas neither was statistically significant in patients without neoadjuvant treatment. Conclusions: Both indices showed modest discrimination. The adjusted associations varied by model and subgroup. Incremental clinical value was not established.

Objective: This study evaluated the association between the preoperative 5-factor Modified Frailty Index (mFI-5) and in-hospital cumulative postoperative morbidity, as measured by the Comprehensive Complication Index (CCI), in patients undergoing colorectal cancer resection. Methods: This retrospective, single-center cohort study included 455 patients who underwent resection for colorectal cancer between January 2015 and April 2021. Patients were classified as mFI-5 = 0, mFI-5 = 1, or mFI-5 ≥ 2. The primary outcome was high cumulative morbidity during the index hospitalization, defined as CCI ≥ 26.2. Associations with categorical outcomes were evaluated using multivariable logistic regression. Deviation from a linear trend was assessed using a likelihood ratio test, and sensitivity analyses were performed after excluding patients who died, restricting the analysis to elective patients, and using Firth penalized logistic regression. An exploratory interaction between categorical mFI-5 and emergency surgery was assessed using Firth penalized logistic regression. Results: Of the patients, 230 (50.5%) had mFI-5 = 0, 96 (21.1%) had mFI-5 = 1, and 129 (28.4%) had mFI-5 ≥ 2. The rates of CCI ≥ 26.2 were 17.8%, 12.5%, and 28.7%, respectively, and did not demonstrate a linear gradient across categories. Compared with mFI-5 = 0, mFI-5 ≥ 2 was associated with higher odds of CCI ≥ 26.2 after adjustment (OR 2.17, 95% CI 1.21–3.89; p = 0.010), whereas no association was observed for mFI-5 = 1 (OR 0.71, 95% CI 0.34–1.48; p = 0.364). A deviation from the linear trend was observed for CCI ≥ 26.2 (p = 0.025). In exploratory analyses, the adjusted OR was 2.43 (95% CI 1.30–4.54) among in-hospital survivors and 1.79 (95% CI 0.96–3.33) in the elective-only cohort. Firth analyses yielded similar results. The joint interaction test yielded p = 0.012, although the emergency subgroup contained a zero-event cell. Conclusions: mFI-5 ≥ 2 was associated with higher adjusted odds of high cumulative postoperative morbidity, whereas mFI-5 = 1 did not show an intermediate increase in risk. The non-monotonic pattern and attenuation of the association in the elective-only cohort support cautious interpretation of mFI-5 ≥ 2 as an exploratory risk indicator requiring external validation.

Background and Objectives: To compare the Comprehensive Complication Index (CCI) with the conventional Clavien–Dindo (CD) classification for association with readmission after cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for colorectal peritoneal metastases. Materials and Methods: Single-center retrospective cohort of 26 patients treated with CRS-HIPEC for peritoneal metastases of colonic or rectal origin. The patient-level CD grade was the highest of the individually graded complications of the index admission; the CCI was calculated with the standard formula. A prespecified threshold of CCI ≥ 26.2—the value of a single CD grade IIIa complication—defined a high cumulative burden. Unplanned readmission was assessed at 30 and 90 days after discharge as co-primary outcomes; classification agreement and correlates of CCI level were exploratory, without adjustment for multiplicity. Results: Agreement was moderate (kappa = 0.54, 95% confidence interval [CI] 0.25–0.83). Six of 26 patients (23.1%) had no major complication by the CD classification yet a high cumulative burden by the CCI (exact McNemar p = 0.031). Readmission occurred in 32.0% by 30 days and 44.0% by 90 days. For 90-day readmission the CCI gave a numerically higher area under the curve than the CD classification (0.672 vs. 0.555; DeLong p = 0.074), and readmission was more frequent above the CCI threshold (55.6% vs. 14.3%; odds ratio 6.95, 95% CI 0.64–378.69); neither comparison was significant. CCI level correlated with body mass index (rho = 0.541) and the Peritoneal Cancer Index (rho = 0.423), both p < 0.05. Conclusions: The CCI identified a high cumulative burden in six patients recorded as having no major complication by the CD classification, but its numerically higher discrimination for readmission was not statistically demonstrated. These exploratory findings require confirmation in larger cohorts.

Purpose: This study aimed to investigate the potential role of dyslipidemia in the pathogenesis of hemorrhoidal disease (HD) and to explore the underlying mechanisms.Materials and Methods: In this prospective study, 200 patients presenting with benign anorectal complaints between February-March 2025 were enrolled. One hundred patients diagnosed with hemorrhoidal disease (HD group) and 100 patients with other benign anorectal conditions (control group) underwent fasting lipid profile assessment. The HD group was classified according to Goligher’s classification, and the relationship between hemorrhoidal grade and lipid levels was analyzed.Results: Compared with the control group, the HD group exhibited significantly higher levels of LDL (123.7 ± 41.7 vs. 103.9 ± 48.4 mg/dL), triglycerides (173.0 ± 126.1 vs. 141.8 ± 74.5 mg/dL), and total cholesterol (198.2 ± 53.9 vs. 171.7 ± 60.3 mg/dL). HDL levels correlated inversely with hemorrhoidal grade, being highest in Grade I and lowest in Grade IV disease.Conclusion: Our findings suggest an association between hemorrhoidal disease and dyslipidemia. Because this was an observational study, causality cannot be established; further studies are needed to determine whether lipid management affects the risk or severity of hemorrhoidal disease.

Background/Objectives: In older patients undergoing abdominal surgery, perioperative risk is influenced not only by chronological age but also by frailty, comorbidity burden, and diminished physiological reserve. These factors may limit tolerance of conventional abdominal surgery and increase interest in less invasive surgical approaches in high-risk patients. The trephine approach provides limited surgical access without routine laparotomy, but evidence regarding its use in this population remains limited. This study evaluated the technical feasibility and short-term outcomes of the trephine approach in high-risk older patients. Methods: Patients aged ≥65 years who underwent stoma surgery using the trephine approach at a tertiary referral center between January 2016 and January 2026 were retrospectively reviewed. During the study period, 488 patients underwent stoma surgery; of these, 10 (2.0%) were managed using the trephine approach and formed the study cohort. We used preoperative CT for surgical planning in all cases, with intraoperative endoluminal guidance when required. We analyzed demographic, perioperative, and short-term outcome data descriptively. Results: The mean age was 77.9 ± 9.6 years. Median ASA physical status was 4, median Clinical Frailty Scale score was 5.5, and median Charlson Comorbidity Index was 5.5. Eight patients (80%) underwent emergency surgery. The planned procedure was completed without conversion to laparotomy in 9/10 patients (90%), and bowel resection was performed through the same incision in 4/10 (40%). Median operative time was 32.5 min, and median hospital stay was 5 days. Major complications occurred in 3/10 patients (30%), and 30-day mortality was 2/10 (20%). Conclusions: In this small retrospective series of high-risk older patients, the trephine approach was technically achievable in most cases when used with preoperative CT-based planning and, when needed, intraoperative endoluminal guidance. These findings provide preliminary descriptive evidence regarding the feasibility of this approach in a highly selected clinical setting. Given the small sample size, lack of a comparator, and observed postoperative morbidity and mortality, no conclusions can be drawn about safety, comparative effectiveness, or patient-selection criteria.

Aim: The aim of this study was to adapt and validate the Cryptoglandular Anal Fistula Quality of Life (AF-QoL) scale for Turkish-speaking patients, providing a disease-specific, patient-reported outcome measure (PROM) to assess quality of life (QoL) in cryptoglandular anal fistula. Methods: A prospective, multicenter, cross-sectional study was conducted across seven tertiary centers in Türkiye. The 22-item AF-QoL scale, originally validated in English, was translated and culturally adapted into Turkish following Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) guidelines, including expert consensus and a pilot study ( n = 10). A total of 220 Turkish-speaking adults with cryptoglandular anal fistula completed the scale. Structural validity was evaluated using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Internal consistency was assessed using Cronbach’s alpha, and item–total correlations. Test–retest reliability was evaluated in a clinically stable subgroup of patients. Results: EFA confirmed a six-domain structure, comprising psychological impact, everyday activities, unpredictability/disease control, seton-related issues, social limitations, and discharge/discomfort, explaining 69.2% of the total variance. CFA demonstrated an acceptable overall model fit ( χ ² / df = 1.94, root mean square error of approximation [RMSEA] = 0.048, Comparative Fit Index [CFI] = 0.945, standardized root mean square residual [SRMR] = 0.035). The Turkish AF-QoL demonstrated high internal consistency (Cronbach’s α = 0.828), satisfactory item–total correlations ( r = 0.32–0.76), and good test–retest reliability (intraclass correlation coefficient = 0.74), indicating temporal stability. Conclusions: The Turkish version of the AF-QoL demonstrates satisfactory reliability and structural validity for use in Turkish patients with cryptoglandular anal fistula. This cross-cultural validation provides a disease-specific PROM suitable for clinical and research applications. Further studies assessing additional measurement properties, including structural validity, measurement error, and responsiveness, are warranted. Clinical trial registration: This study was not a clinical trial and thus was not registered in a clinical trial registry.

The aim of our study is to evaluate the effects of glutamine, partially hydrolyzed guar gum and combined glutamine and partially hydrolyzed guar gum form in rats with experimental radiation enteritis by histopathological, immunohistochemical and biochemical measurements. 64 Wistar albino rats with an average weight of 220–280 g were used in the study. 1st group only took water, 2nd group only took glutamine, 3rd group only took partially hydrolyzed guar gum, 4th group took partially hydrolyzed guar gum with glutamine, 5th group took only radiotherapy, 6th group took radiotherapy with glutamine, 7th group took radiotherapy with partially hydrolyzed guar gum and 8th group took radiotherapy, glutamine and guar gum. Partially hydrolyzed guar gum was given with radiotherapy, and glutamine and guar gum were given together with radiotherapy in the 8th group. All rats were weighed on the first, seventh and tenth days. On the tenth day, the rats were sacrificed and their clinical status, biochemical, histopathological and immunohistochemical parameters in the terminal ileum were evaluated. Differences between groups were compared statistically. All groups were compared in terms of crypt length, villus height, crypt abscess, congestion, intraepithelial lymphoid infiltration, stool consistency, myeloperoxidase, malondialdehyde, caspase-3% and tumor necrosis factor alpha mean, and statistical significance was observed (p < 0.05). Weight% difference in rats was statistically significant between groups (p < 0.05). Interleukin-10 values were not statistically significant between groups (p > 0.05). In paired comparisons, there was a statistically significant difference between the control group and the group with radiation enteritis in terms of biochemical, histopathological, immunohistochemical and clinical parameters (p < 0.05). There was no statistically significant difference between the 5th group and 6th group, 7th group and 8th groups in terms of biochemical, histopathological, immunohistochemical and clinical parameters (p > 0,05). The result suggest that glutamine, partially hydrolyzed guar gum and combination therapy may not have a protective effect on radiation enteritis.

Purpose: To evaluate the effects of intraperitoneal Hypericum perforatum oil (St. John’s Wort oil, SJWO) on systemic inflammation and peritoneal histopathology in experimental peritonitis. Methods: Forty-two male Wistar Albino rats were randomized into seven groups (n = 6): control, SJWO, olive oil, peritonitis, peritonitis + saline, peritonitis + SJWO, and peritonitis + olive oil. Peritonitis was induced with freshly prepared autologous fecal suspension, and treatments were administered intraperitoneally at 48 h. On day 5, plasma inflammatory markers, peritoneal thickness, and histopathological scores were assessed blinded. Results: The greatest weight loss was seen in the peritonitis group (p = 0.002). SJWO did not consistently reduce systemic inflammatory markers. Compared with peritonitis + saline, peritonitis + SJWO showed lower parietal fibrosis and vascular proliferation scores (rank-biserial correlation for each outcome, r rb = -0.833; 95% confidence interval -1.000 to -0.500), but visceral fibrosis was not reduced. Conclusion: Intraperitoneal SJWO did not suppress systemic inflammation. The lower early parietal fibrosis and vascular proliferation scores are exploratory because the effect was not observed in visceral tissue, and adhesion formation was not directly assessed.