Cebrail Akyüz

Objectives: Neoadjuvant chemotherapy (NACT) is commonly incorporated into the management of resectable locally advanced gastric cancer. However, survival outcomes in patients who remain classified as pathological stage IIIC after surgery, particularly when analyzed according to NACT exposure, are not well characterized. This study compares overall survival (OS) according to prior NACT exposure among patients who ultimately remained classified as pathological stage IIIC after curative surgery. Methods: This retrospective study included patients who underwent curative surgery between 2010 and 2022 and were diagnosed with pathological stage IIIC gastric cancer on postoperative histopathological examination. Patients were grouped according to whether they received NACT. OS was measured from surgery to death from any cause or last follow-up. Survival was analyzed using the Kaplan–Meier method and Cox proportional hazards regression. Results: The study cohort comprised 75 patients, of whom 24.0 % (18/75) received NACT. OS did not differ significantly between patients who received NACT and those who did not, as assessed by the log-rank test (p=0.749). In multivariable Cox regression analysis, NACT was not identified as an independent factor associated with OS (HR: 0.96; 95 % CI: 0.50–1.84; p=0.902). Conclusions: Within the limitations of this retrospective study, overall survival was comparable according to neoadjuvant chemotherapy status among patients who ultimately remained classified as pathological stage IIIC after curative surgery. These findings should be interpreted cautiously because the compared groups represent biologically distinct populations and the study was not designed to evaluate the therapeutic efficacy of neoadjuvant chemotherapy.

Aim: Perioperative immunonutrition (IN) has been proposed to improve postoperative outcomes in patients undergoing gastrointestinal cancer surgery; however, its clinical benefits in colon cancer surgery remain controversial. This study aimed to evaluate the effect of perioperative IN, as a form of nutritional support, on postoperative outcomes, particularly length of stay (LOS) and postoperative complications, in patients undergoing surgery for colon cancer. Individuals and Method: This single-center, prospective comparative study included 78 patients who underwent elective surgery for colon cancer. Patients were prospectively assigned to receive either perioperative IN (n = 39) or standard perioperative nutrition (n = 39) according to the nutritional protocol applied. Postoperative complications and LOS were prospectively recorded. Multivariable linear regression analysis was performed to assess the association between IN and LOS, adjusting for relevant clinical variables. Results: Postoperative complication rates did not differ significantly between the IN and control groups. However, patients receiving IN had a significantly shorter LOS compared with the control group (median 7 vs 8 days, p = 0.045). In multivariable analysis, perioperative IN remained associated with a reduced LOS (β = −0.313, 95% CI −0.528 to −0.098; p = 0.005). Conclusion: In patients undergoing surgery for colon cancer, perioperative IN was not associated with a reduction in postoperative complication rates but was associated with a shorter LOS. These findings suggest that IN may contribute to enhanced postoperative recovery rather than a direct reduction in postoperative morbidity.

Background: Signet-ring cell colorectal cancer (SRCC) and colorectal cancer with a signet-ring cell component (SRC) are rare histological subtypes associated with poor prognosis. Although these entities are classified separately based on pathological criteria, it remains unclear whether they differ in clinical behavior and survival outcomes. This study aimed to compare the clinicopathological characteristics and survival of patients with SRCC and SRC. Methods: Patients who underwent surgery for colorectal cancer (CRC) between January 2012 and December 2019 and were diagnosed with SRCC or SRC on histopathological examination were retrospectively included. Demographic, clinical, and survival data were analyzed and compared between the two groups. Results: A total of 32 patients (22 males, 10 females) with SRCC or SRC were included, representing 2.6% (32/1253) of all CRC cases operated at our center. Seven patients (five with SRCC and two with SRC) had synchronous distant metastases, including liver-only metastases (9%), diffuse intra-abdominal seeding (9%), and ovarian metastasis (3%). The mean disease-free survival was 19.2 ± 3.3 months overall, and 17.18 ± 3.61 months for SRCC and 19.3 ± 9 months for SRC. The mean overall survival was 70.9 ± 10.18 months overall, and 65.95 ± 13.77 months for SRCC and 79.20 ± 15.03 months for SRC. No statistically significant difference in overall survival was observed between the groups (p = 0.534). Conclusions: SRCC and SRC demonstrate broadly similar clinicopathological features, with younger age at diagnosis observed in SRCC patients. However, given the limited sample size, the absence of statistically significant differences in survival outcomes should be interpreted with caution and does not imply equivalence. Distant metastasis remains the most important prognostic factor in both groups.

Background: Ulcerative colitis (UC) is characterized by chronic mucosal inflammation, oxidative stress, and disruption of intestinal metabolic homeostasis. Immunomodulatory nutrients such as arginine, glutamine, and β-hydroxy β-methylbutyrate (HMB) have shown potential benefits; however, their combined molecular effects on UC remain insufficiently defined. Objective: To investigate the individual and combined effects of arginine, glutamine, and HMB on inflammatory and metabolic gene expression, oxidative stress markers, and histopathological outcomes in a dextran sulfate sodium (DSS)-induced colitis model. Methods: Female Sprague Dawley rats were assigned to six groups: control, DSS, DSS + arginine, DSS + glutamine, DSS + HMB, and DSS + mixture. Colitis was induced using 3% DSS. Colon tissues were examined histologically, serum MDA, MPO, and GSH levels were quantified, and mRNA expression of IL6, IL10, COX2, NOS2, ARG2, CCR1, and ALDH4A1 was measured by RT-qPCR. Pathway enrichment analyses were performed to interpret cytokine and metabolic network regulation. Results: DSS induced severe mucosal injury, elevated MDA and MPO, reduced GSH, and significantly increased IL6, COX2, NOS2, ARG2, and CCR1 expression. Glutamine demonstrated the strongest anti-inflammatory and antioxidant effects by decreasing IL6 and COX2 and restoring GSH. Arginine primarily modulated nitric oxide–related pathways, whereas HMB increased ALDH4A1 expression and metabolic adaptation. The combination treatment produced more balanced modulation across inflammatory, chemokine, and metabolic pathways, consistent with enrichment results highlighting cytokine signaling and amino acid metabolism. Histopathological improvement was greatest in the mixture group. Conclusions: Arginine, glutamine, and HMB ameliorate DSS-induced colitis through coordinated regulation of cytokine networks, oxidative stress responses, and metabolic pathways. Their combined use yields broader and more harmonized therapeutic effects than individual administration, supporting their potential as targeted immunonutritional strategies for UC. Rather than targeting a single inflammatory mediator, this study was designed to test whether combined immunonutrient supplementation could promote coordinated regulation of cytokine signaling, oxidative stress responses, and metabolic adaptation, thereby facilitating mucosal repair in experimental colitis.

Background/Objectives: Isolated cecum necrosis (ICN) is a rare disease and there are few reports on it in the literature. We retrospectively analyzed the patients with acute abdomen who had ICN, in terms of etiology, demographic findings, surgery, and prognosis to determine the best treatment approach. Methods: Seven patients with per-operative diagnosis of isolated cecal necrosis were included in the study. Age, gender, comorbidities, symptoms, laboratory data, imaging modalities, time from symptoms to surgery, surgical procedure, hospital stay, morbidity, and mortality were retrospectively analyzed. Results: The median age of the patients and the F/M ratio were 61 years and 2/5, respectively. The most common comorbidity was chronic renal failure, followed by hypertension, diabetes mellitus, and coronary artery disease. The median time from symptom onset to surgery was 1 day. The ileocolic anastomosis was performed in 4 patients and terminal ileostomy in three patients. The morbidity and mortality rates were 28.5% and 14.3%, respectively. The median length of hospital stay was 12 days. Conclusions: ICN should be suspected in elderly patients with comorbidities presenting to the emergency department with an acute abdomen. Computed tomography is an important diagnostic tool. Diagnostic laparoscopy is a good option for definitive diagnosis and end ileostomy is better than anastomosis in patients with bleeding tendency or hypotensive patients with chronic renal failure on dialysis, coronary artery disease, and in the presence of purulent peritonitis to reduce morbidity and mortality.

Background: Immune modulating enteral nutrition in the preoperative period may reduce postoperative complications in cancer patients. The aim of the study is to evaluate the effect of immune modulating enteral nutrition on postoperative complications in patients who received neoadjuvant chemo-radiotherapy for rectal tumor and subsequently underwent low anterior resection without diverting ostomy. Methods: Preoperative immunonutrition (arginine, omega 3 fatty acids and dietary nucleotides) versus standard nutrition was evaluated. Mortality, infective complications in the first 30 days after the operation, length of hospital stay, cost analysis and laboratory results were analyzed. Results: There was no statistically significant difference between the IN-given and standard-fed groups in terms of postoperative complications, including urinary system (p=1.000) and wound infection (p=0.194), intraabdominal abscess (p=0.493), pulmonary complications (p=0.734), venous thromboembolism (p=1.000), ileus (p=1.000), and anastomotic leak (p=614)). However, the hospital stay was shorter (p=0.022) and the total cost (p=0.013) was lower in the immunonutrition group. Conclusion: Immunonutrition has the potential to reduce the length of hospital stay and hospital costs for patients undergoing surgery for locally advanced rectal cancer.

Objective: This study investigates the prognostic significance of lymph node ratio (LNR) and CA 19-9 levels on survival outcomes in patients with resected pancreatic adenocarcinoma, with the goal of refining risk stratification and guiding treatment strategies. Methods: A retrospective cohort of 123 patients with histopathologically confirmed pancreatic adenocarcinoma who underwent surgical resection was analyzed. Demographic, tumor-specific, and laboratory data, including LNR and CA 19-9 levels, were collected. ROC analysis was performed to establish optimal cut-off points, and Kaplan-Meier survival analysis was used to evaluate survival distributions across groups defined by LNR and CA 19-9 values. Results: The cohort's median survival was 22 months, with a mean survival time of 45.36 ± 4.80 months. Patients with a positive LNR > 0.14 exhibited significantly shorter survival (median: 17 months) compared to those with an LNR ≤ 0.14 (median: 30.2 months, p = 0.001). ROC analysis confirmed LNR > 0.14 as an optimal cut-off for predicting mortality, with an area under the curve (AUC) of 0.646 (p = 0.007), sensitivity of 88.2%, and specificity of 42.7%. CA 19-9 levels were also predictive of survival outcomes: patients with CA 19-9 levels ≥ 39 U/mL had a median survival of 17 months, significantly shorter than the 29-month median survival observed in patients with CA 19-9 < 39 U/mL (p = 0.034). Mortality rates were notably higher in patients with elevated CA 19-9 levels (78.4% vs. 63.3%). Combining both markers, patients with an LNR > 0.14 and CA 19-9 ≥ 39 U/mL demonstrated the poorest survival, with a cumulative survival rate of 0% by the 60th month. In contrast, those with LNR ≤ 0.14 and CA 19-9 < 39 achieved a cumulative survival rate of 33.6% at the 73rd month. This combined marker approach revealed statistically significant survival differences, underscoring the utility of using LNR and CA 19-9 jointly to stratify risk and predict outcomes (p < 0.001). Conclusion: LNR and CA 19-9 levels are significant independent predictors of survival in pancreatic adenocarcinoma. Elevated values in either marker correlate with reduced survival, while combining both enhances prognostic accuracy. Integrating these biomarkers into clinical evaluations could enable more effective risk stratification and guide therapeutic decisions, particularly for patients who may benefit from more aggressive treatment approaches.

The objective of this study was to evaluate and compare the histopathological, clinical, and treatment characteristics of xanthogranulomatous cholecystitis (XGC) in patients undergoing cholecystectomy at a single center. Aim: We aim to enhance the understanding of its presentation and improve its differential diagnosis from other gallbladder pathologies. Methods: We retrospectively reviewed 6783 cholecystectomy cases performed between January 2015 and January 2023 at the General Surgery Clinic of Haydarpaşa Numune Training and Research Hospital, and a diagnosis of xanthogranulomatous cholecystitis was histopathologically established in 131 patients. In this retrospective study, we examined the clinicopathological characteristics, preoperative imaging methods and findings, histopathological images, surgical procedure methods, and postoperative complications of 131 patients. Results: The study included 131 patients, with ages ranging from 18 to 88 years, of which 74 (56.5%) were female and 57 (43.5%) were male. Ultrasound imaging was performed on 128 patients. Ultrasound imaging revealed wall thickening in 72.7% of cases, hypoechoic nodules in 13.3%, biliary tract pathologies in 10.9%, and adenomyomatosis in 3.1%. A total of 59 cases had MRI. On MRI, wall thickening was observed in 50.8% of cases, biliary tract pathologies in 33.9%, adenomyomatosis in 10.2%, hypoechoic nodules in 3.4%, and hypoechoic nodules + wall thickening (HN + WT) in 1.7%. Histopathological diagnosis was diffuse in 79.4% of cases and focal in 20.6%. In addition to cholecystectomy, non-surgical interventions were not required in 77.1% of the cases, while 11.5% underwent ERCP, 9.2% underwent percutaneous procedures, 1.5% underwent both ERCP and percutaneous procedures, and 0.8% underwent other non-surgical interventions. Of the surgeries, 93.1% were elective and 6.9% were emergency. Postoperative complications were not observed in 84% of the patients; 5.3% experienced surgical complications, 5.3% had surgical site infection, and 5.3% had other complications (pneumonia and urinary infection). The length of hospital stay ranged from 0 to 26 days, with a mean of 5.27 ± 4.59 days and a median of 4 days. Conclusions: Xanthogranulomatous cholecystitis is a rare disease of the gallbladder with no characteristic radiological or clinical findings and can often be confused with gallbladder cancer. Further studies involving larger populations are needed to improve the preoperative diagnosis.

(1) Background: We aimed to identify the possible relationship between various diseases of the upper digestive system and colon polyps by analyzing patients with gastric polyps and evaluating the cancers and diseases accompanying the polyps. (2) Methods: Each patient’s age; gender; polyp type and size; presence of Helicobacter pylori (H. pylori), atrophic gastritis, and intestinal metaplasia; status of whether cancer developed during follow-up; status of whether a colonoscopy was performed or not; and colon pathologies detected during colonoscopy were analyzed retrospectively using hospital records. (3) Results: Between the study dates, 19,214 esophagogastroduodenoscopies were performed in the endoscopy unit of our hospital. Gastric polyps were detected in 178 (0.9%) patients. No significant relationship was found between the gastric polyp size and the occurrence of gastric cancer or gastrointestinal system malignancy (p > 0.05). A colonoscopy was performed in 86 of the 178 patients who underwent gastroscopy. The frequency of polyp detection during colonoscopy was statistically significantly higher in patients with gastric polyps than in patients without gastric polyps (p < 0.001). (4) Conclusions: New prospective studies are needed regarding the relationship between gastric polyps and gastrointestinal system diseases. Going forward, a colonoscopy will be required in gastric polyp patients, especially with FGP.

Objective: Sigmoid volvulus is most commonly seen in patients between 60 and 80 years old. The management of volvulus depends on its location and clinical presentation. The fundamental aspects of treatment include evaluating the viability of the colon, relieving the obstruction, and preventing the possibility of recurrence. We aimed to present the clinicopathological characteristics of geriatric colonic volvulus patients treated in a single center. Methods: Patients diagnosed with colonic volvulus and treated in this hospital were included in the study. Mortality rates of patients who underwent and did not undergo preoperative colonoscopic detorsion were compared statistically. In addition, diseases that affect the quality of life and cause deterioration in bowel movements and habits were determined, and these diseases' effect on mortality was evaluated. Results: Forty-four patients who underwent emergency surgery due to volvulus were included in our study. There was sigmoid colon perforation in two patients and cecum perforation in 1 patient. Two patients had cecal volvulus, and right hemicolectomy was performed in these patients; anastomosis was performed in one, and ileostomy was performed in the other. Sigmoid resection was performed in 36 patients, subtotal colectomy in 5 patients, right hemicolectomy in 2 patients, and sigmoidopexy with laparotomy and reduction in 1 patient. Thirteen patients (29.5%) underwent preoperative colonoscopy, and in eight cases, the procedure was conducted a day before the surgery, with the operation being carried out semi-urgently the next day. Conclusion: Intestinal volvulus is a rare condition that can occur in any part of the large intestine. However, it is a severe medical issue that requires prompt diagnosis and treatment due to the possibility of intestinal damage and mortality.