Omer Yalkin

Aim: In this study, we compared real-time particle measurements at the average head level of a surgical team during open and laparoscopic intra-abdominal cancer surgery.Materials and Methods: Between June 2022 and January 2023, 83 consecutive patients diagnosed with intra-abdominal cancer and scheduled for oncological surgery were included. We recorded the patients’ demographic and operative characteristics, including operation time, number of ports in laparoscopic operations, total incision length in laparoscopic operations, and incision length in open operations. The number of particles measuring 0.3, 0.5, 1, 2, 5, and 10 µm in a volume of 0.1 CF (particles/CF) was determined.Results: Of the 83 patients (mean age 58.4 ± 14.1 years), 38 (45.8%) were women. No significant differences were observed between the open (n = 43) and laparoscopic (n = 40) groups in age, sex, body mass index, body surface area, or operation time. Blood loss was significantly higher in the open surgery group (p < 0.001). Particle levels increased during the early intraoperative period in the open surgery group but decreased in the laparoscopic group; however, this difference was not observed in later measurements. Open surgery was associated with higher particle levels during the early intraoperative period.Conclusion: Particle levels increased with open surgery and decreased with laparoscopic surgery over time, indicating the superiority of the laparoscopic approach. However, regardless of the approach, minimizing surgical duration and ensuring adequate personal protective equipment use remain essential.

Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical

Amaç: Bu çalışmada özofagogastrik bileşke adenekarsinomu (AEJ) bulunan 69 hastanın klinikopatoloji özellikleri ve genel sağ kalımı ile ilgili 10 yıllık deneyimimizi paylaşmaktır. Hastalar ve Yöntem: AEJ tanısı konulan ve kliniğimizde opere edilen 69 ardışık hasta çalışmaya dahil edilmiştir. Hastaların demografik özellikleri; laboratuvar parametreleri, cerrahi rezeksiyon yaklaşımı; TNM evreleri; rezeksiyon kapsamı; alınan lenf nodu toplam sayısı; tümör lokalizasyonu; lenfatik, vasküler ve perinöral invazyon varlığı ile genel sağ kalım (OS) durumu kaydedilmiştir. Hastalar Siewert Type II ve Siewert Type III olmak üzere iki gruba ayrılmıştır. Bulgular: Gruplar arasında yaş (p=0.696) ve cinsiyet (p=0.140) bakımından anlamlı fark yoktur. T evresi dağılımı gruplar arasında istatistiksel olarak anlamlı şekilde farklıdır (p=0.0026). R0 düzeyindeki hastalarda OS, R1 düzeyindeki hastalara kıyasla anlamlı olarak daha yüksektir. Lenfatik, vasküler ve perinöral invazyon bulunmayan hastalarda OS istatistiksel olarak anlamlı şekilde daha yüksektir. Bir yıllık OS %85.50, 3 yıllık OS %49.10 ve 5 yıllık OS %43.60 olarak belirlenmiştir. Mortalite riski perigastrik yağ infiltrasyonu varlığında 8.63 kat, vasküler invasyon durumunda 12.60 kat ve perinöral invazyon durumunda 13.45 kat artmıştır. Sağ kalım oranı Siewert Type II ve Type III hastalarda 10 yıllık medyan izlem süresinde sırasıyla %51 ve %41 olarak saptanmıştır. Sonuç: Bu çalışma klinikopatolojik özellikleri ve genel sağ kalımı başarılı bir şekilde değerlendirmiş ve Siewert Type II tümörler ile Siewert Type III tümörlerin benzer sağ kalım sonuçlalarına sahip olduklarını göstermiştir. AEJ hastalarının sonuçları konusundaki mevcut bulgulara katkı sağlamak amacıyla daha geniş serili ve uzun dönem kapsamlı, çok merkezli ileri çalışmalara ihtiyaç vardır.

Aim: To investigate the reliability and educational value of YouTube videos of minimally invasive complete mesocolic excision with right hemicolectomy procedures. Materials and methods: We searched YouTube with the terms “Laparoscopic and Robotic Complete Mesocolic Excision with Right Hemicolectomy” on January 12, 2021. To assess the reliability of the videos, we evaluated nine steps in each video and scored the videos based on the key steps they contained. The videos were divided into three groups according to the source of the upload. The total number of views, length, time since upload, and the number of likes, dislikes, and comments were recorded for each video. Narration, the use of descriptive subtitles, and the upload status by an expert surgeon were also examined. Results: Sixty-eight videos were included in the study. A positive significant correlation was identified between the comprehensiveness score (CS) and the number of views (p=0.025). The CSs of the videos accessed from academic channels, as well as those accessed from journals, congress, and association channels, recorded higher CSs than those obtained from the personal channels of consultants (p=0.003). It was also found that CSs were higher in the videos of expert surgeons (p<0.001) and narrated videos (p<0.001). Conclusion: Not all YouTube videos on this subject have reliability and educational value. Surgical videos on YouTube may be evaluated by a video review commission formed by academic institutions, surgical associations, or expert surgeons, and videos suitable for education could be brought together and published via a free channel.

Objective: This study aimed to assess the content, quality, and reliability of YouTube videos on colorectal cancer screening. Colorectal cancer is the third most common cause of death worldwide. Methods: A basic search was conducted on the YouTube^TM website on November 19, 2020, using the English keywords "colorectal cancer screening," without using any filter. The videos were categorized into five groups according to the source and then each video was evaluated by three physicians. The videos were compared in terms of the quality of the information, and their reliability and comprehensiveness, according to the sources. Results: Of the 137 videos included in the study, 74 (54%) were categorized in the useful information group and 63 (46%) in the misleading information group. It was found that most (47.3%) of the videos in the useful information group were uploaded by academic-based sources. Conversely, most (46%) of the videos in the misleading information group were uploaded by for-profit companies, private hospitals, and medical advertisements. An analysis of the video features according to the upload source revealed that the total views (p=0.023), likes (p=0.004), and viewer engagement with the video (p=0.026) were higher in the public spotlight videos group. Conclusionsː The quality of public spotlight videos with high viewing rates and audience interaction should be increased to inform the public. In addition, there is a need for videos containing comprehensive and accurate information to be uploaded to YouTube, which is an important source of information today, by universities, health organizations, and doctors who do not make a profit (financially) from the results.

The outcomes of surgical interventions for achalasia treatment improved with the advent of minimally invasive surgery and the introduction of robotic surgery. This article describes the technical details of robotic achalasia surgery, shares our initial experiences, and discusses why robotic surgery will become the first choice for the surgical treatment of achalasia. The records of patients with a diagnosis of achalasia who underwent robotic surgery were evaluated retrospectively. The patients’ data were examined in terms of demographic parameters, duration of complaints, treatment options applied previously, robotic surgery technique, and postoperative outcomes. Of the six patients evaluated, four (66.7%) were males and two (33.3%) were females. Their mean age was 32 years (20-51 years), and the mean symptom duration was 4.6 years (2-9 years). All of the patients underwent robotic Heller cardiomyotomy surgery. After the myotomy procedure, five of the six patients (83.3%) underwent partial anterior fundoplication (Dor) as an antireflux procedure. The cruroraphy procedure was performed in one patient (16.7%) due to accompanying hiatal hernia, whereas the procedures were completed in five patients (83.3%) without performing posterior dissection of the oesophagus. In the postoperative follow-up period, no surgical problem was encountered, while reflux symptoms developed in one patient (16.7%) and were controlled by medical therapy. The success of surgical treatment of achalasia is incontrovertible. Due to the various advantages of robotic surgery, it is now frequently used in narrow-area surgeries, such as achalasia surgery.

Aim. This paper investigates the risk factors preventing the reversal and nonreversal of Hartmann’s procedure, as a surgical technique that has been performed in our clinic for ten years. Methods. The study involved a ten‐year Hartmann’s procedure followed up at our center. The patients were divided into Hartmann reversal and nonreversal groups. Groups were examined in terms of age, gender, diagnosis, stage of malignancy, ASA score, comorbidity, perioperative morbidity‐mortality, and the length of the operation. Results. Age (p < 0.001), ASA score (p < 0.001), stage in case of malignancy (p = 0.002), and comorbidities (p < 0.001) were significant risk factors. The ratio of patients without any comorbidities to those with one or more comorbidities was 2.63 (95% CI 1.12–6.20). Among the malignant patients, the ratio of early‐stage patients to advanced‐stage patients in the group with reversal of Hartmann’s colostomy was 2.82 (95% CI 1.30–6.10). In addition, the ratio of older patients to younger patients in group 2 was 0.95 (95% CI 0.92–0.98). A univariate analysis revealed that younger patients, those with lower ASA scores, those without comorbidities, and those with early‐stage malignancy had a greater chance of closure of the stoma. Conclusion. Although Hartmann’s procedure is performed in emergency surgery, the nonreversal of the colostomy is a problem in itself. It should be kept in mind that patients who have high risks are likely to have a permanent stoma.

Objective: The aim of this study was to clarify the prognostic value of the pathological lymph node ratio for elderly and non-elderly gastric cancer patients and to evaluate whether there is a difference in the survival of patients with the same LNR (Lymph Node Ratio).Materials and Methods: A total of 222 patients diagnosed with locally advanced gastric cancer and who underwent gastrectomy were included. The patients were divided into two groups according to age. Clinicopathological properties of the two groups were compared. Potential prognostic factors affecting survival were analyzed. Subsequently, the effect of lymphadenectomy and LNR on survival in both groups was evaluated. Results: Significant differences were detected in terms of the location of primary lesions, hemoglobin and albumin levels between elderly patients and non-elderly patients (p < .05). Overall survival (OS) was significantly worse in elderly patients (22 months vs. 67 months, pConclusion: A survival difference was found between the elderly and non-elderly patients with the same LNR. LNR was found to be an independent factor for survival especially in elderly patients. Survival was found to be further decreased in elderly patients compared to non-elderly patients with increasing LNR.

Kanser, insanlığı gerek maddi gerekse manevi açıdan tehdit eden önemli evrensel bir hastalık olmaya devam etmektedir. Bu nedenle kanserin moleküler biyolojisinin anlaşılması ve kanser tedavisine yönelik güçlü prognostik, diyagnostik ve terapötik ajanların geliştirilmesi adına günümüzde büyük çaba sarf edilmektedir. Bu bağlamda, her ne kadar bazı buluşlar ümitlerimizi yeşertse de tanı ve tedaviye yönelik var olan yöntemler ilerlemiş kanser tiplerine karşı savaşta yetersiz kalmaktadır. Son yıllarda insan genom projesinin tamamlanması ile kanserin moleküler temellerinin aydınlatılması adına bilimsel anlamda ciddi adımlar atılmış ve bu adımlar sonucunda heyecan verici güzel sonuçlar elde edilmiştir. Protein kodlayan genlerden kodlanmayan RNA genlerine, epitelyal mezenkimal geçiş mekanizmasından anjiyogeneze, apoptotik hücre ölümünden otofajiye kadar kanserde rol oynayan moleküler birçok yolak ve mekanizma hakkında bugün detaylı bilgilere sahibiz. Ancak bu bilgiler her gün yayınlanan binlerce kanser araştırma makalesi ile gün geçtikçe daha da güncellenmekte ve var olan bazı bilgiler yeni yaklaşımların ortaya çıkması ile geçerliliğini kaybetmektedir.Kanserin moleküler biyolojisinin ve immünolojisin geniş perspektifte anlatıldığı bu kitap, konunun bütünlüğü göz önünde bulundurularak, okuyucunun daha kolay takip edebileceği 5 kısma bölünmüştür. Birinci kısımda, kanserin moleküler temellerine yer verilerek, epidemiyolojisi, histopatolojisi, kanserde onkogen ve tümör baskılayıcı genler ile ilgili genel konulardan bahsedilmiştir. İkinci kısım, Hanahan ve Weinberg’in 2000 yılında yayınladıkları “kanserin ayırt edici özellikleri” makalesinden esinlenerek oluşturulmuş ve bu kısımda kanser hücrelerinin normal hücrelerden ne gibi farklıklarının olduğu geniş bir çerçevede ele alınmıştır. Üçüncü kısımda, özellikle son yıllarda kanser ilişkili yolaklarda önemli işlevleri tanımlanan birçok molekül ile epigenetik düzenleme mekanizmaları güncel verilerle anlatılırken; dördüncü kısımda ise tümör immünolojisi, immün sistemden kaçış mekanizmaları, tümör mikroçevresi ve immünoterapi konularının detaylı olarak ele alındığı kanserin gelişim mekanizmaları ve kişiselleştirilmiş kanser tedavisi için prognostik biyobelirteçler, tümör immüno-baskılanmasını hedefleme stratejileri, gen tedavisi, kanser immünoterapisindeki hücreler, monoklonal antikorların kullanımı gibi daha birçok yenilikçi yaklaşım açıklanmıştır. Son kısım ise klinikte moleküler tanı amaçlı kullanılan veya tedavi planlama stratejilerinde yardımcı olan biyobelirteçlerin anlatıldığı, anti-kanser tedavi yöntemlerin geniş bir şekilde tartışıldığı, gen tedavisi ve kişiselleştirilmiş tıbbın örnekler ile üzerinde durulduğu kısımdır. Alanında uzman birbirinden değerli birçok bilim insanının katkılarıyla siz okuyucular için özenle derlenerek oluşturulan bu kitapta; kanserin moleküler biyolojisi ve immünolojisine güncel bir bakış açısı getirilmesi amaçlanmıştır. Gelişen teknoloji ve artan bilimsel bilginin ışığında bu eserin değerli ve saygın bilim insanlarına fayda sağlaması temennisiyle…