Burak Isik

Background/Aims: Mean platelet volume (MPV) reflects platelet activation. Platelets have an important role in tumor progression and metastasis. In this study, we wanted to investigate the effect of MPV on survival in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC). Materials and Methods: All data of 376 patients who underwent LT and pathologically diagnosed with HCC were analyzed. By determin ing the cut-off of MPV (10.2 fL), 2 groups with high and low MPV were formed. The groups were compared within themselves. Factors affecting survival were determined by univariate and multivariate analysis. Results: When the groups were compared, patients with low MPV had significantly higher platelet counts, larger tumor sizes, lower BMI, and higher recurrence rates. In multivariate analysis, GGT >104, AFP >200 μg/L, largest tumor diameter >5 cm, and lower MPV were found to be independent risk factors that affected the prognosis. Tumor-free survival was significantly worse in the lower MPV group (P = .002). Conclusion: Pre-transplant low MPV may be useful in predicting poor prognosis and a high rate of tumor recurrence in patients with HCC after liver transplantation. Cite this article as: Şentürk M, İnce V, Üreyen O, et al. Mean platelet volume is a poor prognostic factor in patients undergoing liver transplantation for hepatocellular carcinoma. Turk J Gastroenterol. 2025;36(3):169-173.

Liver Transplant Patients and the Influence of Infectious Diseases Specialists on the Entire Process Karaciğer Nakli Hastalarında Enfeksiyonlar ve Enfeksiyon Hastalıkları Uzmanlarının Süreçteki Etkisi L iver transplantation is a life-saving procedure for patients with end-stage liver disease, yet post-transplant infections remain a significant challenge. The review article by Bayındır et al. [1] provides a detailed and well-structured discussion on this topic, effectively highlighting the critical role of Infectious Diseases (ID) specialists throughout the transplant process. This editorial further emphasizes the relevance of their analysis, reinforcing the importance of infection control, antimicrobial stewardship, and ongoing post-transplant care.

Background: The COVID-19 pandemic has significantly affected breast cancer patients by causing delays in diagnosis and treatment processes. This study aims to investigate the effects of the pandemic on the treatment process and short-term outcomes of breast cancer patients. Methods: This retrospective, cross-sectional, single-center study included 414 patients who underwent surgery for breast cancer at the Inonu University General Surgery Clinic between March 2018 and June 2021. The patients were divided into two groups: pre-pandemic (Pre-COVID-19; n = 240) and pandemic (COVID-19 Era; n = 174) periods. The groups were compared in terms of demographic, clinical, and histopathological variables. Results: During the pandemic period, the use of neoadjuvant therapy (from 21.3% to 34.5%) and preoperative PET-CT imaging (from 80.4% to 90.8%) rates increased, while breast-conserving surgery (from 27.9% to 19.0%) and the presence of comorbid diseases (from 45.0% to 29.9%) decreased significantly. While there was no significant difference between the groups in terms of the time from diagnosis to surgery (25 vs. 28.5 days, p = 0.121), the time to report the pathology result after surgery decreased during the pandemic period (28 vs. 23 days, p < 0.001). There was no significant difference between the groups in terms of immunohistochemical (ER, PR, Ki-67, E-cadherin, and c-erbB2), histopathological (lymphovascular invasion, perineural invasion, comedo necrosis, modified Bloom–Richardson grade, and TNM classification), and clinical (recurrence, metastasis, and axillary lymph node metastasis) features of the tumor. The mortality rate in the Pre-COVID-19 group (7.1%) was significantly higher than in the COVID-19 Era group (2.3%) (p = 0.049). Finally, in terms of the survival analysis, a statistically significant difference was found between the Pre-COVID-19 and COVID-19 Era groups in terms of the mean follow-up duration of the patients (p = 0.044). Conclusions: The study results show that the use of neoadjuvant therapy and radical surgery preference increased in breast cancer treatment during the pandemic period, but there was no significant change in tumor biology and histopathological features. Breast-conserving surgery rates, comorbidity rates, and pathology reporting times were significantly shortened. Long-term follow-up periods of 3 and 5 years are needed to see the impact of the pandemic on breast cancer patients.

Background: Treatment of established portal vein narrowing after living donor hepatectomy is challenging. We aimed to present a new approach termed the “elbow patch reconstruction technique” to correct the narrowed remnant portal vein just or late after right lobe living donor hepatectomy. Methods: Demographic and clinical data of 12 living liver donors with narrowed remnant portal veins and treated with the “elbow patch reconstruction technique” were prospectively collected and retrospectively evaluated. Anatomic variation of the portal vein was defined in accordance with the Nakamura classification; six of the living liver donors had type A, three had type B, and the remaining three had type C. In eight of the living liver donors with a narrowed remnant portal vein, diagnosis was detected by intraoperative Doppler ultrasonography and visual inspection by experienced transplant surgeons in the living donor hepatectomy procedure. In the remaining four living liver donors, diagnosis was performed postoperatively when elevation of liver enzymes was noticed during the routine liver function test and Doppler US. The diagnosis was confirmed by multidetector computed tomography. Results: Data from nine males and three females aged 18 to 54 years were analyzed. All of the living liver donors were followed up for a median of 1710 days (min-max: 1178–4447 days; IQR: 1516 days), and none of the living liver donors had any structural or functional complications in the portal vein. Conclusions: Narrowing remnant portal veins are rare, but they are a life-threatening complication in living liver donors, and this condition requires urgent management. Image guided interventions and narrowed segment resection with end-to-end anastomosis using a vascular graft carried a potential risk for thrombosis and restenosis. To avoid these complications, we shared a technique named “elbow patch reconstruction technique”. This technique can be very effective in relieving the narrowing of the remnant portal vein after right lobe living donor hepatectomy.

Background/Aims: Hepatocellular carcinoma is the main type of primary liver cancer. Macroscopic vascular invasion is usually identified during imaging, whereas microvascular invasion is usually determined by histopathological evaluation. We aim to identify the association between microvascular invasion and other markers of tumor aggressiveness and to identify the role of microvascular invasion in the prognosis of patients who were treated by liver transplantation for hepatocellular carcinoma. Materials and Methods: This is a single-center retrospective analysis of prospectively collected data. Patients who received liver transplantation for hepatocellular carcinoma were included in the study. Data were collected regarding sociodemographic variables, criteria of selection for liver transplantation, pretransplant alpha-fetoprotein, presence or absence of microvascular invasion, presence or absence of recurrence, overall survival, and disease-free survival. Data were analyzed using Statistical Package for the Social Sciences. Results: Sociodemographic laboratory values and radiologic tumor characteristics were found to be similar in patients with or without microvascular invasion. Our study revealed that microvascular invasion is associated with increased recurrence, decreased diseasedfree survival, and decreased overall survival, only for patients with hepatocellular carcinoma beyond Milan criteria at the time of liver transplantation. Conclusion: For patients beyond Milan criteria, but not within Milan criteria, microvascular invasion plays a significant role in predicting recurrence and shorter survival after liver transplantation. Cite this article as: Garzali IU, Carr BI, İnce V, Işık B, Akatlı AN, Yılmaz S. Microvascular invasion in hepatocellular carcinoma: Some puzzling facets. Turk J Gastroenterol. 2024;35(2):143-149.

Background and Aim: Patients with hepatocellular carcinoma (HCC) are managed in various hospital departments, which complicates the assessment of the overall picture. In our large liver transplant institute, we evaluate all HCC patients in a weekly multi-disciplinary liver tu-mor board, and their data are prospectively collected in an institutional HCC database to evaluate HCC causes, tumor features, treatments, and survival. Materials and Methods: Baseline data for patients (n=1322) were prospec-tively recorded, including hepatitis status, routine clinical serum parame-ters, radiological assessment of maximum tumor diameter (MTD), tumor number, presence of macroscopic portal vein thrombosis (PVT), and serum alpha-fetoprotein (AFP) levels. Results: Cirrhosis was found in 81.1% of patients; 58.5% had hepatitis B virus (HBV), 14.9% hepatitis C virus (HCV), 8.9% cryptogenic cirrhosis, and less than 2% had alcoholism. MTD was 10 cm) were primarily in the no-surgery group. Parallel differences were found for AFP levels (highest in the no-surgery group). PVT was present in similar proportions (25.0% for transplant, 28.0% for no-surgery). The presence of cirrhosis was higher in the transplant group. MTD and levels of serum AFP, gamma-glutamyl transferase (GGT), and blood platelets were prognostic parameters for transplant. Furthermore, AFP and GGT levels were prog-nostic for transplanted PVT patients. Only albumin was prognostic in the no-surgery patients. Conclusion: Transplanted HCC patients have longer survival, smaller tu-mors, and more severe liver damage than no-surgery patients. Prognostic subsets were identified within the surgery and the PVT groups.