Omer Akay

Background: Neoadjuvant therapy is the standard treatment for locally advanced rectal cancer; however, treatment response remains heterogeneous, and research has increasingly shifted from isolated anatomical predictors toward biologically integrated response assessment. This study evaluated whether anatomical tumor location was independently associated with pathological response to neoadjuvant therapy. Materials and Methods: This multicenter retrospective study included 179 patients with stages II-III rectal adenocarcinoma undergoing long-course neoadjuvant chemoradiotherapy followed by total mesorectal excision between January 2023 and January 2026. Tumor location was categorized as upper (>10 cm), mid (5-10 cm), or low (P = .358). Major response occurred in 47.5% of patients without lymphovascular invasion but in only 3.3% of those with lymphovascular invasion, which was associated with lower odds of major response (OR 0.05, 95% CI 0.01-0.15; P < .001). Conclusion: Anatomical tumor location was not independently associated with pathological response following neoadjuvant chemoradiotherapy. These findings suggest that response assessment should extend beyond simple anatomical variables and be interpreted within the broader context of tumor biology and integrated clinicopathological assessment.

Background/Objectives: Postoperative hypocalcemia is the most common complication following thyroidectomy; however, previous studies have largely relied on biochemical definitions without distinguishing symptomatic hypocalcemia from asymptomatic biochemical abnormalities. This study aimed to identify the independent predictors of symptomatic postoperative hypocalcemia. Methods: This retrospective single-center study included 245 adult patients who underwent thyroidectomy between January 2017 and December 2022. Patients were classified as normocalcemic (n = 88), asymptomatic biochemical hypocalcemic (n = 87), or symptomatic hypocalcemic (n = 70) according to calcium status within the first 72 postoperative hours. Demographic, surgical, biochemical, ultrasonographic, cytological, and histopathological variables were analyzed. Independent predictors were identified using multivariable logistic regression. Results: Symptomatic hypocalcemia occurred more frequently after bilateral total thyroidectomy with central neck dissection (p = 0.001). Patients with symptomatic hypocalcemia had lower preoperative serum calcium and lower postoperative albumin and parathyroid hormone levels than the other groups (all p < 0.05). Although high-risk FNAB cytology and malignant histopathology were associated with hypocalcemia in univariate analyses, neither remained independently predictive after adjustment. Bilateral total thyroidectomy with central neck dissection (adjusted OR 6.63, 95% CI 1.68–26.11; p = 0.007) and lower preoperative serum calcium (adjusted OR 0.46, 95% CI 0.22–0.94; p = 0.036) were independent predictors of symptomatic hypocalcemia after thyroidectomy. Conclusions: Symptomatic postoperative hypocalcemia should be considered a distinct clinical outcome rather than merely a biochemical abnormality. Bilateral total thyroidectomy with central neck dissection and lower preoperative serum calcium independently predicted symptomatic hypocalcemia, whereas ultrasonographic findings, FNAB cytology, histopathological diagnosis, and incidental parathyroidectomy did not. Although the absence of perioperative vitamin D and magnesium measurements is an important limitation, the identified predictors may provide clinically useful information for perioperative risk stratification.

Background and Objectives: We aimed to evaluate early postoperative radiographic changes in sagittal foot alignment following laparoscopic sleeve gastrectomy and to investigate the association between early weight loss and sagittal foot alignment parameters. Materials and Methods: This study included 72 consecutive patients who underwent primary laparoscopic sleeve gastrectomy. Standardized lateral foot radiographs were obtained preoperatively and at the fourth postoperative month. Meary’s angle, calcaneal pitch, and talar declination angle were measured on all radiographs. Demographic and clinical variables, including age, sex, height, body weight, and body mass index (BMI), were recorded. Results: Meary’s angle demonstrated a significant postoperative decrease from 15° (IQR, 8°) to 11° (IQR, 12°) (p < 0.001), indicating improvement in medial longitudinal arch alignment. In contrast, no significant postoperative changes were observed in the calcaneal pitch (p = 0.227) or talar declination angles (p = 0.751). The proportion of patients within the normal range for all measured sagittal alignment parameters increased postoperatively, without showing statistical significance. Statistical analysis revealed that all postoperative sagittal alignment parameters showed significant correlation with preoperative values. Notably, postoperative Meary’s angle demonstrated a very strong positive correlation with preoperative Meary’s angle (r = 0.80, p < 0.001), whereas no significant correlation was identified between postoperative Meary’s angle and either postoperative weight or weight/BMI loss (p > 0.05). Although BMI loss showed a significant correlation with postoperative calcaneal pitch and talar declination angles, these correlations were weak to moderate (r = −0.403, and r = −0.362, respectively). Conclusions: Early postoperative body weight/BMI loss following sleeve gastrectomy is associated with modest, parameter-specific improvements in sagittal foot alignment, primarily reflected by changes in Meary’s angle, suggesting that the medial longitudinal arch may be more responsive to early postoperative unloading than other sagittal alignment parameters. The strong association between preoperative and postoperative measurements underscores the central role of baseline alignment in determining early postoperative outcomes.

SUMMARY OBJECTIVE: The response to neoadjuvant therapy in patients with locally advanced rectal cancer varies considerably among individuals. While some patients achieve a complete pathological response, others may even experience disease progression during treatment. The aim of the study was to investigate the predictive value of serum adipokines in determining the response to neoadjuvant therapy. METHODS: This prospective study included patients diagnosed with rectal cancer and scheduled for neoadjuvant therapy at our institution between September 2020 and September 2022. Before the treatment, blood samples were collected from the patients, and levels of serum adipokines (adiponectin, leptin, resistin, and adipsin) were measured. Following surgical resection, the Modified Ryan Scoring System was used to assess the response to neoadjuvant chemoradiotherapy. Patients were then divided into two groups according to the response to the treatment (Group 1: tumor regression grade 0; Group 2: tumor regression grade 1–3). RESULTS: In the 58 patients included, no significant differences were observed in terms of demographics, tumor characteristics, or serum biochemical parameters. However, levels of adiponectin (p=0.039) and resistin (p=0.017) were significantly lower in the pathologic complete response group. CONCLUSION: Adiponectin and resistin might contribute to anticipating response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer. The incorporation of these markers into personalized therapy approaches has the potential to improve correct decision-making in the management of locally advanced rectal cancer.

Introduction: Celiac artery stenosis (CAS) may exacerbate postoperative complications by impairing arterial perfusion in upper abdominal organs. This study evaluated the prevalence of CAS in patients undergoing pancreaticoduodenectomy and its association with clinically significant postoperative pancreatic fistula (POPF). Methods: A retrospective analysis of 151 patients who underwent pancreaticoduodenectomy between 2017 and 2022 was conducted. CAS was assessed via preoperative computed tomography with a stenosis threshold of ≥50%. Multivariate logistic regression identified risk factors for POPF. Results: CAS ≥50% was observed in 17.2% of patients, and Grade B/C POPF occurred in 17.9%. In patients with a CAS ≥50%, the risk of POPF was significantly increased (Odds Ratio: 16.458, 95% Confidence Interval: 4.575–59.203, P < .001). A pancreatic duct diameter of less than 3 mm and a soft pancreatic texture were found to be associated with POPF in the univariate analysis ( P = .029, P = .032, respectively). Additionally, the prevalence of smoking and the median age were higher in patients with a CAS ≥50 (respectively, P = .011 and P = .052). Conclusions: CAS is an independent risk factor for clinically significant POPF. Preoperative CAS identification and management are vital to minimizing postoperative complications. Further studies are needed to confirm these findings.

AIM: This study aimed to evaluate the relationship between colonic diverticular disease (CD) and colonic polyps (CP) in Turkiye, considering age and gender distribution. METHODS: This retrospective cross-sectional study analyzed patients who underwent total colonoscopy between 1 January 2021, and 1 January 2022. Patients with a history of colon resection, inflammatory bowel disease, or prior polypectomy were excluded. The presence of CD and CP was assessed according to age, gender, and colonic localization [right (R), left (L), bilateral (B)]. RESULTS: A total of 452 patients were included, with 248 (54.9%) males and 204 (45.1%) females. The mean age was 57.7 ± 13.0 years. Among them, 235 were in the patient group [CD (+) and/or CP (+)], and 217 were in the control group. The study found a significant association between CD and CP, particularly among older patients, with rates of CD (+) and CP (+) increasing with age (p = 0.001). Interestingly, CD (+) patients had a lower risk of CP compared to CD (–) patients (p = 0.003). Additionally, male patients exhibited significantly higher CP rates than females. CONCLUSIONS: Our findings indicate that CD (+) patients have a significantly lower risk of CP (+) compared to CD (–) patients. These results provide valuable insights into the relationship between CD and CP, which may help guide future research.

AIM: The aim of this study was to investigate the effect of metastatic lymph node ratio (mLNR) on overall survival after curative resection in patients with right-sided colon cancer. METHODS: Patients diagnosed with right-sided colon cancer and treated at Istanbul Teaching and Research Hospital between 2012 and 2017 were retrospectively analyzed. Variables including age, sex, total number of lymph nodes removed, metastatic lymph node ratio, disease stage, tumor location, and patient morbidity were compared with overall survival. Kaplan-Meier survival analysis and Cox regression analysis were used to evaluate the impact of these variables on overall survival. RESULTS: A total of 129 patients were included in this study. By the end of the follow-up period, 51 patients (39.5%) had died. Receiver operating characteristic (ROC) analysis identified a cut-off value for mLNR at 0.0801 (p < 0.001), with 39 patients (30.2%) having an mLNR greater than this threshold. Patients with a high mLNR exhibited significantly shorter overall survival (20.3 months, 95% confidence interval (CI): 12.0–28.6) compared to those with a lower mLNR (106.6 months, 95% CI: 98.4–114.8) (p < 0.001). Furthermore, overall survival was significantly lower in patients with advanced-stage tumors, highlighting the prognostic importance of tumor, node, and metastasis (TNM) staging system. In multivariate Cox regression analysis, TNM stage (hazard ratio (HR) = 50.229, 95% CI: 6.678–372.242, p < 0.001) and mLNR (HR = 3.136, 95% CI: 1.843–5.337, p < 0.001) were identified as independent prognostic factors for overall survival. CONCLUSIONS: This study underscores that in right-sided colon cancer, the mLNR and TNM stage provide critical prognostic insights, independent of the total number of lymph nodes removed. These findings support the use of mLNR as a practical and reliable tool for refining prognostic assessments and guiding personalized treatment strategies, emphasizing its potential role in clinical decision-making.