Arda Ulaş Mutlu

Concordance Between AI-generated Recommendations and Multidisciplinary Tumor Board Decisions in Postoperative Breast Cancer Management: A Retrospective Validation Study - Turkish Journal of Surgical Oncology

Background: This study investigated the impact of previous abdominal surgery (PAS) on short‐term outcomes in robotic resection for colorectal cancer. Methods: 517 patients with colon or rectal cancer undergoing robotic resection between 2014 and 2024 were categorised into the no‐PAS ( n = 359) and PAS ( n = 158) groups with further subdivision into minor and major PAS. Thirty‐day outcomes and pathologic findings were compared. Results: No significant differences existed between the PAS and no‐PAS groups regarding preoperative characteristics. The rates of conversions (0.6% vs. 1.1%), intraoperative complications (2.5% vs. 2.2%), mean number of nodal harvest (32.5 ± 17.4 vs. 32.5 ± 17.1), and surgical margin positivity (2.5% vs. 0.6%) were similar. The minor PAS subgroup demonstrated a higher rate of surgical margin positivity (3.2% vs. 0%, p = 0.04). Conclusions: The results of this study suggest that robotic colorectal cancer surgery can be performed with similar short‐term outcomes and comparable oncologic resection quality in patients with PAS.

The ergonomic impact of robotic vs. laparoscopic surgery on operating room nurses: A multicenter survey analysis - Turkish Journal of Surgery

Perianal complications of Crohn’s disease are one of the significant reasons for abdominoperineal resection in patients with medically refractory perianal Crohn’s disease. A 35-year-old man with Crohn’s disease with colostomy presented to our clinic due to perianal fistulas. Complete stricture of the anus was observed, and the patient was found unsuitable for the stoma closure. The Turnbull–Cutait procedure was performed and he was discharged on the fifth postoperative day. In the second month after surgery, rectoscopy revealed a 2 cm long pouch on the neorectum. Then, the patient was treated with antibiotics and infliximab. Following the treatment, the symptoms of the patient were regressed. In the 10th postoperative month, a perianal abscess was seen, and the patient was treated with antibiotics. His ileostomy was reversed in the 18th postoperative month without any complications. In the 42nd postoperative month, no complications were reported. This case report presents the index perianal Crohn’s disease case successfully treated with the Turnbull–Cutait procedure.

Total neoadjuvant therapy (TNT) has emerged as a promising approach for managing locally advanced rectal cancer (LARC), aiming to enhance resectability, increase pathological complete response (pCR), improve treatment compliance, survival, and sphincter preservation. This study compares the clinical outcomes of TNT, with either induction or consolidation chemotherapy, to those of the standard chemoradiotherapy (CRT). In this retrospective multi-institutional study, patients with stage II-III LARC who underwent CRT or TNT from seven oncology centers between 2021 and 2024 were retrospectively analyzed. The TNT group was categorized into induction or consolidation groups based on the sequence of chemotherapy and radiotherapy. Clinical and pathological data and treatment outcomes, including pCR, event-free survival (EFS), and overall survival (OS), were analyzed. Among the 276 patients, 105 received CRT and 171 underwent TNT. The TNT group showed significantly higher pCR (21.8% vs. 2.9%, p < 0.001) and lower lymphatic (26.3% vs. 42.6%, p = 0.009), vascular (15.8% vs. 32.7%, p = 0.002), and perineural invasion rates (20.3% vs. 37.6%, p = 0.003). Furthermore, 16.9% of TNT patients opted for non-operative management (NOM), compared to 0.9% in the CRT group (p < 0.001). The median interval between the end of radiotherapy and surgery was longer in the TNT group (17.6 weeks vs. 8.8 weeks, p < 0.001). The 3-year EFS was 58.3% for CRT and 71.1% for TNT (p = 0.06). TNT is associated with higher pCR, lower lymphatic and vascular invasion rates, and higher rates of NOM compared to CRT. This supports the use of TNT as a viable treatment strategy for LARC, offering potential benefits in quality of life.

Extramural venous invasion is an independent predictor of poor outcome in colorectal cancer, whereas the significance of the intramural component of venous and lymphatic and perineural invasion is unclear. To evaluate the prognostic impact of intramural components for venous, lymphatic, and perineural invasions and the relation of these invasion patterns with clinicopathological features in patients with colon cancer. A retrospective cross-sectional study. The analysis included 626 patients with colon cancer in stages II and III. All patients were divided into four categories (no invasion, intramural invasion only, extramural invasion only, or both intramural and extramural invasions) for vascular invasion, lymphatic invasion and perineural invasion. The primary outcomes were 5-year disease-free and overall survival. Right-sided (for vascular invasion, 24.7% vs. 33.9%, p = 0.007; for perineural invasion, 34.5% vs. 41.5%, p = 0.034) and dMMR tumors (for vascular invasion, 13.5% vs. 33.5, p < 0.001; for perineural invasion, 25% vs. 41.4%, p = 0.004) exhibited less venous and perineural invasion. Compared with no invasion, presence of intramural invasion only, did not exert any effect on disease-free or overall survival for vascular invasion, lymphatic invasion, and perineural invasion. Multivariate analyses revealed that the presence of both intramural and extramural invasion was independently associated with poor disease-free and overall survival for venous (hazard ratios: 2.39, p = 0.001; hazard ratios: 2.46, p = 0.001), lymphatic (hazard ratios: 2.456, p < 0.001; hazard ratios: 2.13, p = 0.02) and perineural invasion (hazard ratios: 2.99, p < 0.001; hazard ratios: 2.68, p < 0.001), respectively. Our data strongly advocates the importance of reporting intramural and extramural components of invasion since the presence of intramural invasion alone may not be considered as a high-risk factor for systemic recurrence.