İsa Caner Aydın

Aims: This study evaluated the association of preoperative carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) levels at diagnosis with pathological aggressiveness and local recurrence in patients with gastric cancer undergoing gastrectomy.Methods: This retrospective single-center study included 58 patients who underwent subtotal or total gastrectomy and had available preoperative tumor markers. CEA >5 ng/ml and CA19-9 >37 U/ml were considered elevated. Clinicopathological data, recurrence patterns, disease-free survival (DFS) events, and overall survival were analyzed.Results: Elevated CEA and CA19-9 were detected in 17 (29.31%) and 12 (20.69%) patients, respectively. At least one marker was elevated in 24 patients (41.38%), and both markers were elevated in 5 (8.62%). During follow-up, local recurrence occurred in 7 patients (12.07%), peritoneal recurrence in 16 (27.59%), distant metastasis in 9 (15.52%), and DFS events in 21 (36.21%). Local recurrence was not significantly associated with tumor marker status. However, patients with DFS events had higher CEA and CA19-9 levels (p=0.029 and p=0.006). Elevation of either marker was associated with DFS events (p=0.026), while concomitant elevation was associated with N3 disease and advanced pathological stage.Conclusion: In this limited cohort, preoperative CEA and CA19-9 levels were not significantly associated with local recurrence, but they may reflect tumor burden, nodal involvement, and risk of DFS events after gastrectomy.

Objective: Cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is an aggressive locoregional treatment for selected patients with peritoneal surface malignancies. Although its oncological role has been widely discussed, longitudinal data focusing on postoperative quality-of-life (QoL) trajectories remain limited. This study aimed to describe longitudinal QoL trajectories during the first two years after CRS/HIPEC and to provide exploratory descriptive comparisons according to selected clinical characteristics. Methods: This retrospective single-center cohort study included 144 consecutive adult patients who underwent CRS/HIPEC between January 2018 and July 2022. Patients were evaluated preoperatively and postoperatively at day 14 and at 1, 3, 6, 12, 18, and 24 months. QoL was assessed during routine follow-up primarily using the EORTC QLQ-C30 questionnaire; the EORTC QLQ-CR29 was also administered in institutional practice as a supplementary instrument in selected settings. Repeated QLQ-C30 measurements were analyzed descriptively using the Friedman test with post hoc Nemenyi comparisons. Results: Questionnaire completion rates were 100% at baseline, postoperative day 14, and month 1; 96.5% at months 3 and 6; 91.0% at month 12; 81.9% at month 18; and 75.7% at month 24. Longitudinal analyses demonstrated significant time effects across multiple QoL domains, including global health status, physical functioning, emotional functioning, role functioning, cognitive functioning, social functioning, pain, fatigue, and diarrhea. The most pronounced deterioration was observed in the early postoperative period, particularly at postoperative day 14. Thereafter, several domains improved gradually; however, recovery was domain-specific and did not consistently return to preoperative levels during follow-up. In exploratory descriptive analyses, patients with major postoperative complications showed more pronounced early impairment in global health status, physical functioning, and social functioning, together with greater pain and fatigue burden, particularly at postoperative day 14 and month 1. Exploratory subgroup comparisons also suggested heterogeneity in recovery patterns according to primary tumor origin. Later follow-up findings should be interpreted cautiously in view of attrition over time and the absence of adjusted longitudinal modeling. Conclusions: Quality of life declines substantially during the early postoperative period after CRS/HIPEC, followed by gradual but incomplete recovery over time. This recovery pattern is non-linear and varies across domains. Exploratory descriptive findings suggested that early postoperative QoL impairment may be greater in patients with major complications, but these subgroup patterns require confirmation in prospectively designed studies using adjusted longitudinal models. Longitudinal QoL assessment may provide clinically meaningful insight into postoperative recovery after CRS/HIPEC.

Background/Objectives: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) are effective treatment modalities for patients with peritoneal carcinomatosis (PC), though splenectomy is frequently required and its impact on outcomes remains unclear. Previous studies have evaluated splenectomy as a binary variable without distinguishing surgical indication, potentially obscuring important prognostic differences. This retrospective study aimed to evaluate the impact of splenectomy on postoperative morbidity and survival in patients undergoing CRS + HIPEC. Methods: A retrospective analysis was conducted on 149 patients who underwent CRS + HIPEC between 2018–2022 at a single tertiary center. The study examined patients with various cancer origins, including colorectal, ovarian, gastric, pseudomyxoma peritonei, and malignant peritoneal mesothelioma. Demographic characteristics, surgical procedures, complications, and survival outcomes were comprehensively analyzed. Patients were categorized by splenectomy and further stratified by surgical indication (iatrogenic injury, peritoneal implants, hilar tumor invasion). Results: Splenectomy was associated with longer ICU stay (median 1.5 vs. 1 day, p < 0.001) and hospitalization (median 12 vs. 9 days, p = 0.005). Individual pulmonary complications were more frequent in the splenectomy group, though major complication rates (Clavien–Dindo ≥ 3) were similar (34.7% vs. 21.7%, p = 0.086). When analyzed without stratification by indication, splenectomy showed no impact on OS (median 42.7 vs. 42.2 months, p = 0.665) or DFS (median 32.1 vs. 35.4 months, p = 0.138). However, stratification by indication revealed divergent prognostic effects: splenectomy for peritoneal implants independently predicted worse DFS (OR = 17.814, 95% CI: 3.025–104.894, p = 0.001), while splenectomy for hilar invasion was protective (OR = 0.136, 95% CI: 0.025–0.736, p = 0.021). PCI independently predicted both OS (OR = 1.150 per point, p = 0.006) and DFS (OR = 1.166 per point, p < 0.001). Primary tumor type was not independently prognostic after adjusting for PCI (OS p = 0.345, DFS p = 0.163). Conclusions: Splenectomy during CRS + HIPEC was associated with prolonged intensive care and hospital stays without increasing major complications. Peritoneal implant-related splenectomy predicts worse DFS, likely reflecting extensive disease burden, while hilar invasion-related splenectomy is protective, possibly reflecting more complete regional clearance achieved during en bloc resection to attain CC-0. Given the retrospective nature of this study and the heterogeneous patient population, these findings should be interpreted with caution. Further prospective research with larger, more homogeneous patient cohorts is warranted to definitively establish the long-term implications of splenectomy in CRS + HIPEC procedures.

Introduction: Peritoneal carcinomatosis (PC) patients undergoing cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) face a high risk of morbidity. Surgical site infections (SSIs) are among the main contributors to this issue. This relation is influenced not only by the effects of major surgical resections but also by the hemodynamic changes induced by HIPEC. Although elevated lactate levels (LL) have been associated with greater complication rates in CRS-HIPEC patients, their direct association with the development of SSIs has not been thoroughly investigated. Methods: Patients who underwent CRS + HIPEC were retrospectively reviewed. Pre-operative demographic data, hemodynamic parameters and records, transfusion records, and all post-operative follow-up and treatment records were analyzed. Patients were categorized into SSI+ and SSI-. Factors contributing to SSI development were examined using regression analysis. Results: A total of 110 patients who underwent CRS + HIPEC between January 2018 and December 2021 were included in the study. LL obtained at intensive care unit (ICU) admission were greater in patients who developed SSIs (p = 0.020). Cutoff point for ICU admission LL in diagnosing SSI was ≥6 mmol/L (area under the curve: 0.640 [0.526-0.753], p = 0.020). SSI development (23% vs. 50%, p = 0.003) was more prevalent in patients with lactate values ≥6 mmol/L. In multi-variable analysis, LL ≥6 mmol/L (odds ratio [OR]: 4.614, p = 0.005) and clean-contaminated wounds (OR: 27.677, p = 0.002) were related with increased SSI development. Conclusion: In patients with PC, LL of 6 mmol/L or greater during the ICU stay have been associated with SSI development. For this high-risk patient subgroup, a readily available peri-operative parameter such as lactate may guide prophylactic antibiotic selection. However, despite its high specificity, the low sensitivity of our findings should be carefully considered before clinical decision-making. Further studies analyzing larger, more homogeneous cohorts are needed to better clarify the relation between LL, SSI development, and prophylactic antibiotic use.

Background: This study aimed to compare the clinical, pathological, and biochemical characteristics of upper rectal cancer (URC) and mid–lower rectal cancer (MLRC) in stage II and III non-metastatic rectal cancer and to identify distinct prognostic factors influencing survival and recurrence. Material and Methods: This retrospective cohort study included 100 patients with stage II and III non-metastatic rectal adenocarcinoma who underwent neoadjuvant chemoradiotherapy (nCRT) followed by curative-intent surgery between 2021 and 2024. Patients were categorized into URC (n = 53) and MLRC (n = 47) groups. Parameters analyzed included demographic factors, ASA score, surgical characteristics, pathological features (tumor stage, lymph node involvement, lymphovascular invasion (LVI), perineural invasion (PNI), tumor budding, tumor regression grade (TRG)), and biochemical markers (carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), white blood cell (WBC) count, neutrophil count, platelet count (PLT), and C-reactive protein (CRP)). One-year overall survival (OS) and disease-free survival (DFS) were analyzed using Kaplan–Meier survival curves, and Cox regression models identified independent prognostic factors. Results: Preoperative CEA levels were higher in MLRC (p = 0.05), whereas WBC count (p = 0.01), neutrophil count (p = 0.02), PLT (p = 0.01), and CRP levels (p = 0.01) were higher in URC. Pathological analysis revealed higher LVI (p = 0.04), PNI (p = 0.04), and tumor budding (p = 0.03) in MLRC. At one-year follow-up, OS rates were 82.1% (URC) vs. 80.3% (MLRC) (p = 0.85), and DFS rates were 78.6% (URC) vs. 73.4% (MLRC) (p = 0.72). Multivariate Cox regression analysis identified age (HR: 1.04, p = 0.03), ASA score (HR: 1.22, p = 0.01), CRP (HR: 1.18, p < 0.001), preoperative CEA (HR: 1.12, p = 0.02), preoperative CA19-9 (HR: 1.09, p = 0.03), LVI (HR: 1.42, p < 0.001), PNI (HR: 1.35, p = 0.02), and tumor budding (HR: 1.28, p = 0.03) as independent prognostic factors for OS. Similar trends were observed for DFS, with T stage (HR: 1.35, p = 0.01) and tumor size (HR: 1.22, p = 0.01) also being found significant. Conclusions: Inflammatory markers, tumor burden indicators (LVI, PNI, budding, tumor size, T stage), and preoperative CEA/CA19-9 were identified as significant predictors, suggesting a risk-adapted approach to rectal cancer treatment.

Background: The management of locally advanced rectal cancer (LARC) has seen the emergence of total neoadjuvant therapy (TNT) as a promising approach. TNT has shown potential in enhancing tumor regression, increasing pathological complete response (pCR) rates, and improving the control of systemic disease. However, the impact of TNT on complications during and after surgery remains uncertain. This research aimed to assess surgical complications linked to TNT in comparison with conventional neoadjuvant chemoradiotherapy (nCRT). Additionally, this study explored the potential of the Prognostic Nutritional Index (PNI) as a predictor of surgical outcomes. Methods: A retrospective cohort study was conducted at Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, including patients with LARC who underwent either TNT or nCRT followed by curative excision (TME). Demographic data, perioperative complications, and tumor-related variables were also analyzed. The prognostic value of the PNI in predicting surgical complications was assessed using multivariate logistic regression analysis. Statistical significance was set at p < 0.05. Results: A total of 103 patients with LARC were included, of whom 38 (36.9%) received TNT and 65 (63.1%) underwent nCRT. TNT was associated with significantly higher rates of anastomotic leakage (13.2% vs. 6.2%, p = 0.04) and wound infections (23.7% vs. 9.2%, p = 0.02). The mean tumor size was significantly smaller in the TNT group (3.22 ± 1.10 cm) than in the nCRT group (3.65 ± 1.26 cm, p = 0.02). The PNI was significantly lower in the TNT group (38.96 ± 5.54) than in the nCRT group (41.31 ± 4.65, p = 0.03). Multivariate logistic regression analysis demonstrated that a lower PNI was independently associated with increased surgical complications (β = −1.09, p = 0.028, 95% CI: −2.06–−0.12). Conclusions: Although TNT demonstrates clear oncological benefits in LARC, it is associated with increased perioperative morbidity. Our findings suggest that the PNI is a valuable predictive biomarker of surgical complications in patients treated with TNT. Preoperative nutritional assessment and optimization may improve perioperative outcomes and mitigate the risks associated with TNT. Future prospective studies should explore targeted interventions to enhance the safety profile of TNT while preserving its oncological advantages.

Background: This study aimed to evaluate the diagnostic yield of colonoscopy in asymptomatic individuals aged 45–49 years compared with those aged 50–54 years in a Turkish population, providing insights into region-specific screening strategies. Methods: This retrospective multicenter study was conducted across three tertiary endoscopy units in Turkey. Screening colonoscopy data from 3943 asymptomatic individuals aged 45–54 years between 2018 and 2023 were analyzed. The patients were stratified into two groups: 45–49 years (Group 1) and 50–54 years (Group 2). Demographic characteristics, polyp size, histological features, and prevalence of early-onset advanced colorectal neoplasia (EAO-aCRN) were assessed. Results: A total of 3943 patients were included, with 862 in Group 1 (45–49 years) and 3081 in Group 2 (50–54 years). The polyp detection rate was 16.6% in Group 1 and 22.9% in Group 2 (p < 0.001). The adenoma detection rates were 10.8% and 13.9% in Groups 1 and 2, respectively (p = 0.018). The advanced polyp detection rates were 3.2% and 7.3% in Groups 1 and 2, respectively (p < 0.001). Mean polyp size was 6.5 ± 5.1 mm in Group 1 and 8.8 ± 8.4 mm in Group 2 (p < 0.001). The mean number of polyps per patient was 1.5 ± 0.8 in Group 1 and 1.9 ± 1.6 in Group 2 (p = 0.023). Advanced neoplasia was detected in 16.6% of Group 1 patients compared with 22.9% of Group 2 patients (p < 0.001). Conclusions: While CRC screening at age 45 demonstrated lower detection rates of polyps and advanced neoplasia than at age 50, the higher prevalence of EAO-CRN among 45–49-year-olds in Turkey underscores the importance of early screening in high-risk populations. Tailored regional strategies incorporating individual risk factors are crucial for optimizing CRC prevention policies.

Background and Objectives: Mucinous adenocarcinoma (MAC) and mucinous components (MCP) in colorectal cancers (CRC) have shown conflicting results regarding their prognostic impact. This study aims to evaluate survival differences between MAC, MCP, and non-mucinous adenocarcinoma (nMAC) in stage II and III CRC patients. Materials and Methods: 224 CRC patients who underwent surgery between 2013 and 2021 were analyzed retrospectively. Patients were classified as nMAC, MCP, or MAC based on the percentage of extracellular mucin. Those who received neoadjuvant therapy, had stage I or IV TNM disease, and emergency cases were excluded. Survival analysis was performed using Kaplan–Meier curves and Cox regression models. Results: MAC patients showed worse survival outcomes compared to nMAC (p = 0.025). No difference in survival was found between MCP and nMAC (p = 0.055). Multivariate analysis identified MAC (OR: 2.814; p = 0.014) and perineural invasion (PNI) (OR: 2.283; p = 0.008) as independent factors associated with worse survival. Kaplan–Meier analysis revealed MAC’s worse prognosis than nMAC (p = 0.027). Conclusions: MAC was shown to have a worse prognosis than nMAC in stage II and III CRC patients, while MCP survival rates were similar with nMAC. These findings suggest that MAC requires more careful treatment approaches, while MCP and nMAC have better survival rates. Further studies focusing on molecular and genetic profiles are needed to better understand these outcomes.