Ali Karabulut

Background/Objectives: Emergency colorectal cancer (CRC) surgery combines acute physiological disturbance with heterogeneous operative decisions. We evaluated the discrimination, calibration, and prediction error of the contemporary American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) Surgical Risk Calculator in an institutional emergency CRC cohort. Methods: This retrospective study included 198 patients undergoing clinically indicated emergency CRC resection during 2020–2024. Recorded 30-day outcomes were compared with version 4.0.4 predictions using area under the receiver operating characteristic curve (AUC), observed-to-expected (O/E) ratios, exploratory calibration plots, and Brier scores. Renal-failure analysis included 170 patients, and leak analysis included 118 patients with an anastomosis. Results: Mortality occurred in 25 patients (12.6%); discrimination was strong (AUC 0.882, 95% confidence interval [CI] 0.807–0.958), with an O/E ratio of 1.03 (95% CI 0.67–1.52). Pneumonia and cardiac complications had AUCs of 0.768 and 0.799 but were underpredicted (O/E 3.48 and 3.62). Surgical site infection occurred in 40.4%, with limited discrimination (AUC 0.544, 95% CI 0.462–0.626) and underprediction (O/E 3.15, 95% CI 2.49–3.92). Anastomotic leak occurred in 12 of 118 patients (10.2%). Mean absolute error for hospital stay was 5.46 days. Conclusions: Mortality ranking was strong, while absolute-risk estimation differed by outcome. Larger multicenter validation with consistent outcome definitions is necessary before these probabilities can support reliable individual risk communication in emergency CRC surgery.

Aims: Self-expandable metal stenting (SEMS) may convert emergency surgery for malignant left-sided colorectal obstruction into elective resection. This study evaluated SEMS placement as a bridge to surgery (BTS).Methods: This retrospective single-centre case series included consecutive SEMS attempts for malignant obstruction of the descending colon, sigmoid colon or rectosigmoid. Technical success was the primary outcome. Clinical success and procedure-related adverse events were assessed, with operative, postoperative and pathological outcomes described after successful bridging.Results: Of 26 patients undergoing attempted or completed SEMS placement, five treated with palliative intent were excluded. Technical success and successful bridging were achieved in 16/21 BTS attempts (76.2%; 95% confidence interval, 52.8-91.8). All 16 achieved clinical decompression. The five technical failures underwent emergency Hartmann’s procedure. No perforation or clinically significant bleeding occurred in 21 attempts; no migration or re-obstruction occurred after 16 successful deployments. Among successfully bridged patients, the median interval to surgery was 5 days. Primary anastomosis was performed in 15 (93.8%), and seven (43.8%) received a stoma, including six diverting ileostomies. Five (31.3%) developed postoperative complications; four had a highest Clavien-Dindo grade of I and one had grade II. No anastomotic leakage, reoperation or 30-day mortality was recorded in this cohort. Median postoperative stay was 6.5 days (interquartile range, 5-9).Conclusion: Successful SEMS placement enabled decompression and elective resection. The 76.2% technical success rate, selected population and small retrospective cohort limit conclusions regarding overall safety and comparative effectiveness.

Background/Objectives: We compared the prognostic performance of preoperative prognostic nutritional index (PNI) and Gustave Roussy Immune Score (GRIm-s) after curative-intent gastrectomy. Methods: This retrospective cohort included 168 patients, including five postoperative in-hospital deaths. Continuous PNI and ordinal GRIm-s were compared using censoring-adjusted time-dependent AUC and concordance, with paired bootstrap confidence intervals. Preoperative prediction models underwent bootstrap internal validation; restricted mean survival time and time-varying Cox analyses addressed non-proportional hazards. Results: There were 92 deaths and 107 disease-free survival (DFS) events. At 36 months, overall survival (OS) AUC was 0.659 for PNI and 0.527 for GRIm-s (difference 0.132, 95% CI 0.039–0.226); corresponding DFS values were 0.650 and 0.516 (difference 0.134, 95% CI 0.035–0.228). After optimism correction, preoperative PNI-model AUCs were 0.610 for OS and 0.595 for DFS. PNI associations weakened over time. The cohort-derived 49.6 threshold was used only in secondary exploratory analyses. Conclusions: PNI showed better unadjusted discrimination than GRIm-s at three years, but modest internally validated model performance limits clinical interpretation. These findings do not establish clinical utility, a validated cutoff, or a substitute for pathological assessment. External validation is required.

Purpose: This study aimed to provide an updated evaluation of the clinicopathological characteristics and survival outcomes of mammary Paget disease by analyzing pure Paget, Paget + DCIS, and Paget + IDC subgroups within the contemporary SEER cohort, which includes consistent HER2 reporting and reflects the modern systemic therapy era. Methods: Cases diagnosed in the SEER database between 2010 and 2021 were analyzed. Clinicopathological parameters were compared across subgroups. Overall survival (OS) and cancer-specific survival (CSS) were evaluated using Kaplan-Meier analyses and multivariable Cox regression models. Results: Paget-associated subgroups exhibited distinct biological profiles, characterized by lower hormone receptor positivity and markedly higher HER2 positivity compared with IDC. In unadjusted analyses, pure Paget and Paget + IDC groups demonstrated lower survival, whereas Paget + DCIS showed the most favorable outcomes (P < 0.001) . However, after adjustment for key prognostic determinants, including age, stage, grade, nodal status, and treatment, histological subgroup was not an independent predictor of OS or CSS. Conclusion: In the modern therapeutic era, survival differences across the Paget spectrum appear to reflect the underlying carcinoma’s biological and clinical characteristics rather than the presence of Paget disease itself. This study represents the most contemporary, comprehensively adjusted population-level analysis to date and clarifies that, when tumors are matched for stage and subtype, Paget disease does not independently worsen prognosis.

Background and Objectives: Diverting ileostomy is frequently used after low anterior resection (LAR) for rectal cancer to mitigate the clinical consequences of anastomotic leakage. The one-stitch method (OM) has been proposed as a simplified alternative to the traditional method (TM), with potential procedural advantages. However, evidence regarding its short-term outcomes and procedural efficiency remains limited and largely context-specific. This study aimed to compare perioperative outcomes of OM and TM in a single-center cohort. Materials and Methods: This retrospective cohort study included patients who underwent LAR with diverting ileostomy for rectal cancer, between January 2022 and November 2025. A total of 67 patients were analyzed (OM: n = 31; TM: n = 36). Operative time, intraoperative blood loss, length of hospital stay, stoma-related complications, overall postoperative morbidity and anastomotic leakage were compared. Subgroup analysis was performed for laparoscopic cases. Multivariable logistic regression was used to explore factors associated with postoperative complications. Results: Baseline demographic and clinical characteristics did not differ significantly between groups. The OM was associated with shorter operative time and lower intraoperative blood loss compared with TM, both in the overall cohort and in the laparoscopic-only subgroup. No statistically significant differences were observed between OM and TM regarding stoma-related complications, overall postoperative complications or anastomotic leakage. Length of hospital stay was shorter in the TM group. In multivariable analysis, ileostomy technique was not independently associated with postoperative complications, whereas laparoscopic surgery was associated with a lower likelihood of postoperative complications. Given the limited sample size, the study was underpowered for infrequent safety endpoints. Conclusions: In this single-center retrospective analysis, the OM was associated with improved procedural efficiency but did not demonstrate a clear advantage in postoperative recovery or hospital stay. No statistically significant differences in short-term morbidity were observed; however, equivalence cannot be inferred due to limited statistical power. These findings should be interpreted as regional validation data and underscore the need for larger prospective studies incorporating longer-term and patient-centered outcomes.

Aims: There might be a potential relationship between headaches and constipation. This study aimed to observe the benefits of treating chronic constipation in disease management in patients with episodic migraine (EM). Methods: Patients diagnosed with EM according to ICHD-3 were recorded according to aura presence/absence, disease duration, frequency of attacks/day/month, severity of attacks (Visual Analog Scale (VAS) assessment) and detailed demographic information and clinical parameters. Of these patients, those with Bowel habit abnormalities (discomfort and bloating in the abdomen, abdominal pain, hard feces, excessive strain during defecation, infrequent defecation and feeling of incomplete emptying) were diagnosed with chronic constipation according to the Rome IV diagnostic criteria during the interiktal period. All participants underwent abdominal ultrasonography and assessed constipation index (CI). Daily 15 cc lactulose syrup and a nutrition program were administered to the EM group with chronic constipation, simple analgesic+prophylactic treatment was administered to EM patients without chronic constipation in severe attacks, and simple analgesic/triptan+symptomatic treatment was administered to patients with mild-moderate attacks. Results: A total of 106 patients with EM (n=54, 50.9%) chronic constipation and (n=52, 49.1%) non-chronically constipated participated in the study. The relationship between nausea and vomiting (p=0.000), vitamin D levels (p=0.036) and chronic constipation was found to be statistically significant. The difference between pre-and post-treatment USG/CI values, average VAS scores, and pain frequency (day/month) in chronically constipated patients was statistically significant (p=0.000). Conclusion: This study is important because it shows that medical treatment targeting intestinal transit in patients with EM who have chronic constipation and additional supportive supplements that change dietary habits significantly reduce intestinal volume, which in turn relieves the severity of migraine headaches and reduces their frequency.

Objective: This study aimed to evaluate the performance of large language models (LLMs) in answering questions from the American Board of Surgery In-Training Examination (ABSITE). Methods: Multiple choice ABSITE Quiz was entered into the most popular LLMs as prompts. ChatGPT-4 (OpenAI), Copilot (Microsoft), and Gemini (Google) were used in the study. The research comprised 170 questions from 2017 to 2022, which were divided into four subgroups: Definitions, Biochemistry/Pharmaceutical, Case Scenario, and Treatment & Surgical Procedures. All questions were queried in LLMs, between October 1, 2024, and October 5, 2024. Correct answer rates of LLMs were evaluated. Results: The correct response rates for all questions were 79.4% for ChatGPT, 77.6% for Copilot, and 52.9% for Gemini, with Gemini significantly lower than both LLMs ( P < 0.001). In the definition category, the correct response rates were 93.5% for ChatGPT, 90.3% for Copilot, and 64.5% for Gemini, with Gemini significantly lower ( P = 0.005 and P = 0.015, respectively). In the Biochemistry/Pharmaceutical question category, the correct response rates were equal in all three groups (83.3%). In the Case Scenario category, the correct response rates were 76.3% in ChatGPT, 72.8% for Copilot, and 46.5% for Gemini, with Gemini significantly lower ( P < 0.001). In the Treatment & Surgical Procedures category, the correct response rates were 69.2% for ChatGPT, 84.6% for Copilot, and 53.8% for Gemini. Although Gemini had the lowest accuracy, there was no statistically significant difference ( P = 0.236). Conclusion: In the ABSITE Quiz, ChatGPT and Copilot had similar success, whereas Gemini was significantly behind.

Kolorektal rezeksiyonla bağırsak derin infiltre eden endometriozis (DIE) yönetimi karmaşık bir işlemdir. DIE, alt tipler arasında en kötüsüdür çünkü çevre yapılara infiltran özellikte nodül oluşturmaktadır. Kolorektal endometriozis DIE tanısını koymak için ayrıntılı klinik öykü, fizik muayene ve görüntüleme yöntemleri gereklidir. Bağırsak tutulumlu DIE tedavisinde cerrahiye geçiş zamanı lezyonun semptomatik hale gelip tıbbi tedaviye yanıt vermediği ve yaşam kalitesinin düşük olduğu zamandır.DIE için cerrahi tedaviye lezyon boyutu, sayısı, yeri infiltrasyon derinliği ve bağırsak lümen stenozunun derecesinin değerlendirilmesinden sonra karar verilir. Kolorektal endometriozis nodülleri için kullanılan cerrahiler; radikal cerrahi veya konservatif cerrahi olarak ayrılabilir. Kolorektal endometriozis DIE segmental kolorektal rezeksiyonu ve anastomozu, multidisipliner cerrahi uzmanlığı ekibi gerektiren oldukça karmaşık bir cerrahidir. Management of deep infiltrating endometriosis (DIE) with colorectal resection is a complex procedure. DIE is the worst of the subtypes because it forms nodules that infiltrate the surrounding structures. A detailed clinical history, physical examination, and imaging studies are required to diagnose DIE with colorectal endometriosis. The time to proceed to surgery in the treatment of DIE with bowel involvement is when the lesion becomes symptomatic, does not respond to medical treatment, and the quality of life is poor. Surgical treatment for DIE is decided after evaluating the size, number, location, depth of infiltration, and degree of bowel lumen stenosis of the lesions. Surgeries used for colorectal endometriosis nodules can be divided into radical surgery or conservative surgery. Colorectal endometriosis DIE segmental colorectal resection and anastomosis is a highly complex surgery requiring a multidisciplinary surgical expertise team.