1
|
Akkaya H, Özdemir S, Dilek O, Topaloglu AC, Bayhan AZ, Taş ZA, Gökler C, Gülek B. Evaluation of the performance of and interobserver agreement on postoperative baseline CT findings in the identification of locoregional recurrence in patients with pancreatic ductal adenocarcinoma. Abdom Radiol (NY) 2023; 48:3135-3146. [PMID: 37517056 DOI: 10.1007/s00261-023-04012-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 08/01/2023]
Abstract
PURPOSE To evaluate interobserver agreement on the findings of baseline contrast-enhanced multidetector computed tomography (CE-MDCT) performed at the postoperative third month in patients who underwent surgery due to ductal adenocarcinoma of the pancreatic head and investigate the value of these findings in predicting locoregional recurrence. MATERIAL AND METHODS The baseline CE-MDCT images of 198 patients who underwent the Whipple procedure due to pancreatic head tumors were evaluated independently by three radiologists at the postoperative third month. The radiologists were asked to note suspicious findings in terms of locoregional recurrence, including postoperative fat stranding, the presence of perivascular contrast-enhanced solid tissue, short diameter of solid tissue if present, the shape of solid tissue (convex/concave), presence of peritoneal implants, diameter (mm) of pancreatic duct dilatation if present, the presence of lymph nodes larger than 5 mm, portal vein stenosis (≥50 and <50%), the presence of ascites, and the presence of distant metastases, as specified by the Society of Abdominal Radiology in October 2022. The agreement between the radiologists and the value of these parameters in predicting locoregional recurrence were investigated. RESULTS Among the CE-MDCT findings evaluated, the radiologists had a moderate-to-high level of agreement concerning the presence of perivascular contrast-enhanced solid tissue. However, there was a poor interobserver agreement on the shape of solid tissue. A very high level of agreement was found among the radiologists in the evaluation of pancreatic duct dilatation, peritoneal implants, ascites, and the presence of distant metastases. According to the univariate analysis, the rates of portal vein stenosis had a 1.419 -fold effect [odds ratio (OR)=1.419, [95% confidence interval (CI)= 0.548-3.679, p=0.041], lymph node presence had a 2.337 -fold effect [odds ratio (OR)=2.337, [95% confidence interval (CI)= 1.165-4.686, p=0.015], perivascular contrast-enhanced solid tissue had 2.241 -fold effect [odds ratio (OR)=2.241, [95% confidence interval (CI)= 1.072-4.684, p=0.005]. In the multivariate analysis, perivascular contrast-enhanced solid tissue had 2.241 -fold effect [odds ratio (OR)=2.519, [95% confidence interval (CI)= 1.132-5.605, p=0.024]. CONCLUSION In the postoperative baseline CE-MDCT examination, the presence of solid tissue, lymph node presence, and portal vein stenosis in the surgical bed are among the findings that may indicate early locoregional recurrence in patients with pancreatic ductal adenocarcinoma.
Collapse
Affiliation(s)
- Hüseyin Akkaya
- Department of Radiology, Adana City Training and Research Hospital, University of Health Sciences, Kışla District, Dr. Mithat Özsan Boulevard, 4522. Street No. 1, 01230, Yüreğir, Adana, Turkey.
| | - Selim Özdemir
- Department of Radiology, Adana City Training and Research Hospital, University of Health Sciences, Kışla District, Dr. Mithat Özsan Boulevard, 4522. Street No. 1, 01230, Yüreğir, Adana, Turkey
| | - Okan Dilek
- Department of Radiology, Adana City Training and Research Hospital, University of Health Sciences, Kışla District, Dr. Mithat Özsan Boulevard, 4522. Street No. 1, 01230, Yüreğir, Adana, Turkey
| | - Ali Can Topaloglu
- Department of Radiology, Adana City Training and Research Hospital, University of Health Sciences, Kışla District, Dr. Mithat Özsan Boulevard, 4522. Street No. 1, 01230, Yüreğir, Adana, Turkey
| | - Ahmet Ziya Bayhan
- Department of Medical Oncology, Adana City Training and Research Hospital, University of Health Sciences, Kışla District, Dr. Mithat Özsan Boulevard, 4522. Street No. 1, 01230, Yüreğir, Adana, Turkey
| | - Zeynel Abidin Taş
- Department of Pathology, Adana City Training and Research Hospital, University of Health Sciences, Kışla District, Dr. Mithat Özsan Boulevard, 4522. Street No. 1, 01230, Yüreğir, Adana, Turkey
| | - Cihan Gökler
- Department of Surgical Oncology, Adana City Training and Research Hospital, University of Health Sciences, Kışla District, Dr. Mithat Özsan Boulevard, 4522. Street No. 1, 01230, Yüreğir, Adana, Turkey
| | - Bozkurt Gülek
- Department of Radiology, Adana City Training and Research Hospital, University of Health Sciences, Kışla District, Dr. Mithat Özsan Boulevard, 4522. Street No. 1, 01230, Yüreğir, Adana, Turkey
| |
Collapse
|
2
|
Gündoğan E, Sümer F, Çolakoğlu MK, Çiçek E, Gökler C, Aydın MC, Kayaalp C. Laparoscopic resection of choledochal cysts in adults: a series from Turkey. Turk J Surg 2020; 35:223-226. [PMID: 32550332 DOI: 10.5578/turkjsurg.4331] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 11/20/2018] [Indexed: 11/15/2022]
Abstract
Objectives Choledochal cyst is a congenital disease in which surgical treatment is preliminary because of the potential for malignancy. In recent years, increase in technological developments and laparoscopic experience have popularised the use of laparoscopy in adult choledochal cyst surgery. This study aimed to present the results of eight adult patients undergoing laparoscopic choledochal excision surgery. Material and Methods Patients who underwent laparoscopic choledochal cyst excision and hepatico-jejunostomy anastomoses between the years 2013 and 2018 were evaluated retrospectively. Demographic characteristics, preoperative and postoperative findings, pathological results and final condition of the patients were examined. Results Of the eight patients, three were males and five were females. Median age was 41.5 years (22-49). One of the patients had Type IVa and the rest had Type I choledochal cysts. Laparoscopic choledochal cyst excision, cholecystectomy, and hepatico-jejunostomy anastomoses were performed on all of the patients. One patient was converted to open surgery. Three patients had postoperative biliary leakage. Duration of the operations was determined as median 330 (240-480) minutes and blood loss was 50 (10-100) mL. Hospitalization of the patients was median 6 (4-23) days and follow-up time was median 20 (2-65) months. In the late period, cholangitis occured in a patient who was treated with medical therapy and there was no mortality in the follow-up period. Conclusion We suggest that laparoscopic choledochal cyst excision in adults may be an alternative to open surgery due to the satisfactory results in the late period in spite of early problems like self-limiting bile leakage.
Collapse
Affiliation(s)
- Ersin Gündoğan
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Fatih Sümer
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| | | | - Egemen Çiçek
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Cihan Gökler
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Mehmet Can Aydın
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| | - Cüneyt Kayaalp
- Department of General Surgery, Inonu University School of Medicine, Malatya, Turkey
| |
Collapse
|
3
|
Özdoğan HK, Karateke F, Özyazıcı S, Özdoğan M, Özaltun P, Kuvvetli A, Gökler C, Ersoy Z. The predictive value of red cell distribution width levels on mortality in intensive care patients with community-acquired intra-abdominal sepsis. ULUS TRAVMA ACIL CER 2016; 21:352-7. [PMID: 26388271 DOI: 10.5505/tjtes.2015.26737] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Red cell distribution width (RDW) is a part of the complete blood count (CBC) panel reflecting quantitative measure of variability in the size of circulating red blood cells. It has been known that higher RDW is associated with increased mortality in several diseases. The aim of this study was to investigate the association between RDW and hospital mortality in intensive care unit (ICU) patients with community-acquired intra-abdominal sepsis (C-IAS). METHODS A retrospective analysis of the patients with C-IAS was performed between January 1, 2010 and March 31, 2013. Patients' demographics, co-morbidities, laboratory measures including RDW on admission to the ICU, and Acute Physiologic and Chronic Health Evaluation II (APACHE II) score were analyzed. RESULTS A total of one hundred and three patients with C-IAS were included into the study with a mean age of 64±14 years. Overall mortality was 50.5%. RDW day 1 (RDW1) values and APACHE II scores were significantly higher in non-survivors than in survivors. In multivariate analysis, only RDW1 and APACHE II predicted mortality. The area under the receiver operating curves (AUC) of RDW1 and APACHE II were 0.867 (95% CI, 0.791-0.942) and 0.943 (95% CI, 0.902-0.984), respectively. CONCLUSION This study suggests that increased RDW is associated with mortality in ICU patients with C-IAS.
Collapse
Affiliation(s)
- Hatice Kaya Özdoğan
- Department of Anesthesia and Reanimation, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Faruk Karateke
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Sefa Özyazıcı
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mehmet Özdoğan
- Department of General Surgery, Medical Park Hospital, Adana, Turkey
| | - Pınar Özaltun
- Department of Biostatistics, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Adnan Kuvvetli
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Cihan Gökler
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Zeynep Ersoy
- Department of Anesthesia and Reanimation, Adana Numune Training and Research Hospital, Adana, Turkey
| |
Collapse
|
4
|
Menekşe E, Özyazıcı S, Karateke F, Turan Ü, Kuvvetli A, Gökler C, Özdoğan M, Önel S. Rhomboid Flap Technique in Breast-conserving Surgery: An Alternative Method for the Reconstruction of Lumpectomy Defects. J Breast Health 2015; 11:186-191. [PMID: 28331719 DOI: 10.5152/tjbh.2015.2572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/21/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We aimed to present our experience with rhomboid flap reconstruction, which is a simple technique, in breast cancer patients who underwent breast-conserving surgery. METHODS We reviewed the medical records of 13 patients with breast cancer who underwent rhomboid flap reconstruction. The patients were evaluated for tumor size, safe surgical margin, and other clinical and pathological features. RESULTS The mean age of the patients was 43.1 years (range: 28-69 years). The mean tumor diameter was 30.8 mm (range: 15-60 mm). The mean of the safe margin of resection was evaluated to be 17.8 mm (range: 5-30 mm). Re-excision was required for one patient in the same session. CONCLUSION Rhomboid flap reconstruction can facilitate the applicability of breast-conserving surgery in early breast cancer patients with large tumor-to-breast-size ratio or tumors close to the skin.
Collapse
Affiliation(s)
- Ebru Menekşe
- Department of General Surgery, Ankara Numune Training and Research Hospital, Ankara, Turkey
| | - Sefa Özyazıcı
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Faruk Karateke
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Ümit Turan
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Adnan Kuvvetli
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Cihan Gökler
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Mehmet Özdoğan
- Department of Surgery, Adana Medline Hospital, Adana, Turkey
| | - Safa Önel
- Department of General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| |
Collapse
|