Faculty of Medicine

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Author: search.filters.author.Duman, Mehmet GürayLanguage: search.filters.language.English

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    Assessment of the Level of Middle Colic Artery Ligation Influence on Survival in Right-Sided Colon Cancer
    (Walter de Gruyter GmbH, 2025-06-01)
    Ulusoy, Cemal
    ;
    Duman, Mehmet Güray
    ;
    Aim: This study aims to investigate whether the addition of ligation of the Middle Colic Artery in its origin to Complete Mesocolic Excision (CME) with Central Vascular Ligation (CVL) affects overall survival and lymph node retrieval. Method: Patients with right-sided colon cancer who underwent curative right or extended right hemicolectomy with CME and CVL were included. In cases with tumors located in the distal part of the ascending colon and the hepatic flexure, the middle colic artery was ligated in its origin. For the cecal and proximal localization of the tumor, the point of ligation was decided on the surgeons' decision. Results: A total number of 169 patients were operated. In 78 patients the tumor was localized in the caecum, in 70 patients in the ascending colon, and 21 in the hepatic flexure. In 59 patients, the middle colic artery was ligated in its origin. Different artery ligation sites according to tumor localization subgroup presented with statistical significance (P = 0.004). The mean number of harvested lymph nodes between the groups was presented with a difference (33.4 vs. 28.5; P = 0.037). Survival rates for cecal, ascending, and hepatic flexure cancer were as follows: 61.5%, 67.1%, and 85.7%, respectively (P = 0.22). The survival rate for all patients was 66.9% (69.5% for patients with middle colic artery ligation and 65.5% for the right branch of middle colic artery ligation, P = 0.42). Conclusion: Ligation of the middle colic artery in its origin did not improve overall survival. However, it resulted in a significantly higher number of harvested lymph nodes.
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    The Incidence of Lymphovascular and Perineural Invasion and their Impact on Survival in Patients with Rectal Cancer
    (Walter de Gruyter GmbH, 2023-12)
    Misimi, Shqipe
    ;
    Cako, Dajana
    ;
    Demirel, Ali İlbey
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    ;
    Ulusoy, Cemal
    Aim: Lymphovascular Invasion (LVI) and Perineural Invasion (PNI) represent undesirable but still realistic pathological features of rectal cancer, associated with poor prognosis and worse survival. The aim of this study is to assess the incidence of LVI and PNI in patients treated for rectal cancer and the impact of LVI and PNI on patient survival. Material and Methods: This retrospective single center observational study, conducted in the period of 2016-2019, includes patients with rectal cancer treated with/without long-course neoadjuvant chemoradiotherapy (nCRT). Data collection encompassed demographics, tumor characteristics, type of surgery (abdominal perineal rectal resection - APR and low anterior rectal resection - LAR), and LVI/PNI presence. Survival during follow-up was estimated and compared for patients with/without LVI and PNI involvement. Results: A total number of 234 patients (77 females and 157 males) with mean age of 61.3 enrolled in the study. Neoadjuvant CRT was conducted in 170 patients. APR procedure was performed in 67 of them and LAR in 167. LVI presence was noted in 55 (24.4%) and PNI in 77 (34.2%) patients. Mean survival during follow-up was 42.07 months. The use of nCRT influenced on survival (p < 0.033). Patients treated with LAR had better survival outcomes (p = 0.001). Presence of LVI and PNI was associated with a worse prognosis (p < 0.001). Conclusion: PNI was more frequent than the LVI in this study. Patients with nCRT conduction had better overall survival. LVI and PNI presence was associated with poor prognosis in terms of overall survival in patients with rectal cancer.
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    Protective ileostomy in rectal cancer surgery - is it really temporary?
    (2023-03-27)
    Ulusoy, Cemal
    ;
    Duman, Mehmet Güray
    ;
    Güçlü Mete, Sıla
    ;
    Demirel, Ali İlbey
    ;
    Aim: This single-center retrospective study aimed to evaluate the rate of protective ileostomy closure in patients with rectosigmoid junction/rectal cancer and to investigate the factors that prevent ileostomy reversal. Material and Method: Patients with rectal cancer treated with/without neoadjuvant chemoradiotherapy were included in this study. All were treated with anterior rectal resection and temporary protective ileostomy creation. Decision for ileostomy closure was brought upon predefined ileostomy closure protocol. Results: Total number of 115 patients (17 with rectosigmoid junction and 98 with rectal cancer) were operated. Neoadjuvant chemoradiotherapy was conducted in 90 of them. Ileostomy closure rate was 73.9%. Mean time for stoma closure in patients with chemoradiotherapy conduction was 227.8 days, while in the rest, time was shorter (168.3 days), without statistical difference. Multivariate analysis revealed that endoscopic examination of the anastomosis during its creation was independent prognostic factor that affected ileostomy closure. Conclusion: More than one quarter of the patients with protective ileostomy experienced non-closure of their stoma due to various events after index rectal cancer surgery. Endoscopic examination of the anastomosis during its creation presented as independent factor affecting ileostomy closure.