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Delaying surgery after neoadjuvant chemoradiotherapy improves prognosis of rectal cancer

World Journal of Gastrointestinal Oncology 2016年第9期8卷 695-706页

作者： mehmet mihmanli Esin Kabul Gürbulak Ismail Ethem Akgün Mustafa Fevzi Celayir Pinar Yazici Deniz Tuncel Tuba Tülin Bek Ayhan Oz Sinan Omeroglu Department of General Surgery Sisli Etfal Training and Research Hospital Department of Pathology Sisli Etfal Training and Research Hospital Department of Radiation Oncology Sisli Etfal Training and Research Hospital

AIM To investigate the prognostic effect of a delayed interval between neoadjuvant chemoradiotherapy(CRT) and surgery in locally advanced rectal *** We evaluated 87 patients with locally advanced mid-or distal rectal cancer undergoing total mesorectal excision following an interval period after neoadjuvant CRT at ?i?li Hamidiye Etfal Training and Research Hospital,Istanbul between January 2009 and January *** were divided into two groups according to the intervalbefore surgery: < 8 wk(group Ⅰ) and ≥ 8 wk(group Ⅱ).Data related to patients,cancer characteristics and pathological examination were collected and *** When the distribution of timing between group Ⅰ(n = 45) and group Ⅱ(n = 42) was viewed,comparison of interval periods(median ± SD) of groups showed a significant difference of as 5 ± 1.28 wk in group Ⅰ and 10.1 ± 2.2 wk in group Ⅱ(P < 0.001).The median follow-up period for all patients was 34.5(9.9-81) *** Ⅱ had significantly higher rates of pathological complete response(p CR) than group Ⅰ had(19% vs 8.9%,P = 0.002).Rate of tumor regression grade(TRG) poor response was 44.4% in group Ⅰ and 9.5% in group Ⅱ(P < 0.002).A poor pathological response was associated with worse disease-free survival(P = 0.009).The interval time did not show any association with local recurrence(P = 0.79).CONCLUSION Delaying the neoadjuvant CRT-surgery interval may provide nodal down-staging,improve p CR rate,and decrease the rate of TRG poor response.

关键词： Rectal carcinoma Pathological tumor response Neoadjuvant chemoradiotherapy Interval timing Tumor down-staging

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Recent developments and innovations in gastric cancer

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World Journal of Gastroenterology 2016年第17期22卷 4307-4320页

作者： mehmet mihmanli Enver Ilhan Ufuk Oguz Idiz Ali Alemdar Uygar Demir Department of General Surgery Sisli Etfal Training and Research Hospital Department of General Surgery Izmir Bozkaya Training and Research Hospital Department of General Surgery Okmeydani Training and Research Hospital

Gastric cancer has an important place in the worldwide incidence of cancer and cancer-related deaths. It can metastasize to the lymph nodes in the early stages, and lymph node metastasis is an important prognostic factor. Surgery is a very important part of gastric cancer treatment. A D2 lymphadenectomy is the standard surgical treatment for c T1N+ and T2-T4 cancers, which are potentially curable. Recently, the TNM classification system was reorganized, and the margins for gastrectomy and lymphadenectomy were revised. Endoscopic, laparoscopic and robotic treatments of gastric cancer have progressed rapidly with development of surgical instruments and techniques, especially in Eastern countries. Different endoscopic resection techniques have been identified, and these can be divided into two main categories: endoscopic mucosal resection and endoscopic submucosal dissection. Minimally invasive surgery has been reported to be safe and effective for early gastric cancer, and it can be successfully applied to advanced gastric cancer with increasing experience. Cytoreductive surgery and hypertherm?c intraper?toneal chemotherapy were developed as a combined treatment modality from the results of experimental and clinical studies. Also, hyperthermia increases the antitumor activity and penetration of chemotherapeutics. Trastuzumab which is a monoclonal antibody interacts with human epidermal growth factor(HER) 2 and is related to gastric carcinoma. The anti-tumor mechanism of trastuzumab is not clearly known, but mechanisms such as interruption of the HER2-mediated cell signaling pathways and cell cycle progression have been reported previously. H. pylori is involved in 90% of all gastric malignancies and Japanese guidelines strongly recommend that all H. pylori infections should be eradicated regardless of the associated disease. In this review, we present innovations discussed in recent studies.

关键词： Gastric Cancer Endoscopic mucosal resection Endoscopic submucosal resection Minimally invasive surge

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Laparoscopic appendectomy for appendiceal mucocele in an 83 years old woman

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World Journal of Gastrointestinal Surgery 2013年第6期5卷 207-209页

作者： Cemal Kaya Pinar Yazici Sinan Omeroglu mehmet mihmanli Department of General Surgery Sisli Etfal Training and Research Hospital

Mucocele of the appendix is an uncommon but potentially dangerous pathological entity that presents in a variety of ***,optimal surgical therapy is controversial;while some authors adopt a simple appendectomy,others recommend extensive resection,such as right *** report the case of an 83 years old woman who presented with cystic neoformation in the right iliac fossa that was preoperatively considered an appendiceal *** electively performed a laparoscopic resection that histological examination defined as a mucinous *** recurrence was observed in the follow-up period of 9 mo.

关键词： Appendiceal tumor Laparoscopy Mucocele Minimal invasive surgery

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