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Introduction: Ileostomy, frequently created after colorectal resections, hinders the physiologic function of the colon and can lead to dehydration and acute kidney injury due to high stoma outputs. This study aimed to evaluate the effectiveness of preventive measures on ileostomy-induced dehydration and related readmissions in a high-volume unit. Methods: In this prospective cohort study at a high-volume colorectal surgery department in Turkiye, the Prospective Ileostomy-induced Dehydration Prevention Bundle Project (PIDBP) was assessed from March 2021 to March 2022. The study enrolled patients undergoing colorectal surgery with ileostomy and involved comprehensive inpatient stoma care, education, and a structured post-discharge follow-up. The follow-up included the "Hydration follow-up scale" to monitor ileostomy output and related complications. The primary outcome was the readmission rate due to dehydration-related complications. The patients receiving the bundle intervention were compared with patients treated in the preceding year, focusing on the effectiveness of interventions such as dietary adjustments, fluid therapy, and pharmacological management. Results: In the study, 104 patients were analyzed, divided into 54 pre-bundle and 50 bundle group patients, with no significant differences in patient characteristics. While the overall readmission rate due to dehydration was 12.5%, a significant reduction in dehydration-related readmissions was observed in the bundle group compared to the pre-bundle group (2% vs. 22%, p = 0.002). Univariate analysis identified high stoma output (> 800 ml/24 h) (p < 0.001), chronic renal failure (CRF) (p = 0.01), postoperative ileus (p = 0.03), higher ASA status (p = 0.04), extended hospital stays (p = 0.03), and small bowel resections (especially in J-pouch patients) (p < 0.001) as significant predictors of readmission. Multivariate analysis revealed that the mean ileostomy output before discharge was the sole significant predictor of dehydration-related readmission (OR 1.01), with an optimal cutoff of 877.5 ml/day identified with an area under the curve (AUC) of 0.947, demonstrating high sensitivity (92.3%) and specificity (86.8%) in predicting readmission risk. Conclusion: The Prospective Ileostomy-induced Dehydration Prevention Bundle Project significantly reduced readmission rates after colorectal surgery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the performance of computed tomography (CT) in the local staging of colon cancer in different segments, with emphasis on parameters that have been found to be significant for rectal cancer, namely, extramural venous invasion (EMVI) and tumor deposits (TDs). Methods: CT and pathology data from 137 patients were independently reviewed by radiology and pathology teams. The performance of CT in categorizing a given patient into good, versus poor prognostic groups was assessed for each segment, as well as the presence of lymph nodes (LNs), TDs and EMVIs. Discordant cases were re-evaluated to determine potential sources of error. Elastic stain was applied for EMVI discordance. Results: The T staging accuracy was 80.2%. For T stage stratification, CT performed slightly better in the left colon, and the lowest accuracy was in the transverse colon. Under-staging was more common (in 12.4%), and most of the mis-staged cases were in sigmoid colon. According to the first comprehensive correlative analysis, the sensitivity, specificity, and accuracy of CT for detecting TDs were found to be 57.9%, 92.4%, 87.6%, respectively. These figures were 44.7%, 72.7%, and 63.5% for LN, and 58.5%, 82.1% and 73% for EMVI. The detection rate was better for multifocal EMVI. The detection rate was also comparable (although substantially underestimated) for LNs, with the half of the LNs missed by CT being < 5 mm. Four patients that were classified as TD by CT, disclosed to be LNs by pathology. Correlative analysis led to refinement of the pathology criteria, with subsequent modifications of the initial reports in 13 (9.5%) patients. Conclusion: Overall, CT performed well in the evaluation of colon cancer, as did TD and EMVI. It is advisable to include these parameters in CT-based staging. Radiologists should be aware of the pitfalls that occur more commonly in different segments. [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study is to evaluate the clinicopathologic associations of tumor budding (Bd) as well as other potential prognosticators including lymphovascular invasion (LVI) in T3/4aN0 colon cancer patients and to investigate their impact on the outcome. Methods: The patients were enrolled in three groups according to the number of budding as Bd1 (0–4 buds), Bd2 (5–9 buds), and Bd3 (> 10 buds). These groups were retrospectively compared in terms of demographic features, other tumor characteristics, operative outcomes, recurrences, and survival. The mean follow-up time was 58 ± 22 months. Results: A total of 194 patients were divided as follows: 97 in Bd1, 41 in Bd2, and 56 in Bd3 groups. The Bd3 group was associated with significantly higher LVI and larger tumor size. The rate of recurrence increased progressively from 5.2% in Bd1 to 9.8% in Bd2 and to 17.9% in Bd3 group (p = 0.03). More importantly, the 5-year overall survival (OS: Bd1 = 92.3% vs. Bd2 = 88% vs. Bd3 = 69.5%, p = 0.03) and disease-free survival (DFS: Bd1 = 87.9% vs. Bd2 = 75.3% vs. Bd3 = 66%, p = 0.02) were significantly worse in Bd3 group. In addition, in the subgroup of patients with the presence of Bd3 and LVI together, the 5-year OS (60% vs. 92%, p = 0.001) and DFS (56.1% vs. 85.4%, p = 0.001) were significantly worse. In multivariate analysis, Bd3+LVI was significantly associated with poor OS and DFS (p < 0.001). Conclusion: In patients with T3/4aN0 colon cancer, high tumor budding negatively affects long-term oncological outcomes. These findings strongly suggest that adjuvant chemotherapy be considered for the patients with Bd3 and LVI together. [ABSTRACT FROM AUTHOR]

Purpose: To assess whether size, diameter, and large vein involvement of MR-detected extramural venous invasion (MR-EMVI) have an impact on neoadjuvant therapy response in rectal adenocarcinoma. Methods: 57 patients with locally advanced rectal adenocarcinoma scanned with MRI before and after neoadjuvant therapy were included. Two abdominal radiologists evaluated the images with special emphasis on EMVI, on initial staging and after neoadjuvant treatment. The sensitivity and specificity of MRI for detection of rest EMVI were determined. The association of various MR-EMVI characteristics including number, size, and main vein involvement with treatment response was investigated. In subjects with discordance of radiology and pathology, elastin stain was performed, and images and slides were re-evaluated on site with a multidisciplinary approach. Results: At initial evaluation, 17 patients were MR-EMVI negative (29.8%) and 40 were MR-EMVI positive (70.2%). Complete/near-complete responders had less number (mean 1.45) and smaller diameter of MR-EMVI (mean 1.8 mm), when compared with partial responders (2.54 and 3.3 mm; p < 0.005). The sensitivity of MRI for rest EMVI detection was high, specificity was moderate, and in one patient elastin stain changed the final decision. In five patients with rest MR-EMVI positivity, carcinoma histopathologically had a distinctive serpiginous perivascular spread, growing along the track of vascular bundle, although it did not appear in intravascular spaces. Conclusion: This study demonstrates that not only the presence, but also size and number of EMVI that may be significant clinically and thus these parameters also ought to be incorporated to the MRI evaluation and prognostication of treatment response. From pathology perspective, tumors growing alongside major vessels may also reflect EMVI even if they are not demonstrably "intravascular." [ABSTRACT FROM AUTHOR]

Purpose: The aim of this study was to compare ghost ileostomy (GI) and defunctioning ileostomy (DI) in patients who underwent low anterior resection (LAR) for rectal cancer in terms of postoperative morbidity, rehospitalization rates, and total costs. Methods: Patients with an anastomosis level between 5 and 10 cm from the anal verge after LAR were analyzed retrospectively. Clinical characteristics, operative outcomes, postoperative morbidity, rehospitalization rates, and total costs were compared. Results: A total of 123 patients were enrolled as follows: 42 patients in the GI group and 81 patients in the DI group. Anastomotic leakage (AL) was identified in three patients who underwent GI, and in all of them, GI was easily converted to DI. There were 96.3% of the patients with DI rehospitalized at least one time because of surgery-related and/or stoma-related complications or stoma closure. When we did not take into account the patients who were rehospitalized for stoma closure, the rates of rehospitalization were 4.7% and 22.2% in the GI and DI groups, respectively (P= 0.01). The mean total costs calculated by removing additional surgical procedures and adding all of the rehospitalization costs were 25,767 USD and 41,875 USD in the GI and DI groups, respectively (P= 0.0001). Conclusion: GI may be a safe and cost-effective method in patients who underwent LAR with low or medium risk factors for AL. It is possible to avoid unnecessary ileostomy and reduce unwanted outcomes due to it, such as postoperative complications, rehospitalizations, and increased total costs by performing GI. [ABSTRACT FROM AUTHOR]

Background: Oncologic outcomes after complete mesocolic excision (CME) in colon cancer are under investigation. The aim of our study was to compare CME and conventional colectomy (CC) in terms of pathological and oncological outcomes for right colon cancer and to evaluate the impact of lymph node metastasis around the vascular tie on survival. Methods: Consecutive patients with right colon cancer who had CME or CC between January 2011 and August 2018 at two specialized centers in Turkey were included. Statistical analyses were performed with respect to demographic characteristics, operative and pathologic outcomes, harvested and metastatic lymph nodes around the vascular tie (LNVT), recurrences, and survival. Results: There were 91 patients in the CME group (58 males, mean age 64 ± 16 years) and 192 patients in the CC group (96 males, mean age 66 ± 14 years). The mean number of harvested lymph nodes (CME: 42 ± 15 vs CC: 34 ± 13, p = 0.01) and LNVT were higher in the CME group (CME: 3.2 ± 2.2 vs CC: 2.4 ± 1.6, p = 0.001). LNVT metastases were 7.7% and 8.3% in the CME and CC groups, respectively (p = 0.85). Three-year overall and disease-free survival rates were 96.4% and 90.9% in the CME group and 90.4% and 87.6% in the CC group in stage I–III patients (p > 0.05). In stage III patients, the 3-year overall survival (92.5% vs 63.5%, p = 0.03) and disease-free survival (85.6% vs 52.1%, p = 0.008) were significantly better in LNVT-negative patients than in LNVT-positive patients. Conclusion: LNVT metastasis seems to be the key factor associated with poor disease-free and overall survival in right colon cancer regardless of the radicality of surgery. [ABSTRACT FROM AUTHOR]

Diverting stoma has many complications and requires another operation. Ghost ileostomy is an option for occasional cases. We aimed to present the clinical data and early postoperative outcomes of our patients who had undergone ghost ileostomy. Ghost ileostomy was performed in 58 patients, depending on the level of the anastomosis, together with the experience and intraoperative decision of the surgeon. The patients were evaluated in terms of comorbidities, type of colorectal disease, and postoperative complications. Thirty-eight patients were male, the mean age was 59 ± 9 years, and the mean body mass index was 27 ± 5 kg/m2. Forty-six patients in whom a ghost ileostomy procedure was performed had sigmoid colon or proximal/middle rectal cancer, whereas eight patients had sigmoid diverticulitis, and four patients had ulcerative colitis. Anastomotic leakage was identified in 3 (5.1%) patients. In one patient, laparoscopic peritoneal lavage was performed, and ghost ileostomy was converted to diverting stoma, whereas in the other two patients, ghost ileostomy was converted to diverting stoma under local anesthesia. Ghost ileostomy can easily be converted to diverting stoma in some patients with no need for general anesthesia to reduce the morbidity of anastomotic leakage. With this method in selected patients, it is possible to avoid diverting stoma and unwanted complications of ileostomy. [ABSTRACT FROM AUTHOR]

Purpose: Live surgical demonstrations are considered an effective educational tool providing a chance for trainees to observe a real-time decision-making process of expert surgeons. No data exists evaluating the impact of live surgical demonstrations on the outcomes of minimally invasive colorectal surgery. This study evaluates perioperative and short-term postoperative outcomes in patients undergoing minimally invasive colorectal surgery in the setting of live surgical demonstrations. Methods: Patients undergoing minimally invasive colorectal surgery which was performed as live surgical demonstrations (the study group) performed between 2006 and 2018 were reviewed. These patients were case-matched with those undergoing operations in routine practice (the control group). The study and control group were compared for intraoperative and short-term postoperative outcomes. Results: Thirty-nine live surgery cases in the study group were case-matched with its thirty-nine counterparts as the control group. Operating time was longer (200 vs 165 min; p = 0.002) and estimated intraoperative blood loss was higher in the study group (100 vs 55 ml; p = 0.008). Patients in the study group stayed longer in the hospital (6 vs 5 days; p = 0.001). While conversion (n = 4 vs n = 1, p = 0.358) and intraoperative complications (n = 6 vs n = 2, p = 0.2) were more frequent in the study group, these outcomes did not reach statistical significance. Overall complications were higher in the study group (n = 22 vs n = 9, p = 0.003). One patient underwent a reoperation due to postoperative bleeding, and one mortality occurred in the live surgery group. Conclusions: Live surgical demonstrations in minimally invasive colorectal surgery seem to be associated with increased risk of operative morbidity. [ABSTRACT FROM AUTHOR]

Summary: Purpose: Medullary carcinoma (MC) is a rare tumor with a solid growth pattern without glandular differentiation and constitutes less than 1% of colorectal cancers. Lymph node positivity and distant organ metastasis were reported to be lower than in other poorly differentiated adenocarcinomas. Therefore, the diagnosis of MC is pathologically important in terms of follow-up and treatment. We aimed to investigate the characteristics of medullary cancer in our case series. Methods: 427 patients with colorectal cancer (CRC) who underwent surgery between January 2011 and December 2017 were evaluated retrospectively in 2 groups as MC (n = 13) and non-MC (n = 414) in terms of demographic characteristics, pathological data, and oncological outcomes. Results: 76.9% (n = 10) of the MC group were female while 36% (n = 149) of the non-MC group were female (p = 0.003). The tumors were located in the right colon in 84.6% (n = 11) of the MC patients and in 26.6% (n = 110) of the non-MC patients (p < 0.001). The rate of laparoscopy was 83.8% for all CRC patients, and 53.8% for the MC group (p = 0.01). T4 cases (69.2%) and tumor volume (131 ± 87 cm3) in the MC group were significantly higher than in the non-MC group (p < 0.05). The rate of high microsatellite instability (MSI) was 85%. 5‑year overall survival was 75% for the patients with MC and 82% for non-MC (p = 0.13). Conclusion: MC is commonly localized in the right colon, has a large tumor size, and is mostly diagnosed in the T4 stage. As MC most likely have defects in DNA MMR, correct pathological diagnosis is important for postoperative treatment and the prognosis of the patients. [ABSTRACT FROM AUTHOR]

Background: Surgery is the preferred treatment for gallbladder polyps, not only for relieving the symptoms but also for eliminating the potential risk of malignancy. In our study, we investigated whether patients who had undergone surgery truly had a surgical indication and beyond question required laparoscopic cholecystectomy due to malignancy. Materials and methods: 185 patients who were prediagnosed with gallbladder polyps were operated in VKV American Hospital, Istanbul between January 2004 and July 2015. Retrospective data of all patients included patients' age, gender, symptoms, preoperative ultrasonography, pathology reports, radiologic findings regarding the number and size of the polyps, and postoperative follow-up. Results: 140 out of 185 patients were symptomatic before surgery. 85 patients (60.7 %) reported that their symptoms persisted after they had undergone surgery. 20 (14.3 %) of the patients with postoperatively persisting symptoms had no polyps in their pathologic examination. Only 35 out of 140 patients (25 %) reported relief of symptoms following surgery. Postoperative pathologic investigation revealed adenocarcinoma in only 1 patient and adenomatous polyps in 2 patients. Conclusion: Postoperative pathologic investigations reveal only a very small percentage of premalignant and malignant polyps among patients who have undergone laparoscopic cholecystectomy. This finding clearly points out that we require new methods to differentiate cholesterol polyps from adenomatous polyps. Furthermore, the surgical indication criteria for patients with gall bladder polyps should be updated to prevent futile operations and morbidity. [ABSTRACT FROM AUTHOR]

Purpose: Previous studies demonstrated survival benefits in association with the addition of chemoradiotherapy after surgery in gastric cancer. This study aimed to examine the efficacy in terms of loco-regional control and survival and safety of 5-FU-based adjuvant chemoradiotherapy after D2 curative surgery. Methods: This study included 228 patients (81 female, 147 male) treated for gastric cancer with curative surgery plus adjuvant chemoradiotherapy. Majority of the patients underwent at least D2 lymph node resection. Median three cycles of fluorouracil chemotherapy were administered, and 45-Gy radiotherapy was delivered at 1.8 Gy/fraction concomitantly during the second cycle of chemotherapy. Local control, regional control, distant metastasis and overall survival rates were estimated. Results: The median age of the patients was 54 years (range 25-74 years). The most common grade III toxicities were nausea (10 %) and neutropenia (9 %). During radiotherapy, grade IV local skin reaction occurred in one patient. Median duration of follow-up was 47 months. Local, regional and distant recurrence developed in 9 (4 %), 41 (18 %) and 45 (20 %) patients, respectively. Overall 5-year survival rate was 57.2 %, and disease-free 5-year survival rate was 53.8 %. Multivariate analysis identified less than 15 lymph node involvement as an independent predictor of better survival ( p < 0.001). Conclusions: Concomitant 5-FU-based chemoradiotherapy seems to be an effective and tolerable adjuvant regimen on local control and survival in curatively resected node-positive stomach cancer, particularly when combined with D2 resection. [ABSTRACT FROM AUTHOR]

Aims: To assess the efficacy of extended lymph node dissection in gastric cancer and to identify factors affecting lymph node detection. Methods: A prospective study of 126 gastric cancer patients was conducted. Patients eligible for curative resection received total gastrectomy and extended lymphadenectomy (D2) and paraaortic lymph node sampling as the standard of care (study group). Supramesocolic total lymphadenectomy of the upper gastrointestinal tract was performed on 23 autopsy cases as a control group. Results: Fifty-five gastric carcinoma patients were included in the study group. Median age was 58 years (range 31-80 years); 14 patients were female (25 %), and 41 were male (75 %). The median number of lymph nodes harvested from the specimen was 47 (24-95), and the median number of metastatic lymph nodes was 15 (1-71). In contrast, in the autopsy comparative group, the median number of harvested lymph nodes was 72 (50-91). The median number of stational lymph nodes excised (lymph nodes excised from stations 4, 5, 10, 11, 12, and 16) was significantly higher in the control group than in the study group ( P < 0.05). Lymph node detection was adversely affected by body mass index (BMI) ( P < 0.03). In the study group, stations 5, 12, 11, and 10 had the highest lymph node absence (LNA) (noncompliance) ratio with percentages of 53, 36, 33, and 22 %, respectively. In the autopsy group, LNA (noncompliance) was not detected. Conclusions: Lymph nodes should be dissected by surgeons with sufficient technical and anatomical experience, and then examined and counted by experienced pathologists to reduce the occurrence of LNA. The results of this anatomical study can serve as a guideline to assess the success of lymph node dissection during gastric cancer surgery. Similar studies should be conducted in every country to establish national guidelines. [ABSTRACT FROM AUTHOR]

Purpose. This study was conducted to investigate the effect of octreotide on colorectal carcinogenesis by administering octreotide either alone or combined with polyglactin, which is a well-known suture material, on chemically induced colorectal cancer development in rats. Methods. A total of 72 rats were divided into six groups. Two groups were subjected to a colotomy and repair using polyglactin. Another two groups underwent a sham procedure. The fifth group received octreotide alone and the sixth group served as a control. Both groups of rats in the polyglactin and sham groups received octreotide additionally. Methylnitrosourea was administered rectally to all the animals at a dose of 4 mg/kg per week for 20 weeks to induce carcinogenesis. Octreotide was injected twice a day at a total daily dose of 100 μg/kg. The thymidine labeling index was used to assess the synthesis phase fraction in order to measure the cell proliferation rate. Results. The mean number of tumors per rat was significantly higher in the polyglactin group than in both the sham and control groups. It was significantly lower in the octreotide and polyglactin + octreotide groups than in the control and polyglactin groups, respectively. All the animals in the octreotide group had one tumor, while 66.6% of the control group had multiple tumors. The number of multiple tumors was significantly lower in the polyglactin + octreotide and sham + octreotide groups than in the polyglactin and sham groups, respectively. The mean tumor size in the octreotide group was significantly smaller than in the control group, whereas it was larger in the polyglactin group in comparison with the sham and control groups. It was also reduced in the polyglactin + octreotide group in comparison with the polyglactin group. The thymidine labeling index was significantly higher in the polyglactin group compared with both the sham and control groups, whereas it was lower in the octreotide group in comparison with the control group. The addition of octreotide administration to the polyglactin usage and the sham procedure significantly decreased the thymidine labeling indexes. Conclusion. These results indicate that octreotide reduces the frequency of tumor occurrence and has an inhibitory effect on its development in chemically induced experimental colorectal cancer. Octreotide can also reduce the enhancing effect of polyglactin on colorectal carcinogenesis when it is combined with polyglactin. [ABSTRACT FROM AUTHOR]

Local tumor recurrence following restorative surgery for colorectal cancer may occasionally result from the promotion of a neoplastic lesion in a zone of proliferative instability adjacent to the anastomosis. This study was designed to determine the influence of various suture materials on experimental colorectal carcinogenesis. A total of 72 rats were divided into six groups, four of which were subjected to colotomy and repair using catgut, silk, polyglactin (PG), or stainless steel. The fifth group was given a sham procedure and the sixth group served as a control. Methylnitrosourea was administered rectally to all the animals, at a dose of 4 mg/kg/week for 20 weeks. The mean number of tumors per rat was significantly higher in the PG group than in the other groups. The mean tumor size was found to be significantly larger in each of the suture material groups than in the sham group. A tendency for tumor occurrence to develop at the anastomosis rather than at the other colon sites was seen in the PG group. These results indicate that PG has an adverse effect on local tumor occurrence in experimental colorectal carcinogenesis. [ABSTRACT FROM AUTHOR]